Department of Pharmaceutical Services, Hiroshima University Hospital.
Division of Patient Safety, Hiroshima University Hospital.
Biol Pharm Bull. 2021;44(8):1060-1066. doi: 10.1248/bpb.b21-00143.
Optimization of medication therapy for the elderly is a matter of rapidly growing importance, which is addressed by pharmacists through comprehensive reviews. In this study, the impact of medication review by pharmacists on medication optimization and avoidance of adverse drug events (ADE) was investigated, as well as differences in the triggers for pharmaceutical intervention to allow for optimization of medication by patient age. Data for this study were collected from reports recorded between April 2013 and March 2019 for patients admitted to the Hiroshima University Hospital. In response to pharmacists' proposals, prescriptions were modified in 18932 cases, comprising 17% of the total 111479 patients during hospitalization. The frequency of such intervention was higher in elderly patients aged ≥65 years than in those <65 years (20 vs. 14%, p < 0.01). The reasons for pharmacists' intervention were primarily (67%) medication history or clinical symptoms in all age groups. Patient complaint was a minor reason in patients aged ≥75 years, accounting for only 2% of all interventions; laboratory results were a more typical reason, accounting for 24% of all interventions. These findings reveal the importance of pharmacists' interventions for optimizing medication and preventing ADEs, particularly in elderly patients. Thus, pharmacists must evaluate the medications and conditions, including laboratory results, in the medical records of elderly patients more carefully than those of younger patients as elderly patients might be unable to communicate about subjective symptoms.
优化老年人的药物治疗是一个日益重要的问题，药剂师通过全面审查来解决这个问题。在这项研究中，调查了药剂师进行药物审查对药物优化和避免药物不良事件（ADE）的影响，以及药物干预触发因素的差异，以便根据患者年龄优化药物。本研究的数据来自 2013 年 4 月至 2019 年 3 月期间广岛大学医院住院患者的报告记录。根据药剂师的建议，对 18932 例处方进行了修改，占住院期间 111479 例患者的 17%。≥65 岁的老年患者的干预频率高于<65 岁的患者（20%比 14%，p<0.01）。药剂师干预的原因主要是（67%）所有年龄段的用药史或临床症状。≥75 岁患者的投诉是次要原因，仅占所有干预的 2%；实验室结果是更典型的原因，占所有干预的 24%。这些发现揭示了药剂师干预对优化药物和预防 ADE 的重要性，特别是在老年患者中。因此，药剂师必须比年轻患者更仔细地评估老年患者的病历中的药物和情况，包括实验室结果，因为老年患者可能无法就主观症状进行沟通。
