对解决住院老年人多重用药问题倡议的评估

IF 1.3 Q4 PHARMACOLOGY & PHARMACY Journal of the American College of Clinical Pharmacy : JACCP Pub Date : 2024-05-26 DOI:10.1002/jac5.1978

Calvin J. Meaney Pharm.D., FCCP, Natalie Tjota M.D., Kevin Pham, Gina Prescott Pharm.D., FCCP, Fred Doloresco Pharm.D., M.S., Michael Ott Pharm.D., Robert Wahler Pharm.D., Zachary Wikerd M.D.

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引用次数: 0

摘要

背景老年人用药过多会造成与用药相关的伤害。去处方干预措施通常在门诊环境中使用，可能会遗漏医疗服务有限的患者。住院是一个独特的接触点，可与多学科团队一起解决老年人的多药问题。方法这项回顾性队列研究考察了对住院老年人进行多药干预的可行性和有效性。干预措施由一个多学科团队根据质量改进框架制定，并由学术教学服务机构的临床药剂师实施。研究对象包括 65 岁及以上的老年人。药剂师完成了一次全面的用药检查，确定了药物治疗问题（MTPs），并使用有效工具（Beers 和 STOPP/START 标准）对多药（五种或五种以上慢性药物）和潜在不适当药物（PIMs）进行了额外评估，在住院期间实施了建议。描述性统计用于描述干预措施及其结果。报告遵循 SQUIRE 声明。结果 155 名患者接受了综合药物治疗干预。98.7%的老年人使用了多种药物，82.6%的老年人至少接受了一次 PIM（共 261 次）。这表明，住院期间非常有必要采取干预措施来解决多药治疗和 PIM 问题。每名患者的 MTP 中位数为两个（共 287 个），最常见的是药物不良反应（52.3% 的患者出现过）、无适应症用药（47.7%）和无适应症用药（31%）。阿片类药物是最常见的 PIM（出现在 36.1%的患者中），其次是苯二氮卓（10.3%）和骨骼肌松弛剂（8.4%）。共有 40.6% 的 PIM 在出院时成功停药。结论在住院老年人中，复方药物治疗无处不在。多学科的处方方法可以减少住院期间的 PIMs。

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Evaluation of an initiative to address polypharmacy in hospitalized older adults

Background

Polypharmacy contributes to medication-related harm in older adults. Deprescribing interventions are often employed in the outpatient setting, potentially missing patients with limited healthcare access. Hospitalization represents a unique touch point to address polypharmacy in older adults with a multidisciplinary team.

Methods

This retrospective cohort study examined the feasibility and effectiveness of a polypharmacy intervention in hospitalized older adults. The intervention was developed by a multidisciplinary team with a quality improvement framework and implemented by clinical pharmacists on an academic teaching service. Adults aged 65 years and older were included. Pharmacists completed a comprehensive medication review with the identification of medication therapy problems (MTPs), with additional evaluation for polypharmacy (five or more chronic medications) and potentially inappropriate medications (PIMs) using validated tools (Beers and STOPP/START criteria), with recommendations implemented during hospitalization. Descriptive statistics were used to describe the intervention and its outcomes. Reporting followed the SQUIRE statement.

Results

The polypharmacy intervention was provided to 155 patients. Polypharmacy occurred in 98.7% of older adults, whereas 82.6% received at least one PIM (261 total). This demonstrates a significant need for an intervention to address polypharmacy and PIMs during hospitalization. A median of two MTPs was identified per patient (total 287), the most common being adverse drug reaction (present in 52.3% of patients), medication without indication (47.7%), and indication without medication (31%). Opioids were the most common PIM (present in 36.1% of patients), followed by benzodiazepines (10.3%) and skeletal muscle relaxants (8.4%). A total of 40.6% of PIMs were successfully deprescribed at discharge.