Identifying opportunities for pediatric medication therapy management in children with medical complexity.
Identifying opportunities for pediatric medication therapy management in children with medical complexity.
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DOI：
10.1016/j.japh.2022.04.005
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发表时间：
2022-09
影响因子：
2.1
通讯作者：
Orth, Lucas E.
中科院分区：
文献类型：
--
作者：
Marquez, Clyde;Thompson, Riley;Feinstein, James A.;Orth, Lucas E.
描述标准化的儿科药物治疗管理(MTM)模型如何识别潜在的干预措施及其对具有医疗复杂性(CMC)和多药联用的儿童的药物方案复杂性指数(MRCI)得分的影响。这项回溯性概念验证研究包括从2020年8月到2021年7月在三级独立儿童医院内的CMC大型门诊初级保健医疗机构接受初级护理的儿科患者。在指数访问时，评估了使用≥5活性药物的0至18岁确诊患者的用药概况，以了解与药物相关的问题、潜在的干预措施以及拟议干预措施对MRCI评分的潜在影响。在100名患者中，使用儿科MTM模型确定了平均3.4±0.3个与药物相关的问题。与药物有关的常见问题(25%的患者)包括不适当/不必要的治疗、不理想的治疗、未得到充分治疗的症状、不良反应、临床上有意义的药物-药物相互作用或重复治疗。97例患者(97%)有机会进行5.0±2.9次潜在干预。最常见的建议干预措施包括停药试验(69%)、患者/照顾者教育(55%)、剂型修改(51%)、剂量修改(49%)和频率修改(46%)。所有患者的平均基线MRCI评分为32.6(95%可信区间为29.3~35.8)。在应用理论干预措施(p<；0.001)后，MRCI评分平均下降4.9%(95%CI3.8-5.9)。平均潜在评分降低不受患者年龄或复杂慢性病数量的显著影响。建议的干预措施对MRCI评分的潜在影响在基线药物计数较高的患者中显著更大(p<；0.001)。大多数有医疗复杂性的儿童可能会从药剂师指导的儿科MTM服务中受益。一项对积极用药方案的标准化审查发现，几乎所有患者都有多种与用药相关的问题和潜在的干预措施。建议的药物干预将显著降低MRCI衡量的药物治疗方案的复杂性。进一步对药剂师指导的儿科MTM服务进行前瞻性评估是有必要的。
To describe how a standardized pediatric medication therapy management (MTM) model identifies potential interventions and their impact on Medication Regimen Complexity Index (MRCI) scores in children with medical complexity (CMC) and polypharmacy. This retrospective proof-of-concept study included pediatric patients receiving primary care in a large outpatient primary care medical home for CMC within a tertiary freestanding children’s hospital from August 2020 through July 2021. Medication profiles of established patients aged 0 to 18 years with ≥5 active medications at the time of the index visit were assessed for medication-related concerns, potential interventions, and potential impact of proposed interventions on MRCI scores. Among 100 patients, an average of 3.4 ± 0.3 medication-related concerns was identified using the pediatric MTM model. Common medication-related concerns (>25% of patients) included inappropriate/unnecessary therapy, suboptimal therapy, undertreated symptom, adverse effect, clinically significant drug-drug interaction, or duplication of therapy. Ninety-seven patients (97%) had opportunities for 5.0 ± 2.9 potential interventions. Most common proposed interventions included drug discontinuation trial (69%), patient/caregiver education (55%), dosage form modification (51%), dose modification (49%), and frequency modification (46%). The mean baseline MRCI score was 32.6 (95% CI 29.3–35.8) among all patients. MRCI scores decreased by a mean of 4.9 (95% CI 3.8–5.9) following application of the theoretical interventions (p<0.001). Mean potential score reduction was not significantly affected by patient age or number of complex chronic conditions. Potential impact of the proposed interventions on MRCI score was significantly greater in patients with higher baseline medication counts (p<0.001). Most children with medical complexity would likely benefit from a pharmacist-guided pediatric MTM service. A standardized review of active medication regimens identified multiple medication-related concerns and potential interventions for nearly all patients. Proposed medication interventions would significantly reduce medication regimen complexity as measured by MRCI. Further prospective evaluation of a pharmacist-guided pediatric MTM service is warranted.
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影响因子：
2.2
作者：
Bužančić I;Dragović P;Pejaković TI;Markulin L;Ortner-Hadžiabdić M
通讯作者：
Ortner-Hadžiabdić M
影响因子：
2.4
作者：
Feudtner C;Feinstein JA;Zhong W;Hall M;Dai D
通讯作者：
Dai D
DOI：
10.1001/archpediatrics.2011.161
发表时间：
2012-01-01
影响因子：
--
作者：
Feudtner, Chris;Dai, Dingwei;Metjian, Talene A.
通讯作者：
Metjian, Talene A.
影响因子：
5.4
作者：
Barnett, Erin R.;Trepman, Alissa Z.;Leyenaar, Joanna K.
通讯作者：
Leyenaar, Joanna K.
影响因子：
8
作者：
Antoon, James W.;Hall, Matt;Williams, Derek J.
通讯作者：
Williams, Derek J.