Mills Pamela, MacLure Katie
NHS Ayrshire and Arran, United Kingdom.
Independent Research Consultant, Aberdeen AB32 6RU, United Kingdom.
Explor Res Clin Soc Pharm. 2021 Aug 26;3:100065. doi: 10.1016/j.rcsop.2021.100065. eCollection 2021 Sep.
Polypharmacy in elderly patients is common with potential for harm. Cognitive impairment is postulated as the biggest contributor to poor medication management with increased risk of hospital admission. There is limited information about approaches to identify high risk patients for polypharmacy review.
Pilot study to determine if a new patient prioritisation tool would identify appropriate patients for pharmacist polypharmacy review.
Prioritisation tool developed to rank community-dwelling elderly patients prescribed 10 or more medications with cognitive impairment for pharmacist polypharmacy review. Tool used General Practice (GP) appointments, Emergency Department attendances, repeat medications and cognitive impairment to create a score to prioritise review invitations. Reviews were completed by GP clinical pharmacists who recorded interventions and measured outcome assessments using the adapted RiO scoring tool.
Polypharmacy reviews completed for 34 patients from three GP practices. Demographic results were 62% female ( = 21), median 78 years [IQR 72-80], median 3 comorbidities [IQR 2-4] with most reviews conducted face-to-face ( = 29; 85%). Pharmaceutical care interventions were hospital admission possible or likely prevention for the majority of patients (85%, = 29) which contrasts with the historical level of 33% ( = 228) patients with traditional processes.
Pilot study demonstrated that the new tool identified appropriate patients for review prioritisation as patients had complex pharmaceutical care needs.
老年患者多重用药现象普遍，存在潜在危害。认知障碍被认为是导致用药管理不善及住院风险增加的最大因素。关于识别多重用药审查高风险患者方法的信息有限。
进行一项试点研究，以确定一种新的患者优先级工具能否识别出适合接受药剂师多重用药审查的患者。
开发了一种优先级工具，用于对开具10种或更多药物且有认知障碍的社区老年患者进行排名，以便药剂师进行多重用药审查。该工具利用全科医疗（GP）预约、急诊科就诊、重复用药情况和认知障碍来创建一个分数，以确定审查邀请的优先级。审查由GP临床药剂师完成，他们记录干预措施，并使用改编后的RiO评分工具进行结果评估。
对来自三个GP诊所的34名患者进行了多重用药审查。人口统计学结果显示，62%为女性（n = 21），年龄中位数为78岁[四分位间距72 - 80]，合并症中位数为3种[四分位间距2 - 4]，大多数审查是面对面进行的（n = 29；85%）。对于大多数患者（85%，n = 29），药物治疗护理干预措施是预防可能或很可能的住院情况，这与传统流程中33%（n = 228）的患者情况形成对比。
试点研究表明，新工具能够识别出适合进行审查优先级排序的患者，因为这些患者有复杂的药物治疗护理需求。
