Department of Clinical Pharmacy, Fujita Health University School of Medicine.
Department of Pharmacy, National Center for Geriatrics and Gerontology.
Biol Pharm Bull. 2022;45(8):1166-1171. doi: 10.1248/bpb.b22-00245.
Polypharmacy in older adults causes problems such as increased adverse drug reactions, overdose or duplication, and poor medication adherence. We have established a "medication review team" organized by pharmacists. This prospective and retrospective observational study evaluated the effectiveness of the pharmacist-led team-based approach for reducing polypharmacy as compared to the individual pharmacist approach. Data on the individual pharmacist approach were collected retrospectively, but prospectively for the pharmacist-led team approach. The study included patients who were admitted to the nephrology, orthopedic surgery, and psychiatry wards. Characteristics for patient included in each study group were adjusted using the propensity score method. The pharmacist-led team approach had a significantly higher medication change rate compared to that of the individual pharmacist approach (odds ratio (OR), 2.28; 95% confidence interval (CI), 1.21 to 4.46; p = 0.009). The rate of patients with two or more medication discontinuations and the rate of patients with intervention by young clinical pharmacist were also significantly higher in the pharmacist-led team approach (OR, 2.19; 95% CI, 1.06 to 4.74; p = 0.03 and OR, 5.67; 95% CI, 1.22 to 53.15; p = 0.02, respectively). The rate of patients with discontinuation of potentially inappropriate medications was not significantly different between the two groups (OR, 2.07; 95% CI, 0.86 to 5.33; p = 0.11). Our results suggest that it is possible to improve the quality of medication review by conducting team conferences even with only pharmacists.
老年人的多种用药会导致不良反应增加、药物过量或重复使用以及药物依从性差等问题。我们成立了一个由药剂师组织的“用药审查团队”。本前瞻性和回顾性观察性研究评估了与个体药剂师方法相比，由药剂师领导的团队方法在减少多种用药方面的有效性。个体药剂师方法的数据是回顾性收集的，而由药剂师领导的团队方法的数据是前瞻性收集的。该研究纳入了入住肾病、骨科和精神科病房的患者。使用倾向评分法调整纳入每个研究组的患者特征。与个体药剂师方法相比，由药剂师领导的团队方法的药物调整率显著更高（比值比（OR），2.28；95%置信区间（CI），1.21 至 4.46；p=0.009）。药物停用 2 种或以上的患者比例和接受年轻临床药剂师干预的患者比例在由药剂师领导的团队方法中也显著更高（OR，2.19；95% CI，1.06 至 4.74；p=0.03 和 OR，5.67；95% CI，1.22 至 53.15；p=0.02，分别）。两组患者中潜在不适当药物停药率无显著差异（OR，2.07；95% CI，0.86 至 5.33；p=0.11）。我们的研究结果表明，即使只有药剂师参与，通过开展团队会议也可以提高药物审查质量。
