Klimentidis Diamantis
Psychiatric Clinic Agia Aikaterini, Thessaloniki, Greece.
Explor Res Clin Soc Pharm. 2024 Feb 28;13:100427. doi: 10.1016/j.rcsop.2024.100427. eCollection 2024 Mar.
Clinical pharmacists significantly improve pharmacotherapy outcomes. Patients with serious mental illness (SMI) represent a group particularly vulnerable to medication mismanagement, potentially benefiting from pharmaceutical care targeting medication appropriateness.
This study aimed to assess the prevalence of inappropriate medication for somatic comorbidities in SMI patients and to evaluate the impact of clinical pharmacist-led interventions.
A pre-post intervention audit involving clinical pharmacist intervention was conducted on SMI patients with somatic comorbidities in a psychiatric clinic in Greece. A comprehensive medication review was undertaken by a clinical pharmacist. The Medicines Appropriateness Index (MAI) and Assessment of Underutilization of medication (AOU) instruments were used to gauge pharmacotherapy appropriateness before and after intervention. Physician acceptance rates and clinical significance were also noted. Statistical analysis employed descriptive and inferential methods, with a significance level set at α = 0.05.
A total of 58 patients were reviewed. Most patients (75.86%) were being inappropriately treated at baseline, versus 15.52% post-intervention. The pharmacist proposed 107 interventions of which 104 (97.2%) were physician-accepted. Changes in MAI and AOU identified improved medication appropriateness post-intervention [χ = 33.029, < 0.005]. Pharmacist interventions resulted in more (52.1%, = 25), less (16.7%, = 8) and no changes (31.2%, = 15) in the total number of prescribed medicines [median difference:1, < 0.005]. From 49 medication initiation recommendations, the most prescribed medicines were statins for primary or secondary prevention ( = 21, 42.8%), aspirin for primary or secondary prevention ( = 9, 18.36%) and metformin ( = 4, 8.2%).
SMI patients had a high prevalence of physical comorbidities, mainly cardiovascular disease, and a high ratio of inappropriate medication treatment. Intervention by a clinical pharmacist significantly improved medication appropriateness and led to the adoption of a new standard of care, to be checked with re-auditing.
临床药师可显著改善药物治疗效果。严重精神疾病（SMI）患者是特别容易出现用药管理不当的群体，可能会从针对用药合理性的药学服务中受益。
本研究旨在评估SMI患者躯体合并症用药不当的发生率，并评估临床药师主导的干预措施的影响。
在希腊一家精神病诊所，对患有躯体合并症的SMI患者进行了一项包括临床药师干预的干预前后审核。由一名临床药师进行全面的用药审查。用药适宜性指数（MAI）和药物利用不足评估（AOU）工具用于衡量干预前后的药物治疗适宜性。还记录了医生的接受率和临床意义。统计分析采用描述性和推断性方法，显著性水平设定为α = 0.05。
共审查了58例患者。大多数患者（75.86%）在基线时接受了不适当的治疗，而干预后这一比例为15.52%。药师提出了107项干预措施，其中104项（97.2%）被医生接受。MAI和AOU的变化表明干预后用药适宜性得到改善[χ = 33.029，< 0.005]。药师的干预导致处方药物总数增加（52.1%， = 25）、减少（16.7%， = 8）和无变化（31.2%， = 15）[中位数差异：1，< 0.005]。在49项用药起始建议中，最常开具的药物是用于一级或二级预防的他汀类药物（ = 21，42.8%）、用于一级或二级预防的阿司匹林（ = 9，18.36%）和二甲双胍（ = 4，8.2%）。
SMI患者躯体合并症的发生率很高，主要是心血管疾病，且用药不当治疗的比例很高。临床药师的干预显著改善了用药适宜性，并导致采用了一种新的护理标准，需通过重新审核进行检查。
