风险指标可提高养老院中具有抗胆碱能特性药物的处方质量。
Risk Indicators Improve the Prescription Quality of Drugs with Anticholinergic Properties in Nursing Homes.
机构信息
Pole Territorial Santé Publique et Performance, Hôpitaux Champagne Sud, 10003 Troyes, France.
Fondation Korian Pour le Bien Vieillir, 75008 Paris, France.
出版信息
Int J Environ Res Public Health. 2021 Dec 31;19(1):423. doi: 10.3390/ijerph19010423.
AIM
The objective of this study was to assess the impact of a collaborative therapeutic optimization program on the rate of potentially inappropriate prescription of drugs with anticholinergic properties in nursing homes.
METHODS
Quasi-experimental study in 37 nursing homes in France. The intervention included the use of quality indicators for prescriptions combined with educational sessions and dedicated materials for nursing home staff (unlimited access to study material for staff, including nurses, general practitioners, pharmacists). Indicators were calculated based on routine data collected from an electronic pill dispenser system. The primary outcome was the presence of at least one prescription containing ≥1 drug from a list of 12 drugs with anticholinergic properties. A difference-in-differences analysis was conducted at 18 months as well as propensity score weighting to minimize any potential indication bias. A generalized estimating equation model estimated the probability of being prescribed at least one target drug at any time during a 9-month period for each resident.
RESULTS
In total, 33 nursing homes (intervention group: = 10; control group: = 23) were included, totalling 8137 residents. There was a decrease in the use of drugs with anticholinergic properties over time in both groups, as well as a decline in the intervention group compared to the control group (Odds Ratio: 0.685, 95% CI: 0.533, 0.880; < 0.01) that was attributable to the intervention. An estimated 49 anticholinergic properties drug prescriptions were avoided by the intervention.
CONCLUSION
This study found that an intervention based on indicators derived from routine prescription data was effective in reducing use of drugs with anticholinergic properties prescriptions in nursing homes.
目的
本研究旨在评估协作治疗优化方案对养老院中具有抗胆碱能特性的潜在不适当药物处方率的影响。
方法
在法国的 37 家养老院进行了准实验研究。干预措施包括使用处方质量指标，结合针对养老院工作人员的教育课程和专用材料（工作人员可以无限访问学习材料，包括护士、全科医生、药剂师）。指标是根据电子药丸分配器系统收集的常规数据计算得出的。主要结果是存在至少一种含有 12 种具有抗胆碱能特性药物之一的处方。在 18 个月时进行了差异分析以及倾向评分加权，以尽量减少任何潜在的指示偏差。广义估计方程模型估计了每个居民在 9 个月期间的任何时间被处方至少一种目标药物的概率。
结果
共有 33 家养老院（干预组： = 10；对照组： = 23），共 8137 名居民。两组的抗胆碱能药物使用随着时间的推移而减少，与对照组相比，干预组的下降更为明显（比值比：0.685，95%置信区间：0.533，0.880；<0.01），这归因于干预措施。通过干预，避免了约 49 份具有抗胆碱能特性的药物处方。
结论
本研究发现，基于常规处方数据得出的指标的干预措施可以有效减少养老院中具有抗胆碱能特性的药物处方的使用。
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