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药学干预改善老年住院患者用药合理性的可行性研究
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| 篇名： | 药学干预改善老年住院患者用药合理性的可行性研究 |
| TITLE： | Study on the feasibility of pharmaceutical intervention to improve medication appropriateness in elderly inpatients |
| 摘要： | 目的 评价临床药师主导的药学干预服务对老年住院患者用药合理性的影响。方法采用非随机同期对照试验设计，以2021年6月起连续入住盐城市第一人民医院老年科2个诊疗小组的老年患者为研究对象，根据纳入与排除标准，2个诊疗小组各选取前40例患者（按照患者入院时间先后顺序），设为对照组和干预组。对照组患者接受常规诊疗护理服务；干预组患者在对照组基础上接受由临床药师主导的药学干预服务，临床药师发现潜在不适当用药（PIM）并提出用药方案优化建议。以《老年人潜在不适当用药判断标准——美国老年医学会Beers标准（2019年版）》（以下简称“Beers标准”）和《中国老年人潜在不适当用药判断标准（2017年版）》（以下简称“中国标准”）作为用药审查的参考工具。比较2组患者入院时和出院时的药品适宜性指数（MAI）总分（主要评价指标）、PIM数量、用药数量及住院天数、住院期间药物相关不良事件数量、临床药师用药方案优化建议数量、优化建议被临床医师采纳执行率。结果入院时，2组患者MAI总分、基于Beers标准的PIM数量、基于中国标准的PIM数量、用药数量比较，差异均无统计学意义（P＞0.05）。出院时，2组患者基于中国标准的PIM数量、住院天数比较，差异均无统计学意义（P＞0.05），而干预组患者的MAI总分、基于Beers标准的PIM数量、用药数量均显著低于对照组（P＜0.05）。干预组患者入院时被记为“用药不适当”的药品占比（34.5％）显著高于出院时（19.5％）（P＜0.05）。对照组患者出院用药数量与入院用药数量的差值[3（1～4.8）]显著高于干预组患者[1（0～2.8）]（P＝0.012）。与入院时比较，干预组患者出院时基于“有效性”维度“、疗程”维度被记为“用药不适当”的药品占比显著降低（P＜0.05）。住院期间临床药师对干预组的用药情况共提出70条用药方案优化建议，其中39条建议被临床医师采纳执行，采纳执行率为55.7％。结论临床药师主导的药学干预服务能够改善以MAI为主要评价指标的老年住院患者的整体用药合理性。 |
| ABSTRACT： | OBJECTIVE To evaluate the effects of pharmaceutical interventio n led by clinical pharmacists on medication appropriateness of elderly inpatients. METHODS A non-randomized concurrent controlled trial was carried out. Elderly patients admitted to two treatment groups in the geriatric department of Yancheng First People ’s Hospital since June 2021 were selected as the research objects. According to the inclusion and exclusion criteria ，the first 40 patients were selected from each of the two treatment groups （according to the order of admission time ）and set as the control group or the intervention group. The control group received routine treatment and nursing services ，and the intervention group additionally received pharmaceutical intervention led by clinical pharmacists on the basis control group. Clinical pharmacists found potential inappropriate medication （PIM）and put forward suggestions on optimization of medication regimen. American Geriatrics Society 2019 Updated AGS Beers Criteria ® for PIM Use in Older Adults （hereinafter referred to as “Beers criteria ”）and the Criteria of PIMs for Older Adults in China 2017 Edition （hereinafter referred to as “Chinese criteria ”）were used as reference tools for drug use review. The medication appropriateness index （MAI）total scores （main evaluation indicator ），the number of PIMs ，the number of drugs used ，the length of hospital stay ，the number of drug-related adverse events during hospital stay ，the number of drug regimen optimization suggestions by pharmacists ， and implementation rate of E-mail：zhihuadou@163.com optimization suggestions adopted by clinicians were compared between 2 groups at admission and at discharge. RESULTS At admission ，there were no statistically differences in MAI total scores，the number of PIMs based on Beers criteria ，the number of PIMs based on Chinese criteria or the number of drugs used between 2 groups（P＞0.05）. At discharge ，there were no statistically differences in the number of PIMs based on Chinese criteria and the length of hospital stay between 2 groups（P＞0.05），but the MAI total scores ，the number of PIMs based on Beers criteria and the number of drugs used in the intervention group were lower than those in the control group （P＜0.05）. In the intervention group，the proportion of drugs recorded as “inappropriate medication ”at admission （34.5％）was significantly higher than that at discharge（19.5％）（P＜0.05）. The difference between the number of drugs discharged from hospital and the number of drugs admitted to hospital in the control group [ 3（1-4.8)] was significantly higher than that in the intervention group [ 1（0-2.8)]（P＝ 0.012）. Compared with admission ，the proportion of drugs recorded as “inappropriate medication ”in the intervention group at discharge was significantly decreased on the basis of “effectiveness”dimension and “course”dimension （P＜0.05）. During hospitalization，clinical pharmacists put forward 70 optimization suggestions of drug regimen for the intervention group ，among which 39 suggestions were adopted and implemented by clinicians ，with an implementation rate of 55.7％. CONCLUSIONS The pharmaceutical intervention led by clinical pharmacists can improve overall appropriateness of drug use in the elderly inpatients using MAI as main evaluation indicator. |
| 期刊： | 2022年第33卷第13期 |
| 作者： | 李寅，许晓乐，孟佳佳，窦志华 |
| AUTHORS： | LI Yin，XU Xiaole ，MENG Jiajia，DOU Zhihua |
| 关键字： | 药学干预；老年住院患者；用药合理性；潜在不适当用药 |
| KEYWORDS： | pharmaceutical intervention ；elderly inpatients ；medication appropriateness ；potential inappropriate medication |
| 阅读数： | 194 次 |
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