Graeb Fabian, Berger Bianca, Alf Frank, Reiber Petra, Essig Gundula, Wolke Reinhold
Institut für Gesundheits- und Pflegewissenschaften, Hochschule Esslingen, Flandernstraße 101, 73732, Esslingen, Deutschland.
Z Gerontol Geriatr. 2025 May;58(3):214-219. doi: 10.1007/s00391-024-02340-1. Epub 2024 Aug 13.
Polypharmacy and the resulting problems lead to considerable consequences for those affected. There are also considerable problems with the medication management.
Which interventions and programs for optimizing the supply of medication are available for nursing homes and which implementation problems can be expected?
A literature search was carried out for interventional studies in nursing homes in Germany, with a focus on improving medication safety.
A total of six programs were identified for which evaluation results are available. Despite a mostly multimodal approach with several pillars of intervention (e.g., medication reviews, further education and training, development of aids), the results are largely disappointing. The effects on the number of prescriptions in general, specific medication groups or outcome parameters such as hospital admissions could only be shown in one study, whereby, selection bias could also be at least partly responsible for this. Interdisciplinary collaboration and the implementation of medication recommendations formulated in reviews by the responsible physicians are the main problem areas. At the same time, too little attention is paid to the central role of nurses in the entire process and they are not actively promoted enough. This could be one of the reasons for the difficulties in implementation in practice.
There are nearly no significant changes as a result of the interventions implemented in the studies reviewed. In particular, interprofessional cooperation, especially the skills of nurses and the reluctance on the part of physicians, should probably be given more attention.
多重用药及其引发的问题给患者带来了相当严重的后果。药物管理也存在诸多问题。
养老院可采用哪些干预措施和方案来优化药物供应，可能会遇到哪些实施问题？
对德国养老院的干预性研究进行文献检索，重点关注提高用药安全性。
共确定了六个有评估结果的项目。尽管大多采用多模式方法，有多个干预支柱（如药物审查、继续教育与培训、辅助工具开发），但结果大多令人失望。只有一项研究显示了对总体处方数量、特定药物组或诸如住院等结果参数的影响，不过，选择偏倚可能至少部分导致了这一结果。跨学科合作以及负责医生在审查中制定的用药建议的实施是主要问题领域。与此同时，整个过程中护士的核心作用未得到足够重视，对其积极性的调动也不够。这可能是实际实施困难的原因之一。
在所审查的研究中实施的干预措施几乎没有带来显著变化。特别是跨专业合作，尤其是护士的技能以及医生的不情愿态度，可能应得到更多关注。
