老年人苯二氮卓类药物的处方解除

Ryan Anne Pishock
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引用次数: 1

摘要

苯二氮卓类药物被公认具有快速缓解焦虑和睡眠障碍的能力。然而,尽管它们与危害有关,而且治疗效果往往很短,但它们仍然经常被开处方。在衰老的过程中,治疗各种疾病状态所需药物的积累导致了老年人的多重用药。老年人有一些独特的因素,使他们更容易受到苯二氮卓类药物抗胆碱能副作用的影响,这些副作用可能导致跌倒、认知障碍和抑郁。鉴于这些关切,多个专业组织已将苯二氮卓类药物的开处方确定为国家公共卫生优先事项,并强烈建议寻求其他共同决策方法。虽然非药物技术被广泛认为可以安全地处理临床医生在选择开苯二氮卓类药物时提供的常见原因,但越来越需要对开处方者进行有关这些实用方法的教育,以及基于证据的临床实践指南,以支持成功的开处方[1]。该DNP项目的目的是通过参与宾夕法尼亚州老年专科初级保健实践的循证教育项目,提高开处方者对开处方方法的了解,并提出可选择的开处方决策。研究参与者包括开苯二氮卓类药物处方的内科医生、执业护士和医师助理。结果表明,在参与循证教育后,参与者对自己的态度、知识和实践的评价表明,他们对处方方法和替代处方选择的知识有所改善。
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Deprescribing Benzodiazepines in Older Adults
Benzodiazepines are well established as having the ability to produce rapid relief of anxiety and sleep disorders. However, despite their association with harm and often-short therapeutic effects, they continue to be prescribed often. Through the process of aging, the accumulation of medications needed to treat various disease states contributes to polypharmacy among the elderly. Older adults have unique factors that position them at a higher susceptibility of the anticholinergic side effects of benzodiazepines, which can result in falls, cognitive impairments and depression. Given these concerns, multiple professional organizations have identified the deprescribing of benzodiazepines as a national public health priority and have strongly recommended the pursuit of alternative shared decision-making approaches. While non- pharmacologic techniques are widely recognized to safely manage the common reasons clinicians provide when choosing to prescribe benzodiazepine’s, there is a mounting need for prescriber education regarding these practical approaches as well as evidence-based clinical practice guidelines to support successful deprescribing [1]. The purpose of this DNP project was to improve prescriber knowledge of deprescribing approaches and present alternative prescribing decisions through participation of an evidence-based education program at a geriatric specialized, primary care practice in Pennsylvania. The study participants consisted of Physicians, Nurse Practitioners and Physician Assistants who prescribe benzodiazepines. The results indicated an improvement in the participant’s knowledge of deprescribing approaches and alternative prescribing choices, as evidenced by how they rated their attitudes, knowledge and practices after participating in the evidence-based education.
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