Anderssen-Nordahl Emilie, Fernández-Liz Eladio, Sabaté Gallego Mònica, Bosch Ferrer Montserrat, Sánchez-Arcilla Rosanas Margarita, Cervera León Mercè, Magrinyà Joaquim Miquel, Barceló-Colomer Maria Estrella
Clinical Pharmacology Service, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Clinical Pharmacology Group, Vall d'Hebron Research Institute, Barcelona, Spain.
Front Pharmacol. 2024 Sep 13;15:1445141. doi: 10.3389/fphar.2024.1445141. eCollection 2024.
In response to the rising population of nursing home residents with frailty and multimorbidity, optimizing medication safety through drug utilization review and addressing medication-related problems (MRPs) is imperative. Clinical decision support systems help reduce medication errors and detect potential MRPs, as well as medication reviews performed by a multidisciplinary team, but these combined assessments are not commonly performed. The objective of this study was to evaluate the impact on medication plans of a multidisciplinary team intervention in nursing homes, by analyzing the medication plan before and after the intervention and assessing whether the recommendations given had been implemented.
A multicenter before-after study, involving five nursing homes, assessed the impact of a multidisciplinary team intervention, to estimate effectiveness related to the review of the prescribed medications. The follow-up period for each patient was 12 months or until death if prior, from July 2020 to February 2022, and involved 483 patients. The clinical pharmacologist coordinated the intervention and reviewed all the prescribed medications to make recommendations, focused on the completion of absent data, withdrawal of a drug, verification of whether a drug was adequate, the substitution of a drug, and the addition of drugs. Since the intervention was performed during the COVID-19 pandemic, optimization of psychotropic drugs and absorbent pads were limited.
The intervention had an impact with recommendations given for 398 (82.4%) of the patients and which were followed by 58.5% of them. At least one drug was withdrawn in 293 (60.7%) of the patients, with a mean of 2.3 (SD 1.7). As for the total of 1,097 recommendations given, 355 (32.4%) were followed. From the intervention, antipsychotics, antidepressants, benzodiazepines, statins, and diuretics were the most frequently withdrawn.
The findings underscore the impact of targeted interventions to reduce inappropriate medications and enhance medication safety in nursing homes. The proposed recommendations given and followed show the importance of a multidisciplinary team, coordinated by a clinical pharmacologist, for a patient-centered approach to make medication reviews regularly, with the help of clinical decision support systems, to help reduce potential MRPs and polypharmacy.
为应对疗养院中体弱多病的居民人数不断增加的情况，通过药物利用审查优化用药安全并解决与药物相关的问题（MRP）势在必行。临床决策支持系统有助于减少用药错误并检测潜在的MRP，多学科团队进行的药物审查也是如此，但这些综合评估并不常见。本研究的目的是通过分析干预前后的用药计划并评估所给出的建议是否得到实施，来评估疗养院中多学科团队干预对用药计划的影响。
一项多中心前后对照研究，涉及五家疗养院，评估了多学科团队干预的影响，以估计与审查处方药物相关的有效性。每位患者的随访期为12个月，或如果在此之前死亡则至死亡，时间从2020年7月至2022年2月，共涉及483名患者。临床药理学家协调干预措施并审查所有处方药物以提出建议，重点是完善缺失的数据、停用药物、核实药物是否合适、更换药物以及添加药物。由于干预是在新冠疫情期间进行的，精神药物和吸收垫的优化受到限制。
干预措施对398名（82.4%）患者给出了建议，其中58.5%的患者遵循了这些建议。293名（60.7%）患者至少停用了一种药物，平均停用2.3种（标准差1.7）。在所给出的总共1097条建议中，可以遵循355条（32.4%）。在干预措施中，抗精神病药、抗抑郁药、苯二氮䓬类药物、他汀类药物和利尿剂是最常停用的药物。
研究结果强调了针对性干预对减少疗养院中不适当用药并提高用药安全性的影响。所提出并被遵循的建议表明，由临床药理学家协调的多学科团队对于以患者为中心的方法很重要，该方法借助临床决策支持系统定期进行药物审查，以帮助减少潜在的MRP和多重用药。
