Tantipinichwong Nicha, Keller Michelle S
Cedars-Sinai Medical Network, Pharmacy Services, Beverly Hills, CA, USA.
Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
Sci Rep. 2024 Dec 30;14(1):31719. doi: 10.1038/s41598-024-82285-y.
The unintended consequences of polypharmacy pose significant risks to older adults. The complexities of managing numerous medications from multiple prescribers demand a comprehensive approach to mitigate harms. Pharmacist-led clinics have been shown to improve outcomes in patients with diabetes and hypertension. Pharmacist-led clinics focused on broader issues of polypharmacy have the potential to lead to better outcomes for older patients. We describe the design and the pre-post evaluation of a polypharmacy clinic. We conducted a retrospective standardized chart review of polypharmacy visits during October and November 2022. Systematic data collection was completed by March 2023. Our review included 84 polypharmacy visits; the average patient age was 80. Patients were on 17.3 (range: 7-33) medications at-visit and 15.9 (range: 4-30) medications post-visit, with an average of 1.4 medications deprescribed per visit. In patients with many medications (range: 17-33 medications) at the polypharmacy consult visit, 2.6 medications were deprescribed post-visit. In patients with a moderate number of medications (range: 7-16 medications) at-visit, 0.9 medications were deprescribed post-visit. Medication list accuracy increased to 72% at follow-up visits compared to initial visits (66%). 44% of patients were on 1 or more Potentially Inappropriate Medications (PIMs) and 24% were on 1 or more Drugs with Strong Anticholinergic Properties (DSAPs) at initial visits. At follow-up visit, the proportion of patients with PIMs decreased by 28%, and the proportion of patients with DSAPs decreased by 54%. Our evaluation demonstrates the value of a polypharmacy clinic in improving medication list accuracy and deprescribing PIMs and DSAPs.
多重用药的意外后果给老年人带来了重大风险。管理来自多个开方者的多种药物的复杂性需要一种全面的方法来减轻危害。由药剂师主导的诊所已被证明能改善糖尿病和高血压患者的治疗效果。专注于多重用药更广泛问题的药剂师主导诊所有可能为老年患者带来更好的治疗效果。我们描述了一个多重用药诊所的设计和前后评估。我们对2022年10月和11月的多重用药就诊进行了回顾性标准化病历审查。系统的数据收集在2023年3月完成。我们的审查包括84次多重用药就诊；患者平均年龄为80岁。患者就诊时服用17.3种（范围：7 - 33种）药物，就诊后服用15.9种（范围：4 - 30种）药物，每次就诊平均停用1.4种药物。在多重用药咨询就诊时服用多种药物（范围：17 - 33种药物）的患者中，就诊后停用了2.6种药物。在就诊时服用中等数量药物（范围：7 - 16种药物）的患者中，就诊后停用了0.9种药物。与初次就诊（66%）相比，随访就诊时用药清单的准确性提高到了72%。在初次就诊时，44%的患者服用了1种或更多潜在不适当药物（PIMs），24%的患者服用了1种或更多具有强抗胆碱能特性的药物（DSAPs）。在随访就诊时，服用PIMs的患者比例下降了28%，服用DSAPs的患者比例下降了54%。我们的评估证明了多重用药诊所在提高用药清单准确性以及停用PIMs和DSAPs方面的价值。
