Tuula Anita, Merks Piotr, Waszyk-Nowaczyk Magdalena, Drozd Mariola, Petrova Galina, Viola Reka, Bobrova Veera, Scott Michael, Oona Marje, Volmer Daisy
Institute of Pharmacy, Faculty of Medicine, University of Tartu, Tartu, Estonia.
Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland.
Front Pharmacol. 2024 Feb 16;15:1348400. doi: 10.3389/fphar.2024.1348400. eCollection 2024.
Pharmacist-led medication reviews (MR) are one of the key methods to support medication safety in polypharmacy patients. The aims of this study were to pilot MRs in Eastern European community pharmacies, describe medication use in polypharmacy patients, and evaluate the usability of medication safety assessment tools. The MR pilot was undertaken in Estonia, Latvia, Poland, Hungary, Romania, and Bulgaria. Patients who used at least five medicines were directed to the service by their GPs. Data on drug-related problems (DRPs) and adherence were collected by pharmacists through structured patient interviews. Databases for identification of potential drug-drug interactions (pDDIs) and adverse drug reactions (ADRs) named Inxbase/Riskbase, as well as an integrated tool comprising potentially inappropriate medicines (PIMs) lists EU(7)-PIM and EURO-FORTA, were applied retroactively to the MR pilot data to investigate possibilities for their use and to describe medication use and potential risks in the study population. A total of 318 patients were included in the study, 250 of them elderly (≥65 years). One hundred and eighty (56.6%) participants had a total of 504 pDDIs based on Inxbase analysis. On average, there were 1.6 pDDIs per participant. Twenty-five (5.0%) of the 504 pDDIs were in a high-risk category. A total of 279 (87.7%) participants had a potential ADR in at least one of 10 Riskbase categories. One hundred and fifty-four (20.8%) of the potential ADRs were in a high-risk category. Twenty-seven pDDIs and 68 ADRs documented as DRPs during the service were not included in the databases. Using the integrated EU(7)-PIM/EURO-FORTA PIM list, a total of 816 PIMs were found in 240 (96%) of the 250 elderly participants (on average 3.4 PIMs per elderly participant). Seventy-one (29.6%) of the participants were using high-risk PIMs. Twenty-one percent of high-risk PIMs and 13.8% of medium-risk PIMs were documented as DRPs by the pharmacists during the pilot. Medication safety assessment tools can be useful in guiding decision-making during MRs; however, these tools cannot replace patient interviews and monitoring. Tools that include a thorough explanation of the potential risks and are easy to use are more beneficial for MRs.
由药剂师主导的用药评估（MR）是保障多重用药患者用药安全的关键方法之一。本研究的目的是在东欧社区药房试点用药评估，描述多重用药患者的用药情况，并评估用药安全评估工具的实用性。用药评估试点在爱沙尼亚、拉脱维亚、波兰、匈牙利、罗马尼亚和保加利亚开展。使用至少五种药物的患者由其全科医生转介至该服务。药剂师通过结构化患者访谈收集与药物相关问题（DRP）和用药依从性的数据。名为Inxbase/Riskbase的用于识别潜在药物相互作用（pDDI）和药物不良反应（ADR）的数据库，以及包含潜在不适当药物（PIM）清单EU(7)-PIM和EURO-FORTA的综合工具，被追溯应用于用药评估试点数据，以研究其使用可能性，并描述研究人群的用药情况和潜在风险。共有318名患者纳入研究，其中250名是老年人（≥65岁）。基于Inxbase分析，180名（56.6%）参与者共有504种潜在药物相互作用。平均每名参与者有1.6种潜在药物相互作用。504种潜在药物相互作用中有25种（5.0%）属于高风险类别。共有279名（87.7%）参与者在10个Riskbase类别中的至少一个类别中存在潜在药物不良反应。154种（20.8%）潜在药物不良反应属于高风险类别。服务期间记录为药物相关问题的27种潜在药物相互作用和68种药物不良反应未纳入数据库。使用EU(7)-PIM/EURO-FORTA综合潜在不适当药物清单，在250名老年参与者中的240名（96%）中总共发现了816种潜在不适当药物（平均每名老年参与者3.4种潜在不适当药物）。71名（29.6%）参与者正在使用高风险潜在不适当药物。在试点期间，药剂师将21%的高风险潜在不适当药物和13.8%的中度风险潜在不适当药物记录为药物相关问题。用药安全评估工具在用药评估过程中指导决策时可能有用；然而，这些工具不能替代患者访谈和监测。包含对潜在风险的详尽解释且易于使用的工具对用药评估更有益。
