Schmidt I, Claesson C B, Westerholm B, Nilsson L G, Svarstad B L
National Board of Health and Welfare, Stockholm, Sweden.
J Am Geriatr Soc. 1998 Jan;46(1):77-82. doi: 10.1111/j.1532-5415.1998.tb01017.x.
To evaluate the impact of regular multidisciplinary team interventions on the quantity and quality of psychotropic drug prescribing in Swedish nursing homes.
A randomized controlled trial.
A sample of 33 nursing homes: 15 experimental homes and 18 control homes representing 5% of all Swedish nursing homes.
The sample consisted of 1854 long-term care residents with an average age of 83 years. Seventy percent of the residents were women, and 42% had a documented diagnosis of dementia. An additional 5% had a psychotic disorder, and 7% had a diagnosis of depression.
Experimental homes participated in an outreach program that was designed to influence drug use through improved teamwork among physicians, pharmacists, nurses, and nurses' assistants. Multidisciplinary team meetings were held on a regular basis throughout the 12-month study period.
Lists of each resident's prescriptions were collected 1 month before and 1 month after the 12-month intervention. Measures included the proportion of residents with any psychotropic drug, polymedicine, and therapeutic duplication and proportion of residents with nonrecommended and acceptable drugs in each psychotropic drug class, as defined by current Swedish guidelines.
Baseline results show extensive psychotropic drug prescribing, with the most commonly prescribed drugs being hypnotics (40%), anxiolytics (40%), and antipsychotics (38%). After 12 months of team meetings in the experimental homes, there was a significant decrease in the prescribing of psychotics (-19%), benzodiazepine hypnotics (-37%), and antidepressants (-59%). Orders for more acceptable antidepressants also increased in the experimental homes. In the control homes there was increased use of acceptable antidepressants, but there were no significant reductions in other drug classes.
There is excessive prescription of psychotropic drugs in Swedish nursing homes. Improved teamwork among caregivers can improve prescribing as defined by clinical guidelines.
评估定期多学科团队干预对瑞典养老院精神药物处方数量和质量的影响。
一项随机对照试验。
33所养老院的样本：15所试验养老院和18所对照养老院，占瑞典所有养老院的5%。
样本包括1854名长期护理居民，平均年龄83岁。70%的居民为女性，42%有痴呆症诊断记录。另外5%患有精神障碍，7%被诊断为抑郁症。
试验养老院参与了一项外展项目，该项目旨在通过改善医生、药剂师、护士和护工之间的团队合作来影响药物使用。在为期12个月的研究期间定期召开多学科团队会议。
在为期12个月的干预前1个月和干预后1个月收集每位居民的处方清单。测量指标包括使用任何精神药物、多种药物联用和治疗重复的居民比例，以及根据当前瑞典指南定义的每种精神药物类别中使用非推荐药物和可接受药物的居民比例。
基线结果显示精神药物处方广泛，最常用的药物是催眠药（40%）、抗焦虑药（40%）和抗精神病药（38%）。在试验养老院进行了12个月的团队会议后，抗精神病药（-19%）、苯二氮䓬类催眠药（-37%）和抗抑郁药（-59%）的处方量显著减少。试验养老院中更可接受的抗抑郁药的处方量也有所增加。在对照养老院中，可接受的抗抑郁药的使用有所增加，但其他药物类别没有显著减少。
瑞典养老院存在精神药物过度处方的情况。护理人员之间改善团队合作可以按照临床指南改善处方情况。
