Stuhec Matej, Svetanic Nusa, Vovk Tomaz, Gorjan Gazdag Anteja, Cuk Zala, Batinic Borjanka
Department of Pharmacology & Department of Clinical Pharmacy, Medical Faculty Maribor, University of Maribor, Maribor, Slovenia.
Department of Clinical Pharmacy, Ormoz's Psychiatric Hospital, Ormoz, Slovenia.
Front Pharmacol. 2025 Sep 1;16:1667584. doi: 10.3389/fphar.2025.1667584. eCollection 2025.
Collaboration with clinical pharmacists in the medication review process can potentially optimize pharmacotherapy for elderly patients with mental disorders and somatic comorbidities.
This study aimed to evaluate the impact of clinical pharmacists' recommendations during medication reviews, including changes in the number of medications, potentially inappropriate medications (PIMs), potential drug-drug interactions (DDIs), and adherence to treatment guidelines.
A retrospective, non-interventional study was conducted in a psychiatric hospital in Slovenia. The study included inpatients aged ≥65 years with mental disorders who were referred for medication reviews between 2013 and 2018 and had at least one therapy modification related to somatic comorbidities (heart failure, arterial hypertension, or diabetes). Clinical pharmacists conducted type 3 medication reviews (advanced medication reviews), as defined by the Pharmaceutical Care Network Europe They recorded their recommendations in the hospital's electronic system immediately after completing the medication review. Data from before (before the medication review) and after (outcomes extracted from the electronic system at discharge) were systematically reviewed. The primary outcomes were changes in the number of medications, PIMs, and DDIs before and after the intervention. The secondary outcome was adherence to treatment guidelines for somatic comorbidities (heart failure, arterial hypertension, and diabetes).
The study included 100 inpatients with a mean age of 78.1 years (SD = 6.78). The total number of medications decreased by 6.6% (from 1,144 to 1,068; p < 0.001), with an acceptance rate of 59.2%. After the review, X-type DDIs decreased by 75.8% (from 33 to 8; p < 0.001), and D-type DDIs decreased by 56.9% (from 188 to 81; p < 0.001). The number of PIMs also significantly decreased (p < 0.001), with reductions of 29.5% (from 308 to 217) based on the Priscus List and 17.5% (from 343 to 283) according to the Beers Criteria. Adherence to treatment guidelines for somatic comorbidities improved significantly (from 3.3%-13.2% to 50.0%-72.6%; p < 0.001).
This study demonstrates that interventions by clinical pharmacists during the medication review process effectively reduced the number of medications, PIMs, and DDIs while significantly improving adherence to treatment guidelines.
在药物审查过程中与临床药师合作可能会优化患有精神障碍和躯体合并症的老年患者的药物治疗。
本研究旨在评估临床药师在药物审查期间的建议所产生的影响，包括药物数量、潜在不适当用药（PIM）、潜在药物相互作用（DDI）的变化以及对治疗指南的依从性。
在斯洛文尼亚的一家精神病医院进行了一项回顾性、非干预性研究。该研究纳入了年龄≥65岁、患有精神障碍且在2013年至2018年间被转诊进行药物审查并且至少有一项与躯体合并症（心力衰竭、动脉高血压或糖尿病）相关的治疗调整的住院患者。临床药师进行了欧洲药学保健网络定义的3型药物审查（高级药物审查）。他们在完成药物审查后立即将建议记录在医院的电子系统中。系统地审查了干预前（药物审查前）和干预后（出院时从电子系统中提取的结果）的数据。主要结局是干预前后药物数量、PIM和DDI的变化。次要结局是对躯体合并症（心力衰竭、动脉高血压和糖尿病）治疗指南的依从性。
该研究纳入了100名平均年龄为78.1岁（标准差 = 6.78）的住院患者。药物总数减少了6.6%（从1144种降至1068种；p < 0.001），接受率为59.2%。审查后，X型DDI减少了75.8%（从33例降至8例；p < 0.001），D型DDI减少了56.9%（从188例降至81例；p < 0.001）。PIM的数量也显著减少（p < 0.001），根据普里斯库斯清单减少了29.5%（从308种降至217种），根据比尔斯标准减少了17.5%（从343种降至283种）。对躯体合并症治疗指南的依从性显著提高（从3.3% - 13.2%提高到50.0% - 72.6%；p < 0.001）。
本研究表明，临床药师在药物审查过程中的干预有效地减少了药物数量、PIM和DDI，同时显著提高了对治疗指南的依从性。
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