Grabe D W, Low C L, Bailie G R, Eisele G
Albany College of Pharmacy, NY 12208, USA.
Clin Nephrol. 1997 Feb;47(2):117-21.
Drug-related morbidity and mortality are significant problems in the U.S. Recognition and resolution of drug-related problems (DRP) will decrease drug-related morbidity and mortality and promote optimal therapeutic outcomes. It was the objective of this study to identify DRP in hemodialysis outpatients by performing medication reviews; make appropriate recommendations and determine the significance of any interventions; and estimate outcome in terms of any changes in number of medications/patient or doses/day.
A thorough medication review was conducted with each patient after review of the computerized medication profiles and medical records. Each updated profile was assessed by a clinical pharmacist for the presence of any of the 8 classical DRP plus 2 additional categories (therapeutic duplication and other [specific for dialysis e.g., dry weight]). Appropriate recommendations were made to the physician. Accepted recommendations were deemed as interventions and assigned a significance rank on a published scale of 1 (adverse significance) to 6 (extremely significant) by each of the investigators. A final rank was assigned upon agreement between investigators. Changes in numbers of doses/day or medications/patient were determined.
49 patients were reviewed and 45 patients (21 women, 24 men) were included in the final analysis. Over one month 126 DRP were identified and 102 interventions were made. Drug interactions constituted the most common DRP (27.5%). The second most common DRP (26.5%) was in the dialysis-specific group. The number of interventions per significance rank were as follows: rank 1:0 (0%); rank 2: 7 (6.9%); rank 4: 80 (78%); rank 5: 5 (4.9%); rank 6: 1 (1%). Patients were taking a mean of 10.9 +/- 3.9 medications and a mean of 14.5 +/- 6 doses/day (range, 2-33) prior to the study and 10.7 +/- r and 14.4 +/- 5.8 by the end of the study period.
With the addition of a clinical pharmacist in an hemodialysis unit numerous DRP were detected and interventions made. The majority of interventions were significant and possibly led to better therapeutic outcomes.
在美国，药物相关的发病率和死亡率是重大问题。识别并解决药物相关问题（DRP）将降低药物相关的发病率和死亡率，并促进最佳治疗效果。本研究的目的是通过进行用药评估来识别血液透析门诊患者中的DRP；提出适当建议并确定任何干预措施的重要性；并根据每位患者用药数量或每日剂量的任何变化来评估结果。
在查阅计算机化用药档案和病历后，对每位患者进行全面的用药评估。每位临床药师会根据更新后的档案评估是否存在8种经典DRP中的任何一种以及另外2类（治疗重复和其他[特定于透析，如干体重]）。向医生提出适当建议。被接受的建议被视为干预措施，并由每位研究人员根据已发表的1（不良重要性）至6（极其重要）的量表赋予重要性等级。在研究人员达成一致后确定最终等级。确定每日剂量或每位患者用药数量的变化。
对49名患者进行了评估，最终分析纳入了45名患者（21名女性，24名男性）。在一个多月的时间里，共识别出126个DRP，并进行了102次干预。药物相互作用是最常见的DRP（27.5%）。第二常见的DRP（26.5%）属于透析特定组。每个重要性等级的干预次数如下：1级：0（0%）；2级：7（6.9%）；4级：80（78%）；5级：5（4.9%）；6级：1（1%）。研究前患者平均服用10.9±3.9种药物，平均每日服用14.5±6剂（范围为2 - 33剂），研究期末为10.7±r剂和14.4±5.8剂。
在血液透析单元增加一名临床药师后，检测到大量DRP并进行了干预。大多数干预措施具有重要意义，可能会带来更好的治疗效果。
