J Am Pharm Assoc (2003). 2022 Sep-Oct;62(5):1587-1595.e3. doi: 10.1016/j.japh.2022.04.005. Epub 2022 Apr 12.
Despite potential benefits of medication therapy management (MTM) for complex pediatric patients, implementation of pediatric MTM services is rare.
To describe how a standardized pediatric MTM model identifies potential interventions and their impact on medication regimen complexity index (MRCI) scores in children with medical complexity (CMC) and polypharmacy.
This retrospective proof-of-concept study included pediatric patients receiving primary care in a large outpatient primary care medical home for CMC within a tertiary freestanding children's hospital from August 2020 to July 2021. Medication profiles of established patients aged 0-18 years with at least 5 active medications at the time of the index visit were assessed for medication-related concerns, potential interventions, and potential impact of proposed interventions on MRCI scores.
Among 100 patients, an average of 3.4 ± 2.6 medication-related concerns was identified using the pediatric MTM model. Common medication-related concerns (>25% of patients) included inappropriate or unnecessary therapy, suboptimal therapy, undertreated symptom, adverse effect, clinically impactful drug-drug interaction, or duplication of therapy. A total of 97% had opportunities for 5.0 ± 2.9 potential interventions. Most common proposed interventions included drug discontinuation trial (69%), patient or caregiver education (55%), dosage form modification (51%), dose modification (49%), and frequency modification (46%). The mean baseline MRCI score was 32.6 (95% CI 29.3-35.8) among all patients. MRCI scores decreased by a mean of 4.9 (95% CI 3.8-5.9) after application of the theoretical interventions (P < 0.001). Mean potential score reduction was not significantly affected by patient age or number of complex chronic conditions. Potential impact of the proposed interventions on MRCI score was significantly greater in patients with higher baseline medication counts (P < 0.001).
Most CMC would likely benefit from a pharmacist-guided pediatric MTM service. A standardized review of active medication regimens identified multiple medication-related concerns and potential interventions for nearly all patients. Proposed medication interventions would significantly reduce medication regimen complexity as measured by MRCI. Further prospective evaluation of a pharmacist-guided pediatric MTM service is warranted.
尽管药物治疗管理（MTM）对复杂儿科患者有潜在益处，但儿科 MTM 服务的实施却很少见。
描述标准化儿科 MTM 模型如何识别潜在干预措施及其对患有复杂医疗状况（CMC）和多种药物治疗的儿童的药物治疗方案复杂性指数（MRCI）评分的影响。
这项回顾性概念验证研究纳入了 2020 年 8 月至 2021 年 7 月期间在一家三级独立儿童医院的大型门诊初级保健医疗之家接受初级保健的患有 CMC 的年龄在 0 至 18 岁的已建立患者。对就诊时至少有 5 种活性药物的既定患者的药物概况进行评估，以确定与药物相关的问题、潜在干预措施以及拟议干预措施对 MRCI 评分的潜在影响。
在 100 名患者中，使用儿科 MTM 模型平均确定了 3.4 ± 2.6 种与药物相关的问题。常见的与药物相关的问题（> 25%的患者）包括不适当或不必要的治疗、治疗效果不佳、治疗不足的症状、不良反应、具有临床影响的药物相互作用或治疗重复。共有 97%的患者有机会进行 5.0 ± 2.9 次潜在干预措施。最常见的拟议干预措施包括药物停药试验（69%）、患者或照护者教育（55%）、剂型修改（51%）、剂量修改（49%）和频率修改（46%）。所有患者的基线 MRCI 评分平均为 32.6（95%CI 29.3-35.8）。应用理论干预措施后，MRCI 评分平均降低了 4.9（95%CI 3.8-5.9）（P < 0.001）。潜在评分降低的平均幅度与患者年龄或复杂慢性疾病的数量无关。在基线药物计数较高的患者中，拟议干预措施对 MRCI 评分的潜在影响显著更大（P < 0.001）。
大多数 CMC 患者可能受益于药师指导的儿科 MTM 服务。对主动药物治疗方案的标准化审查确定了几乎所有患者的多种与药物相关的问题和潜在干预措施。拟议的药物干预措施将显著降低 MRCI 衡量的药物治疗方案复杂性。需要进一步前瞻性评估药师指导的儿科 MTM 服务。
