Department of Geriatrics, University Hospital of Caen Normandie, Caen, France.
Department of Pharmacy, University Hospital of Caen Normandie, Caen, France.
Eur J Clin Pharmacol. 2023 Oct;79(10):1391-1400. doi: 10.1007/s00228-023-03551-y. Epub 2023 Aug 19.
The impact of several pharmaceutical interventions to reduce the use of potentially inappropriate medications (PIMs) and potentially omitted medications (POMs) has been recently studied. We aimed to determine whether clinical medication review (CMR) (i.e. a systematic and patient-centred clinical assessment of all medicines currently taken by a patient) performed by a geriatrician and a pharmacist added to standard pharmaceutical care (SPC) (i.e. medication reconciliation and regular prescription review by the pharmacist) resulted in more appropriate prescribing compared to SPC among older inpatients.
A retrospective observational single-centre study was conducted in a French geriatric ward. Six criteria for appropriate prescribing were chosen: the number of PIMs and POMs as defined by the STOPP/STARTv2 list, the total number of drugs prescribed, the number of administrations per day and the number of psychotropic and anticholinergic drugs. These criteria were compared between CMR and SPC group using linear and logistic regression models weighted on propensity scores.
There were 137 patients included, 66 in the CMR group and 71 in the SPC group. The mean age was 87 years, the sex ratio was 0.65, the mean number of drugs prescribed was 9, the mean MMSE was 21 and at admission 242 POMs, and 363 PIMs were prescribed. Clinical medication review did not reduce the number of PIMs at discharge compared to SPC (beta = - 0.13 [- 0.84; 0.57], p = 0.71) nor did it reduce the number of drugs prescribed (p = 0.10), the number of psychotropic drugs (p = 0.17) or the anticholinergic load (p = 0.87). Clinical medication review resulted in more POMs being prescribed than in standard pharmaceutical care (beta = - 0.39 [- 0.72; - 0.06], p = 0.02). Cardiology POMs were more implemented in the medication review group (p = 0.03).
Clinical medication review did not reduce the number of PIMs but helped clinicians introduce underused drugs, especially cardiovascular drugs, which are known to be associated with morbidity and mortality risk reduction.
最近研究了几种减少潜在不适当药物（PIM）和潜在遗漏药物（POM）使用的药物干预措施的影响。我们旨在确定老年病医生和药剂师进行的临床药物审查（CMR）（即对患者当前服用的所有药物进行系统的以患者为中心的临床评估）与药剂师进行的标准药物治疗（SPC）（即药物调整和定期处方审查）相结合，是否会导致老年住院患者的处方更合理。
在法国老年病房进行了一项回顾性观察性单中心研究。选择了六项适当处方的标准：根据 STOPP/STARTv2 清单定义的 PIM 和 POM 的数量、开具的药物总数、每天的用药次数以及精神药物和抗胆碱能药物的数量。使用倾向评分加权的线性和逻辑回归模型比较 CMR 和 SPC 组之间的这些标准。
共纳入 137 例患者，其中 CMR 组 66 例，SPC 组 71 例。平均年龄为 87 岁，性别比为 0.65，平均开具的药物数为 9 种，平均 MMSE 为 21 分，入院时开具了 242 种 POM 和 363 种 PIM。与 SPC 相比，临床药物审查并未减少出院时的 PIM 数量（β=−0.13 [−0.84；0.57]，p=0.71），也未减少开具的药物数量（p=0.10）、精神药物数量（p=0.17）或抗胆碱能负荷（p=0.87）。临床药物审查导致开出的 POM 数量多于标准药物治疗（β=−0.39 [−0.72；−0.06]，p=0.02）。在药物审查组中，心血管科的 POM 更多地被开出（p=0.03）。
临床药物审查并未减少 PIM 的数量，但有助于临床医生引入未被充分使用的药物，特别是心血管药物，已知这些药物与降低发病率和死亡率风险有关。
