Department of Nursing, Kangda College of Nanjing Medical University, 88 Chunhui Road, Huaguoshan Avenue, Haizhou District, Lianyungang, Jiangsu Province, 222000, China.
Department of Geriatrics, The First People's Hospital of Lianyungang, No. 6 East Zhenhua Road, Haizhou District, Lianyungang, Jiangsu Province, 222061, China.
BMC Psychiatry. 2024 Jun 4;24(1):417. doi: 10.1186/s12888-024-05872-3.
Polypharmacy is common in older adults with psychiatric disorders, but no consensus has reached about the reliable indicators evaluating the benefits and risks of drug-drug interactions (DDIs) in polypharmacy. We aimed to identify indicators suitable for evaluating the clinical significance of DDIs in polypharmacy in older adults with psychiatric disorders.
The online tools were used to distribute and collect the questionnaires. The Delphi method was applied to analyze experts' opinions. The degree of authority and coordination of experts were analyzed using the coefficient of variation, coefficient of coordination, expert's judgment factor, familiarity with the study content factor, and Kendall coordination coefficient. Statistical analysis was conducted using the IBM SPSS® Statistics Package version 26.0.
After three rounds of expert consultation, five primary and eleven secondary indicators were identified. The primary "pharmacodynamic indicator" included "severity of adverse drug reactions", "duration of adverse drug reaction", "symptom relief", "time to onset of symptomatic relief", "number of days in hospital", and "duration of medication". The secondary "pharmacokinetic indicator" contained "dosage administered" and "dosing intervals". The primary "patient tolerance indicator" contained one secondary indicator of "patient tolerability". The primary indicator "patient adherence" contained one secondary indicator of "patient adherence to medication". The primary indicator "cost of drug combination" contained one secondary indicator of "readmission". These indicators were used to determine the clinical significance of DDIs during polypharmacy.
The clinical significance of drug combinations should be taken into account when polypharmacy is used in the elderly. The five primary indicators and eleven secondary indicators might be preferred to evaluate their risks and benefits. Medication management in this population requires a multidisciplinary team, in which nurses play a key role. Future research should focus on how to establish efficient multidisciplinary team workflows and use functional factors to assess DDIs in polypharmacy for psychiatric disorders.
精神障碍老年患者常合并使用多种药物，但目前尚无可靠指标用于评估精神障碍老年患者合并用药时药物-药物相互作用（DDI）的获益与风险。本研究旨在确定适用于评估精神障碍老年患者合并用药时 DDI 临床意义的指标。
采用在线工具发放和回收问卷，应用德尔菲法对专家意见进行分析。采用变异系数、协调系数、专家判断系数、熟悉程度系数和 Kendall 协调系数分析专家权威程度和协调程度。采用 IBM SPSS Statistics Package 26.0 统计软件进行统计学分析。
经过 3 轮专家咨询，共确定了 5 项主要指标和 11 项次要指标。主要的“药效学指标”包括“药物不良反应严重程度”“药物不良反应持续时间”“症状缓解”“症状缓解起效时间”“住院天数”和“用药持续时间”；主要的“药动学指标”包括“给药剂量”和“给药间隔”；主要的“患者耐受指标”包含“患者耐受程度”这一二级指标；主要的“患者服药依从性指标”包含“患者服药依从性”这一二级指标；主要的“药物联合成本指标”包含“再入院”这一二级指标。这些指标用于确定合并用药时 DDI 的临床意义。
在老年患者中应用合并用药时应考虑药物联合的临床意义，可优先选用 5 项主要指标和 11 项次要指标来评估其风险与获益。此类人群的药物管理需要多学科团队合作，其中护士发挥着关键作用。未来的研究应侧重于如何建立高效的多学科团队工作流程，并利用功能因素评估精神障碍老年患者合并用药时的 DDI。
