多药治疗患者的相互作用风险分析及药师干预措施以解决这些问题-一项基于匈牙利社区药房药物重整的多中心描述性研究。
Analysis of interaction risks of patients with polypharmacy and the pharmacist interventions performed to solve them-A multicenter descriptive study according to medication reviews in Hungarian community pharmacies.
机构信息
University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary.
出版信息
PLoS One. 2021 Jun 22;16(6):e0253645. doi: 10.1371/journal.pone.0253645. eCollection 2021.
OBJECTIVE
The study examined the Drug-Related Problems (DRPs) of patients with polypharmacy in 78 Hungarian community pharmacies, especially the interaction risks in terms of their clinical severity. Also, the objective was to analyze pharmacists' interventions to solve the identified interaction risks.
METHODOLOGY
The research was carried out in the framework of the training of specialist pharmacists at Semmelweis University, with the participation of 78 graduated pharmacists with the collaboration of 98 GPs. A total of 755 patients participated in pharmaceutical counseling which meant a medication review process. DRPs were uniformly categorized and the interventions were recorded by pharmacists, while a detailed analysis of interaction risks was performed by authors.
RESULTS
A total of 984 DRPs were registered. The most common category of DRPs was the "non-quantitative safety problems" (62.6%). Interaction risk was the most common cause of DRPs (54.0%). The highest proportion of interaction risks were between two prescription drugs (66.7%). In 30.7% of interaction risks' cases, there was not known negative outcome. In contrast, it was recommended to modify the therapy in 14.9% of interaction risks. Acetylsalicylic acid (22.8%), acenocoumarol (17.7%), and diclofenac (13.9%) were the most common active substances which caused serious interaction risks. A total of 599 pharmacist interventions were used to solve the 531 interaction risks. Pharmacists notified the GPs about the problem in 28.4% of cases and they intervened without the GP in 63.1% of cases, most often with patient education (27.4%).
CONCLUSION
Medication review by community pharmacists is required for the safe medicine using of patients with polypharmacy, as a significant number of DRPs have been recorded. The incidence of interaction risks stood out. It is essential to develop a pharmaceutical guideline to properly classify the clinical relevance of interaction risks (e.g. according to high-risk active substances) and to increase the collaboration with GPs.
目的
本研究考察了 78 家匈牙利社区药店中同时使用多种药物的患者的药物相关问题（DRPs），特别是从临床严重程度方面考察药物相互作用风险。此外，本研究旨在分析药剂师干预措施以解决所确定的相互作用风险。
方法
该研究是在赛梅尔维斯大学专科药剂师培训框架内进行的，有 78 名已毕业药剂师参与，同时有 98 名全科医生合作。共有 755 名患者参与了药物咨询，即进行了药物审查过程。DRPs 被统一分类，药剂师记录干预措施，作者则对药物相互作用风险进行详细分析。
结果
共登记了 984 例 DRPs。最常见的 DRPs 类别为“非定量安全性问题”（62.6%）。药物相互作用风险是 DRPs 的最常见原因（54.0%）。两种处方药之间的相互作用风险最高（66.7%）。在 30.7%的药物相互作用风险病例中，没有已知的不良后果。相比之下，在 14.9%的药物相互作用风险病例中，建议修改治疗方案。引起严重药物相互作用风险的最常见活性物质为乙酰水杨酸（22.8%）、醋硝香豆素（17.7%）和双氯芬酸（13.9%）。为了解决 531 例药物相互作用风险，共使用了 599 例药剂师干预措施。在 28.4%的病例中，药剂师通知了全科医生，在 63.1%的病例中，药剂师在没有全科医生干预的情况下进行干预，最常见的干预措施是对患者进行教育（27.4%）。
结论
需要社区药剂师对同时使用多种药物的患者进行药物审查，以确保安全用药，因为已记录到大量的 DRPs。药物相互作用风险的发生率尤为突出。有必要制定一份药物指南，以正确分类药物相互作用风险的临床相关性（例如，根据高风险活性物质进行分类），并加强与全科医生的合作。
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