Gsell Julian, Baumgartner Sandro, Schlögl Mathias, Leenen Katrin, Béchir Markus, Russmann Stefan
Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology Zurich (ETHZ), 8093 Zurich, Switzerland.
Centre for Internal Medicine, Clinic Hirslanden Aarau, 5001 Aarau, Switzerland.
J Clin Med. 2025 Mar 21;14(7):2142. doi: 10.3390/jcm14072142.
: Polymorbidity and polypharmacy are major challenges in geriatric care, resulting in a reduced quality of life and increased health care costs. : We evaluated the proactive medication management of nursing home residents through personal visits and the use of a clinical decision support system (CDSS) with an integrated Beers Criteria list. : Among 56 nursing home residents, we observed a high prevalence of polypharmacy with an average of 7.9 regular and 5.1 on-demand prescriptions. Proactive medication management led to persistent medication changes in 87.5% of patients. Regular prescriptions were reduced in 21 residents and increased in 18 residents, resulting in a reduced use of cardiovascular drugs and antacids ( < 0.05), but no significant overall reduction in polypharmacy. CDSS alerts based on Beers Criteria made no clinically relevant contribution to medication reduction. : Proactive geriatric medication management led to persistent medication changes and no reduction in overall polypharmacy but reduced the use of selected drug classes that are associated with an increased risk of adverse reactions and costs. The clinical relevance and implementability of Beers Criteria were low, revealing major limitations of algorithm-based alerts for older patients, who require additional personalized evaluations of their individual complex healthcare needs.
共病和多重用药是老年护理中的主要挑战，会导致生活质量下降和医疗保健成本增加。我们通过上门家访以及使用带有综合Beers标准清单的临床决策支持系统（CDSS），对养老院居民的主动用药管理进行了评估。在56名养老院居民中，我们观察到多重用药的高发生率，平均每人有7.9种常规处方和5.1种按需处方。主动用药管理使87.5%的患者持续改变了用药情况。21名居民的常规处方减少，18名居民的常规处方增加，心血管药物和抗酸剂的使用减少（<0.05），但多重用药的总体情况没有显著减少。基于Beers标准的CDSS警报对减少用药没有临床相关贡献。主动的老年用药管理导致了持续的用药改变，且多重用药的总体情况没有减少，但减少了与不良反应风险增加和成本相关的特定药物类别的使用。Beers标准的临床相关性和可实施性较低，揭示了基于算法的警报对老年患者的主要局限性，这些患者需要对其复杂的个人医疗保健需求进行额外的个性化评估。
