长期护理机构居民综合药物评估前后用药情况：回顾性队列研究。
Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study.
机构信息
University of South Australia, UniSA Allied Health and Human Performance, GPO Box 2471, Adelaide, South Australia, Australia.
Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
出版信息
BMC Geriatr. 2022 Jun 8;22(1):493. doi: 10.1186/s12877-022-03187-0.
BACKGROUND
Residential Medication Management Review (RMMR) is a subsidized comprehensive medicines review program for individuals in Australian residential aged care facilities (RACFs). This study examined weekly trends in medicines use in the four months before and after an RMMR and among a comparison group of residents who did not receive an RMMR.
METHODS
This retrospective cohort study included individuals aged 65 to 105 years who first entered permanent care between 1/1/2012 and 31/12/2016 in South Australia, Victoria, or New South Wales, and were taking at least one medicine. Individuals with an RMMR within 12 months of RACF entry were classified into one of three groups: (i) RMMR within 0 to 3 months, (ii) 3 to 6 months, or (iii) within 6 to 12 months of RACF entry. Individuals without RMMRs were included in the comparison group. Weekly trends in the number of defined daily doses per 1000 days were determined in the four months before and after the RMMR (or assigned index date in the comparison group) for 14 medicine classes.
RESULTS
113909 individuals from 1979 RACFs were included, of whom 55021 received an RMMR. Across all three periods examined, decreased use of statins and proton pump inhibitors was observed post-RMMR in comparison to those without RMMRs. Decreases in calcium channel blockers, benzodiazepines/zopiclone, and antidepressants were observed following RMMR provision in the 3-6 and 6-12 months after RACF entry. Negligible changes in antipsychotic use were also observed following an RMMR in the 6-12 months after RACF entry by comparison to those without RMMRs. No changes in use of opioids, ACE inhibitors/sartans, beta blockers, loop diuretics, oral anticoagulants, or medicines for osteoporosis, diabetes or the cognitive symptoms of dementia were observed post-RMMR.
CONCLUSIONS
For six of the 14 medicine classes investigated, modest changes in weekly trends in use were observed after the provision of an RMMR in the 6-12 months after RACF entry compared to those without RMMRs. Findings suggest that activities such as medicines reconciliation may be prioritized when an RMMR is provided on RACF entry, with deprescribing more likely after an RMMR the longer a resident has been in the RACF.
背景
住宅药物管理审查（RMMR）是一项针对澳大利亚养老院居民的补贴综合药物审查计划。本研究考察了 RMMR 前后四个月内以及未接受 RMMR 的居民对照组中药物使用的每周趋势。
方法
这项回顾性队列研究包括 2012 年 1 月 1 日至 2016 年 12 月 31 日期间首次进入永久性护理的年龄在 65 至 105 岁之间的个体，并且至少服用一种药物。在入住养老院后 12 个月内接受 RMMR 的个体被分为三组：（i）RMMR 在入住养老院后 0 至 3 个月内，（ii）3 至 6 个月内，或（iii）入住养老院后 6 至 12 个月内。未接受 RMMR 的个体被纳入对照组。在 RMMR（或对照组中的指定索引日期）前后的四个月内，确定了 14 种药物类别中每 1000 天的定义日剂量数的每周趋势。
结果
来自 1979 家养老院的 113909 名个体被纳入研究，其中 55021 名接受了 RMMR。在所有三个研究期间，与未接受 RMMR 的个体相比，接受 RMMR 后他汀类药物和质子泵抑制剂的使用减少。在入住养老院后 3-6 个月和 6-12 个月内，钙通道阻滞剂、苯二氮䓬类/佐匹克隆和抗抑郁药的使用减少。与未接受 RMMR 的个体相比，在入住养老院后 6-12 个月内接受 RMMR 后，抗精神病药的使用也出现了微不足道的变化。与未接受 RMMR 的个体相比，入住养老院后 6-12 个月内接受 RMMR 后，阿片类药物、ACE 抑制剂/沙坦类、β受体阻滞剂、噻嗪类利尿剂、口服抗凝剂或骨质疏松症、糖尿病或痴呆认知症状药物的使用没有变化。
结论
在入住养老院后 6-12 个月内提供 RMMR 后，与未接受 RMMR 的个体相比，在 14 种药物类别中的 6 种药物类别中，每周使用趋势出现了适度变化。研究结果表明，当在养老院入住时提供 RMMR 时，可能会优先考虑药物重整等活动，并且在居民入住养老院的时间越长，接受 RMMR 后更有可能减少药物使用。
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