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多学科基层医疗团队提供以患者为中心的医疗护理以改善老年多病患者治疗充分性(PCMR):随机对照试验方案。

Person-centred care provided by a multidisciplinary primary care team to improve therapeutic adequacy in polymedicated elderly patients (PCMR): randomised controlled trial protocol.

机构信息

Clinical Pharmacy and Pharmaceutical Care Unit. Department of Pharmacy and Pharmaceutical Technology, and Physical Chemistry. Faculty of Pharmacy and Food Sciences, Universitat de Barcelona, Barcelona, Spain.

Bages-Berguedà-Moianès Primary Healthcare Service, Institut Catala De La Salut, Barcelona, Spain.

出版信息

BMJ Open. 2022 Feb 9;12(2):e051238. doi: 10.1136/bmjopen-2021-051238.

Abstract

INTRODUCTION

The increase in elderly population has led to an associated increase in multiple pathologies, frailty, polypharmacy, healthcare costs, decreased quality of life and mortality. We designed an intervention based on person-centred care model. This article outlines a study protocol, which aims to explore the effects of the intervention to improve therapeutic adequacy in polymedicated elderly patients.

METHODS AND ANALYSIS

An open, randomised, multicentre, controlled clinical trial. The study population includes polymedicated (≥8 prescription medications) patients ≥75 years old. In the intervention group, the multidisciplinary team (primary care pharmacist, family doctor and nurse) will meet to carry out multidimensional reviews (frailty, clinical complexity, morbidity and therapeutic adequacy) of the study subjects. If changes are proposed to the treatment plan, a clinical interview will be conducted with the patient to agree on changes in accordance with their preferences. Follow-up visits will be scheduled at 6 and 12 months. In the control group, where the usual clinical practice will be followed, the necessary data will be collected to compare the results.The key variables are the variation in the mean number of incidents (potentially inappropriate prescription) per patient, the number of medications, the number of changes implemented to the treatment plan and the variation in the number of hospital admissions.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee of the IDIAPJGol and by the University of Barcelona's Bioethics Commission. The results are expected to be published in peer reviewed open-access journals, and as part of a doctoral thesis.

TRIAL REGISTRATION NUMBER

NCT04188470. Pre-results.

摘要

简介

老年人口的增加导致多种疾病、虚弱、多种药物治疗、医疗保健费用增加、生活质量下降和死亡率上升。我们设计了一种基于以人为本的护理模式的干预措施。本文概述了一项研究方案,旨在探讨该干预措施对改善多种药物治疗的老年患者治疗适当性的效果。

方法和分析

一项开放、随机、多中心、对照临床试验。研究人群包括≥75 岁的多种药物治疗(≥8 种处方药物)患者。在干预组中,多学科团队(初级保健药剂师、家庭医生和护士)将开会对研究对象进行多维评估(虚弱、临床复杂性、发病率和治疗适当性)。如果提出改变治疗计划,将与患者进行临床访谈,根据他们的偏好商定改变治疗计划。将安排 6 个月和 12 个月的随访。在对照组中,将遵循常规临床实践,收集必要的数据以比较结果。主要变量是每个患者潜在不适当处方事件(potentially inappropriate prescription)的平均数量变化、药物数量、治疗计划实施的变化数量以及住院人数的变化。

伦理和传播

这项研究得到了 IDIAPJGol 伦理委员会和巴塞罗那大学生物伦理委员会的批准。研究结果预计将在同行评审的开放获取期刊上发表,并作为博士论文的一部分。

试验注册号

NCT04188470。预结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37fa/8830237/19f67e7b97bf/bmjopen-2021-051238f01.jpg

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