Gilson Aaron M, Stone Jamie A, Berbakov Maria E, Hoffins Emily L, Gollhardt Joel, Walker Kenneth, Chui Michelle A
Division of Social and Administrative Sciences & Sonderegger Research Center for Improved Medication Outcomes, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA.
Division of Social and Administrative Sciences, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI, 53705, USA.
Res Social Adm Pharm. 2025 Apr;21(4):253-261. doi: 10.1016/j.sapharm.2025.01.005. Epub 2025 Jan 8.
Misuse of over-the-counter (OTC) medications by older adults (age 65+) can comprise Drug-Age, Drug-Drug, Drug-Disease, and Drug-Label types. Pharmacies in the United States are prevalent sources of OTCs and are an apt setting to address OTC misuse. Senior Safe™ is a pharmacy-system redesign for preventing older adult OTC misuse. The redesign uses signage to designate high-risk OTCs and safer products for older adult use, as well as prompting older adults to engage with pharmacy staff around medication safety issue.
This study compared misuse in pharmacies with initial Senior Safe implementation (Immediate Effects group) to pharmacies with Senior Safe after 3 months (Sustained Effects group).
A non-equivalent group design, involving older adults recruited from matched and randomly-allocated pharmacy sites within a health system, compared the Immediate Effects (n = 83) and Sustained Effects (n = 65) groups. All participants were recruited outside the pharmacy and were given hypothetical symptom scenarios from which to choose (i.e., cough/cold/allergy, pain, or sleep). Participants were then asked to select an OTC to treat that symptom, and explain their OTC use at symptom onset and if symptoms persisted/worsened. Participants' reported OTC use was evaluated for each misuse type. Multivariate modeling estimated differences in misuse between the Immediate and Sustained Effects groups.
No significant differences emerged between Immediate and Sustained Effect groups for any misuse type for which statistical modeling was conducted. Drug-Age misuse was statistically less likely for sleep products (OR = 0.170, p = .005) and for adults aged 85+ when compared to the 65-74 and 75-84 age categories (OR = 3.979, p = .053; OR = 6.900, p = .031, respectively).
These non-significant results suggest that the intervention effect was maintained at three months. Overall, then, misuse reductions occurring immediately after intervention implementation did not significantly increase after three months. System buy-in, including assessing costs to implement and maintain Senior Safe, is critical to promote broader adoption.
65岁及以上老年人滥用非处方药（OTC）可能包括药物-年龄、药物-药物、药物-疾病和药物-标签等类型。在美国，药店是OTC的主要来源，也是解决OTC滥用问题的合适场所。“Senior Safe™”是一种重新设计的药房系统，旨在预防老年人OTC滥用。该重新设计使用标识来指定高风险OTC和更适合老年人使用的安全产品，并促使老年人就用药安全问题与药房工作人员沟通。
本研究比较了首次实施“Senior Safe”的药店（即时效果组）与实施3个月后的“Senior Safe”药店（持续效果组）中的滥用情况。
采用非等效组设计，从卫生系统内匹配并随机分配的药店招募老年人，比较即时效果组（n = 83）和持续效果组（n = 65）。所有参与者均在药店外招募，并给出假设症状场景供其选择（即咳嗽/感冒/过敏、疼痛或睡眠）。然后要求参与者选择一种OTC来治疗该症状，并解释症状出现时他们的OTC使用情况以及症状是否持续/加重。针对每种滥用类型评估参与者报告的OTC使用情况。多变量建模估计即时效果组和持续效果组之间滥用情况的差异。
对于进行统计建模的任何滥用类型，即时效果组和持续效果组之间均未出现显著差异。与65 - 74岁和75 - 84岁年龄组相比，85岁及以上成年人使用睡眠产品时药物-年龄滥用在统计学上不太可能发生（OR = 0.170，p = 0.005）；85岁及以上成年人的药物-年龄滥用在统计学上不太可能发生（OR分别为3.979，p = 0.053；OR = 6.900，p = 0.031）。
这些不显著的结果表明干预效果在三个月时得以维持。总体而言，干预实施后立即出现的滥用减少情况在三个月后并未显著增加。包括评估实施和维持“Senior Safe”的成本在内的系统支持对于促进更广泛的采用至关重要。
