Xác định tác động của việc xem xét thuốc có cấu trúc do dược sĩ dẫn dắt - một nghiên cứu can thiệp có kiểm soát nhằm tối ưu hóa an toàn thuốc cho cư dân tại các cơ sở chăm sóc dài hạn
Tóm tắt
Các cuộc xem xét thuốc góp phần bảo vệ cư dân chăm sóc dài hạn (LTC) khỏi các vấn đề liên quan đến thuốc (DRPs). Tuy nhiên, hiện tại có rất ít nghiên cứu có kiểm soát đã xem xét tác động đến các kết quả liên quan đến bệnh nhân.
Chúng tôi đã xem xét tác động của một cuộc xem xét thuốc một lần do dược sĩ dẫn dắt đối với sự thay đổi thuốc (điểm cuối chính) bao gồm việc ngừng thuốc, số lượng thuốc mạn tính, nhập viện, ngã và tử vong (điểm cuối phụ).
Một nghiên cứu can thiệp có kiểm soát theo chiều dọc đã được thực hiện tại ba cơ sở LTC. Trong nhóm can thiệp (IG), sau khi thực hiện xem xét thuốc, một dược sĩ đã đưa ra các khuyến nghị giải quyết DRPs cho các bác sĩ, y tá và dược sĩ cộng đồng. Nhóm đối chứng (CG) nhận được sự chăm sóc thông thường mà không có cuộc xem xét thuốc. (i) Chúng tôi đã đánh giá số lượng thay đổi thuốc và các điểm cuối phụ ở cả hai nhóm trước (t0) và sau (t1, t2) can thiệp. (ii) Thêm vào đó, việc xem xét thuốc đã được đánh giá trong IG liên quan đến các DRPs đã xác định, phản hồi của nhân viên y tế về các khuyến nghị do dược sĩ gửi và liệu các DRPs có được giải quyết cuối cùng hay không.
107 (IG) và 104 (CG) cư dân đã tham gia nghiên cứu. (i) Nhiều thay đổi thuốc hơn đã được xác định ở IG so với CG tại t1 (
Từ khóa
Tài liệu tham khảo
Auvinen K, Räisänen J, Merikoski M, et al. The Finnish Interprofessional medication assessment (FIMA): baseline findings from home care setting. Aging Clin Exp Res. 2018;31:1471–9. https://doi.org/10.1007/s40520-018-1085-8.
Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc. 2015;16(535):e1–12. https://doi.org/10.1016/j.jamda.2015.03.003.
Alves-Conceição V, da Silva DT, de Santana VL, et al. Evaluation of pharmacotherapy complexity in residents of long-term care facilities: a cross-sectional descriptive study. BMC Pharmacol Toxicol. 2017;18:59. https://doi.org/10.1186/s40360-017-0164-3.
Devik SA, Olsen RM, Fiskvik IL, et al. Variations in drug-related problems detected by multidisciplinary teams in Norwegian nursing homes and home nursing care. Scand J Prim Health Care. 2018;36:291–9. https://doi.org/10.1080/02813432.2018.1499581.
Ruths S, Straand J, Nygaard HA. Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District nursing home (BEDNURS) study. Qual Saf Health Care. 2003;12:176–80. https://doi.org/10.1136/qhc.12.3.176.
Pharmaceutical Care Network Europe Association. PCNE Classification for Drug-Related Problems V6.2. https://www.pcne.org/upload/files/11_PCNE_classification_V6-2.pdf. Accessed 16 Oct 2021.
Gurwitz JH, Field TS, Avorn J, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med. 2000;109:87–94. https://doi.org/10.1016/S0002-9343(00)00451-4.
Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med. 2005;165:68–74. https://doi.org/10.1001/archinte.165.1.68.
Grabowski DC, O'Malley AJ, Barhydt NR. The costs and potential savings associated with nursing home hospitalizations. Health Aff (Millwood). 2007;26:1753–61. https://doi.org/10.1377/hlthaff.26.6.1753.
Maher RL, Hanlon J, Hajjar ER. Clinical Consequences of Polypharmacy in Elderly. Expert Opin Drug Saf. 2014;13:57–65. https://doi.org/10.1517/14740338.2013.827660.
Finkers F, Maring JG, Boersma F, Taxis K. A study of medication reviews to identify drug-related problems of polypharmacy patients in the Dutch nursing home setting. J Clin Pharm Ther. 2007;32:469–76. https://doi.org/10.1111/j.1365-2710.2007.00849.x.
Halvorsen KH, Stadeløkken T, Garcia BH. A Stepwise Pharmacist-Led Medication Review Service in Interdisciplinary Teams in Rural Nursing Homes. Pharmacy (Basel). 2019;7:148. https://doi.org/10.3390/pharmacy7040148.
Griese-Mammen N, Hesberger KE, Messerli M, et al. PCNE definition of medication review: reaching agrrement. Int J Clin Pharm. 2018;40:1199–208. https://doi.org/10.1007/s11096-018-0696-7.
Ferries E, Dye JT, Hall B, Ndehi L, Schwab P, Vaccaro J. Comparison of medication therapy management services and their effects on health care utilization and medication adherence. J Manag Care Spec Pharm. 2019;25:688–95. https://doi.org/10.18553/jmcp.2019.25.6.688.
Furniss L, Burns A, Craig SK, Scobie S, Cooke J, Faragher B. Effects of a pharmacist's medication review in nursing homes. Randomised controlled trial. Br J Psychiatry. 2000;176:563–7. https://doi.org/10.1192/bjp.176.6.563.
Milos V, Rekman E, Bondesson Å, et al. Improving the quality of pharmacotherapy in elderly primary care patients through medication reviews: a randomised controlled study. Drugs Aging 2013;30:235–46. https://doi.org/10.1007/s40266-013-0057-0.
Kwak A, Moon YJ, Song YK, Yun HY, Kim K. Economic impact of pharmacist-participated medication management for elderly patients in nursing homes: a systematic review. Int J Environ Res Public Health. 2019;16:2955. https://doi.org/10.3390/ijerph16162955.
Alldred DP, Kennedy MC, Hughes C, Chen TF, Miller P. Interventions to optimise prescribing for older people in care homes. Cochrane Database Syst Rev 2016;2:CD009095. https://doi.org/10.1002/14651858.cd009095.pub3.
Zermansky AG, Alldred DP, Petty DR, et al. Clinical medication review by a pharmacist of elderly people living in care homes-randomised controlled trial. Age Ageing. 2006;35:586–91. https://doi.org/10.1093/ageing/afl075.
Kua CH, Mak VSL, Huey Lee SW. Health outcomes of Deprescribing interventions among older residents in nursing homes: a systematic review and Meta-analysis. J Am Med Dir Assoc. 2019;20:362–372.e11. https://doi.org/10.1016/j.jamda.2018.10.026.
Steinman MA, Low M, Balicer RD, Shadmi E. Impact of a nurse-based intervention on medication outcomes in vulnerable older adults. BMC Geriatr. 2018;18:207. https://doi.org/10.1186/s12877-018-0905-1.
Pellegrino AN, Martin MT, Tilton JJ, Touchette DR. Medication therapy management services: definitions and outcomes. Drugs. 2009;69:393–406. https://doi.org/10.2165/00003495-200969040-00001.
Chen EYH, Wang KN, Sluggett JK, et al. Process, impact and outcomes of medication review in Australian residential aged care facilities: a systematic review. Australas J Ageing. 2019;38:9–25. https://doi.org/10.1111/ajag.12676.
Houle SK, Grindrod KA, Chatterley T, Tsuyuki RT. Paying pharmacists for patient care: a systematic review of remunerated pharmacy clinical care services. Can Pharm J (Ott). 2014;147:209–32. https://doi.org/10.1177/1715163514536678.
Jaehde U, Thürmann P. Medication safety for nursing home residents. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018;61:1111–8. https://doi.org/10.1007/s00103-018-2796-x.
Freyer F, Kasprick L, Sultzer R, Schiek S, Bertsche T. A dual intervention in geriatric patients to prevent drug-related problems and improve discharge management. Int J Clin Pharm. 2018;40:1189–98. https://doi.org/10.1007/s11096-018-0643-7.
Hanlon JT, Schmader KE, Samsa GP, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45:1045–51. https://doi.org/10.1016/0895-4356(92)90144-C.
Kantelhardt P, Langebrake C. DokuPIK-A documentation system for medication errors and interventions. Krankenhauspharmazie. 2009;30:63–8.
The American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227–46. https://doi.org/10.1111/jgs.13702.
Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107:543–51. https://doi.org/10.3238/arztebl.2010.0543.
Lexow M, Wernecke K, Schmid GL, Sultzer R, Bertsche T, Schiek S. Considering additive effects of polypharmacy: an analysis of adverse events in geriatric patients in long-term care facilities. Wien Klin Wochenschr. 2021;133:816–24. https://doi.org/10.1007/s00508-020-01750-6.
Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ. 1997;315:1096–9. https://doi.org/10.1136/bmj.315.7115.1096.
Almutairi H, Stafford A, Etherton-Beer C, Flicker L. Optimisation of medications used in residential aged care facilities: a systematic review and meta-analysis of randomised controlled trials. BMC Geriatr. 2020;20:236. https://doi.org/10.1186/s12877-020-01634-4.
da Costa FA, Silvestre L, Periquito C, et al. Drug-related problems identified in a sample of Portuguese institutionalised elderly patients and pharmacists’ interventions to improve safety and effectiveness of medicines. Drugs Real World Outcomes 2016;3:89–97. https://doi.org/10.1007/s40801-016-0061-x.
Bitter K, Pehe C, Krüger M, Heuer G, Quinke R, Jaehde U. Pharmacist-led medication reviews for geriatric residents in German long-term care facilities. BMC Geriatr. 2019;19:31. https://doi.org/10.1186/s12877-019-1052-z.
Erzkamp S, Köberlein-Neu J, Rose O. An algorithm for comprehensive medication Management in Nursing Homes: results of the AMBER project. Drug Saf. 2021;44:313–25. https://doi.org/10.1007/s40264-020-01016-0.
Namasivayam AM, Steele CM. Malnutrition and dysphagia in long-term care: a systematic review. J Nutr Gerontol Geriatr. 2015;34:1–21. https://doi.org/10.1080/21551197.2014.1002656.
Paradiso LM, Roughead EE, Gilbert AL, et al. Crushing or altering medications: what’s happening in residential aged-care facilities? Australas J Ageing. 2002;21:123–7. https://doi.org/10.1111/j.1741-6612.2002.tb00432.x.
Mercovich N, Kyle GJ, Naunton M. Safe to crush? A pilot study into solid dosage form modification in aged care. Australas J Ageing. 2014;33:180–4. https://doi.org/10.1111/ajag.12037.
Stubbs J, Haw C, Dickens G. Dose form modification - a common but potentially hazardous practice. A literature review and study of medication administration to older psychiatric inpatients. Int Psychogeriatr. 2008;20:616–27. https://doi.org/10.1017/s1041610207006047.
van Welie S, Wijma L, Beerden T, van Doormaal J, Taxis K. Effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes: an uncontrolled before and after study. BMJ Open. 2016;6:e012286. https://doi.org/10.1136/bmjopen-2016-012286.
Sluggett JK, Chen EYH, Ilomäki J, et al. SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER): study protocol for a cluster randomised controlled trial. 2018;19:37. https://doi.org/10.1186/s13063-017-2417-2.
Barber ND, Alldred DP, Raynor DK, et al. Care homes’ use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people. Qual Saf Health Care. 2009;18:341–6. https://doi.org/10.1136/qshc.2009.034231.
Lee SWH, Mak VSL, Tang YW. Pharmacist services in nursing homes: a systematic review and meta-analysis. Br J Clin Pharmacol. 2019;85:2668–88. https://doi.org/10.1111/bcp.14101.
Mahlknecht A, Krisch L, Nestler N, et al. Impact of training and structured medication review on medication appropriateness and patient-related outcomes in nursing homes: results from the interventional study InTherAKT. BMC Geriatr 2019;19:257. https://doi.org/10.1186/s12877-019-1263-3.
Azermai M, Vander Stichele RRH, Van Bortel LM, Elseviers MM. Barriers to antipsychotic discontinuation in nursing homes: an exploratory study. Aging Ment Health. 2014;18:346–53. https://doi.org/10.1080/13607863.2013.832732.
Janus SI, van Manen JG, IJzerman MJ, Zuidema SU. Psychotropic drug prescriptions in Western European nursing homes. Int Psychogeriatr. 2016;28:1775–90. https://doi.org/10.1017/s1041610216001150.
Supper I, Catala O, Lustman M, Chemla C, Bourgueil Y, Letrilliart L. Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors. J Public Health (Oxf). 2015;37:716–27. https://doi.org/10.1093/pubmed/fdu102.
Fleischmann N, Tetzlaff B, Werle J, et al. Interprofessional collaboration in nursing homes (interprof): a grounded theory study of general practitioner experiences and strategies to perform nursing home visits. BMC Fam Pract 2016;17:123. https://doi.org/10.1186/s12875-016-0522-z.