一项预防药物相互作用和潜在不适当用药的临床药学服务：对一家地区医院老年中级护理患者的连续干预研究。
A Clinical Pharmacy Service to Prevent Drug-Drug Interactions and Potentially Inappropriate Medication: A Consecutive Intervention Study in Older Intermediate Care Patients of a Regional Hospital.
作者信息
Ullmann Alexander Kilian, Bach Oliver, Mosch Kathrin, Bertsche Thilo
机构信息
Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, 04103 Leipzig, Germany.
Drug Safety Center, Medical Faculty, Leipzig University, 04103 Leipzig, Germany.
出版信息
Pharmacy (Basel). 2025 Apr 24;13(3):60. doi: 10.3390/pharmacy13030060.
In intermediate care, older patients with polypharmacy are vulnerable to drug-drug interactions (DDI) and potentially inappropriate medication (PIM). Aims: To perform a consecutive intervention study to evaluate DDI/PIM. Clinically-relevant DDI/PIM were identified using AMeLI (electronic medication list) and PRISCUS 2.0 (PIM list). Consecutive patients (standard care group) were screened for DDI/PIM after admission (t0) and again before discharge (t1). In an interim period, physicians received general education about DDI/PIM. Then, consecutive patients (independent clinical pharmacy group) were screened for DDI/PIM after admission (t2). Physicians were then provided with patient-individualized recommendations by a clinical pharmacist to prevent DDI/PIM. The patients were then screened again for DDI/PIM before discharge (t3). In each group, 100 patients were included with data available for evaluation from 97 (standard care group, median age: 78 years [Q25/Q75: 69/84]) and 89 (clinical pharmacy group, 76 years [67/84]). In the standard care group, DDI were identified in 55 (57%) patients after admission (t0) and 54 (56%) before discharge (t1, ARR[t0/t1] = 0.01, NNT[t0/t1] = 100, n.s.). In the clinical pharmacy group, DDI were identified in 32 (36%) after admission (t2; ARR[t0/t2] = 0.21/NNT[t0/t2] = 5, < 0.01) and 26 (29%) before discharge (t3; ARR[t2/t3] = 0.07/NNT[t2/t3] = 15, n.s.; ARR[t1/t3] = 0.27/NNT[t1/t3] = 4, < 0.001). PIM were identified in patients at t0: 34 (35%), t1: 35 (36%, ARR[t0/t1] = -0.01/NNH[t0/t1] = 100, n.s.), t2: 25 (26%, ARR[t0/t2] = 0.09/NNT[t0/t2] = 12, n.s.), t3: 23 (24%, ARR[t2/t3] = 0.11/NNT[t2/t3] = 10, n.s.; ARR[t1/t3] = 0.12/NNT[t1/t3] = 9, n.s.). In the standard care group, after admission, many DDI/PIM were identified in older intermediate care patients. Before discharge, their number was hardly influenced at all. General education for physicians led to DDI prevention after admission. In addition, the DDI frequency decreased by providing physicians with patient-individualized recommendations.
在中级护理中，使用多种药物的老年患者易发生药物相互作用（DDI）和潜在不适当用药（PIM）。目的：进行一项连续干预研究以评估DDI/PIM。使用AMELI（电子药物清单）和PRISCUS 2.0（PIM清单）识别临床相关的DDI/PIM。连续患者（标准护理组）在入院后（t0）和出院前（t1）再次筛查DDI/PIM。在过渡期间，医生接受了关于DDI/PIM的一般教育。然后，连续患者（独立临床药学组）在入院后（t2）筛查DDI/PIM。然后，临床药师为医生提供针对患者个体的建议以预防DDI/PIM。患者在出院前再次筛查DDI/PIM（t3）。每组纳入100例患者，97例（标准护理组，中位年龄：78岁[Q25/Q75：69/84]）和89例（临床药学组，76岁[67/84]）有可用于评估的数据。在标准护理组中，入院后（t0）55例（57%）患者被识别出有DDI，出院前（t1）54例（56%）（ARR[t0/t1]=0.01，NNT[t0/t1]=100，无统计学意义）。在临床药学组中，入院后（t2）32例（36%）被识别出有DDI（ARR[t0/t2]=0.21/NNT[t0/t2]=5，<0.01），出院前（t3）26例（29%）（ARR[t2/t3]=0.07/NNT[t2/t3]=15，无统计学意义；ARR[t1/t3]=0.27/NNT[t1/t3]=4，<0.001）。在t0时，34例（35%）患者被识别出有PIM，t1时35例（36%，ARR[t0/t1]=-0.01/NNH[t0/t1]=100，无统计学意义），t2时25例（26%，ARR[t0/t2]=0.09/NNT[t0/t2]=12，无统计学意义），t3时23例（24%，ARR[t2/t3]=0.11/NNT[t2/t3]=10，无统计学意义；ARR[t1/t3]=0.12/NNT[t1/t3]=9，无统计学意义）。在标准护理组中，入院后，老年中级护理患者中识别出许多DDI/PIM。出院前，其数量几乎没有受到任何影响。对医生的一般教育导致入院后预防了DDI。此外，通过为医生提供针对患者个体的建议，DDI频率降低。
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