简化养老院居民的用药方案：药剂师和医生使用结构化的五步药物简化工具。
Simplifying medication regimens for residents of aged care facilities: Pharmacist and physician use of a structured five-step medication simplification tool.
机构信息
University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
出版信息
Res Social Adm Pharm. 2024 Aug;20(8):733-739. doi: 10.1016/j.sapharm.2024.04.008. Epub 2024 Apr 9.
BACKGROUND
Pharmacist-led medication regimen simplification using a structured approach can reduce unnecessary medication regimen complexity in residential aged care facilities (RACFs), but no studies have investigated simplification by different health professionals, nor the extent to which simplification is recommended during comprehensive medication reviews.
OBJECTIVES
To compare medication regimen simplification opportunities identified by pharmacists, general medical practitioners (GPs), and geriatricians and to determine if pharmacists identified simplification opportunities during routinely conducted comprehensive medication reviews in RACFs for these same residents.
METHODS
Three pharmacists, three GPs and three geriatricians independently applied the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) to medication data for 83 residents taking medications at least twice daily. Interrater agreement was calculated using Fleiss's kappa. Pharmacist medication review reports for the same 83 residents were then examined to identify if the pharmacists conducting these reviews had recommended any of the simplification strategies.
RESULTS
Overall, 77 residents (92.8 %) taking medications at least twice daily could have their medication regimen simplified by at least one health professional. Pharmacists independently simplified 53.0-77.1 % of medication regimens (Κ = 0.60, 95%CI 0.46-0.75, indicating substantial agreement), while GPs simplified 74.7-89.2 % (Κ = 0.44, 95%CI 0.24-0.64, moderate agreement) and geriatricians simplified 41.0-66.3 % (Κ = 0.30, 95%CI 0.16-0.44, fair agreement). No simplification recommendations were included in the reports previously prepared by pharmacists as part of the comprehensive medication reviews undertaken for these residents.
CONCLUSION
Pharmacists, GPs, and geriatricians can all identify medication regimen simplification opportunities, although these opportunities differ within and between professional groups. Although opportunities to simplify medication regimens during comprehensive medication reviews exist, simplification is not currently routinely recommended by pharmacists performing these reviews in Australian RACFs.
背景
药剂师主导的使用结构化方法的药物治疗方案简化可以减少养老院（RACF）中不必要的药物治疗方案复杂性，但尚无研究调查不同卫生专业人员的简化情况，也没有研究在全面药物审查期间推荐简化的程度。
目的
比较药剂师、全科医生和老年病医生确定的药物治疗方案简化机会，并确定药剂师是否在 RACF 中对这些相同居民进行常规综合药物审查期间确定了简化机会。
方法
三名药剂师、三名全科医生和三名老年病医生分别使用《养老院药物治疗方案简化指南》（MRS GRACE）对至少每天服用两次药物的 83 名居民的药物数据进行应用。使用 Fleiss 的 kappa 计算了组内一致性。然后检查了 83 名相同居民的药剂师药物审查报告，以确定进行这些审查的药剂师是否推荐了任何简化策略。
结果
总体而言，至少每天服用两次药物的 77 名居民（92.8%）的药物治疗方案可以至少由一名卫生专业人员简化。药剂师独立简化了 53.0-77.1%的药物治疗方案（Κ=0.60，95%CI 0.46-0.75，表明存在实质性一致性），而全科医生简化了 74.7-89.2%（Κ=0.44，95%CI 0.24-0.64，中度一致性），老年病医生简化了 41.0-66.3%（Κ=0.30，95%CI 0.16-0.44，一致性一般）。之前由药剂师为这些居民进行的综合药物审查报告中没有包括简化建议。
结论
药剂师、全科医生和老年病医生都可以确定药物治疗方案简化机会，尽管这些机会在专业群体内部和之间存在差异。尽管在全面药物审查期间有简化药物治疗方案的机会，但目前进行这些审查的药剂师并未常规推荐简化。
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