药师主导的长期护理中心老年心房颤动患者干预（PIVOTALL 研究）：一项随机试点和可行性研究。
Pharmacist-led intervention for older people with atrial fibrillation in long-term care (PIVOTALL study): a randomised pilot and feasibility study.
机构信息
Liverpool Centre for Cardiovascular Science, William Henry Duncan Building, University of Liverpool, Liverpool, L7 8TX, UK.
Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L7 8TX, UK.
出版信息
BMC Geriatr. 2024 Jan 16;24(1):64. doi: 10.1186/s12877-023-04527-4.
BACKGROUND
Older care home residents are a vulnerable group of people with atrial fibrillation (AF) at high risk of adverse health events. The Atrial Fibrillation Better Care (ABC: Avoid stroke; Better symptom management; Cardiovascular and other comorbidity management) pathway is the gold-standard approach toward integrated AF care, and pharmacists are a potential resource with regards to its' implementation. The aim of this study was to determine the feasibility of pharmacist-led medicines optimisation in care home residents, based on the ABC pathway compared to usual care.
METHODS
Individually randomised, prospective pilot and feasibility study of older (aged ≥ 65 years) care home residents with AF (ISRCTN14747952); residents randomised to ABC pathway optimised care versus usual care. The primary outcome was a description of study feasibility (resident and care home recruitment and retention). Secondary outcomes included the number and type of pharmacist medication recommendations and general practitioner (GP) implementation.
RESULTS
Twenty-one residents were recruited and 11 (mean age [standard deviation] 85.0 [6.5] years, 63.6% female) were randomised to receive pharmacist-led medicines optimisation. Only 3/11 residents were adherent to all three components of the ABC pathway. Adherence was higher to 'A' (9/11 residents) and 'B' (9/11 residents) components compared to 'C' (3/11 residents). Four ABC-specific medicines recommendations were made for three residents, and two were implemented by residents' GPs. Overall ABC adherence rates did not change after pharmacist medication review, but adherence to 'A' increased (from 9/11 to 10/11 residents). Other ABC recommendations were inappropriate given residents' co-morbidities and risk of medication-related adverse effects.
CONCLUSIONS
The ABC pathway as a framework was feasible to implement for pharmacist medication review, but most residents' medications were already optimised. Low rates of adherence to guideline-recommended therapy were a result of active decisions not to treat after assessment of the net risk-benefit.
背景
老年养老院居民是心房颤动（AF）风险较高的脆弱人群，易发生不良健康事件。心房颤动更好的护理（ABC：避免中风；更好的症状管理；心血管和其他合并症管理）途径是整合 AF 护理的黄金标准方法，药剂师是实施该方法的潜在资源。本研究旨在确定基于 ABC 途径的药师主导的药物优化在养老院居民中的可行性，与常规护理相比。
方法
对患有 AF（ISRCTN14747952）的年龄≥65 岁的养老院居民进行个体随机、前瞻性试点和可行性研究；将居民随机分为接受 ABC 途径优化护理的组和接受常规护理的组。主要结局是描述研究可行性（居民和养老院的招募和保留）。次要结局包括药剂师药物建议的数量和类型以及全科医生（GP）的实施情况。
结果
共招募了 21 名居民，其中 11 名（平均年龄[标准差]85.0[6.5]岁，63.6%为女性）被随机分配接受药师主导的药物优化。只有 3/11 名居民完全遵守 ABC 途径的所有三个部分。对“A”（9/11 名居民）和“B”（9/11 名居民）部分的依从性高于“C”（3/11 名居民）。为 3 名居民提出了 4 项 ABC 特定药物建议，其中 2 项被居民的 GP 实施。药物审查后，ABC 整体依从率没有变化，但“A”部分的依从率增加（从 9/11 名居民增加到 10/11 名居民）。其他 ABC 建议由于居民的合并症和药物相关不良反应的风险而不适当。
结论
ABC 途径作为一个框架，对于药剂师进行药物审查是可行的，但大多数居民的药物已经得到了优化。由于对净风险效益评估后决定不进行治疗，导致对指南推荐的治疗方法的依从率较低。
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