Department of Medical and Clinical Pharmacology, PharmacoVigilance, PharmacoEpidemiology and Drug Informations, Faculty of Medicine, INSERM UMR 1027, University Hospital and Faculty of Medicine, Toulouse, France.
Fundam Clin Pharmacol. 2023 Feb;37(1):182-190. doi: 10.1111/fcp.12820. Epub 2022 Aug 11.
Despite several guidelines for preventing potentially inappropriate medication (PIM) use in older, their prescription rates remain high (25%). The aim of this study was to determine the impact of medication reviews (MRs) on the drug-related problems (DRPs) in older patients in Elderly Residential Care Homes (nursing homes [NHs]). DRP was defined as an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. We conducted a retrospective study on 2819 residents of the 46 NHs between 1 January 2017 and 31 December 2018. Drug prescription was analysed according to European EU(7)-PIM list and START/STOPP list. We then linked each PIM to an appropriate type of DRP. Three months later, we requested the 'updated' drug prescriptions to assess whether the recommendations had been followed. A total of 17 850 prescription lines were registered. A DRP was identified for 25% of them. Following the second request, 13 NHs (28%) responded. About 26% (n = 1188) of the overall prescriptions lines identified as a DRP involved these 13 NHs, which resulted in a recommendation being made during the first MR. Data from the second MR suggested that 53.9% (n = 640) of recommendations were followed with the requested change: 32.0% involved drug withdrawal (n = 381), 9.7% concerned dose adjustment (n = 115) and 6.5% required drug changes (n = 77). Our results show the benefit impact of MR on the quality of drug prescription in older NH residents. MRs should be one of the tools used to improve drug prescriptions in the elderly.
尽管有几项预防老年人潜在不适当用药（PIM）的指南，但他们的处方率仍然很高（25%）。本研究旨在确定药物审查（MR）对老年护理院（养老院[NH]）中老年人的药物相关问题（DRP）的影响。DRP 定义为涉及药物治疗的实际或潜在干扰预期健康结果的事件或情况。我们对 2017 年 1 月 1 日至 2018 年 12 月 31 日期间的 46 家 NH 的 2819 名居民进行了回顾性研究。药物处方根据欧洲 EU(7)-PIM 清单和 START/STOPP 清单进行分析。然后，我们将每个 PIM 与适当类型的 DRP 联系起来。三个月后，我们要求提供“更新后的”药物处方，以评估建议是否得到遵循。共登记了 17850 条处方线。其中 25%的处方线被确定为 DRP。在第二次请求后，有 13 家 NH（28%）做出了回应。在确定为 DRP 的所有处方线中，约 26%（n=1188）涉及这 13 家 NH，这导致在第一次 MR 中提出了建议。第二次 MR 的数据表明，53.9%（n=640）的建议得到了请求的更改：32.0%涉及药物停药（n=381），9.7%涉及剂量调整（n=115），6.5%需要药物更换（n=77）。我们的结果表明，MR 对改善养老院老年人药物处方质量具有有益影响。MR 应该是改善老年人药物处方的工具之一。
