Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits
Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits
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DOI：
10.1007/s00228-010-0982-3
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发表时间：
2011-07-01
影响因子：
2.9
通讯作者：
Eriksson, Tommy
中科院分区：
文献类型：
--
作者：
Hellstrom, Lina M.;Bondesson, Asa;Eriksson, Tommy
为研究老年患者入院时系统性药物核对和住院期间药物回顾对不适当药物和计划外药物相关医院复诊次数的影响，本研究为一项前瞻性对照研究，纳入210例年龄≥ 65岁的老年患者，这些患者入住瑞典一所大学医院的三个内科病房之一。干预患者接受了由包括临床药剂师在内的多专业团队提供的完整的隆德综合药物管理模式（入院和出院时的药物核对，以及药物审查和监测）。对照组患者在出院时接受标准护理和药物核对。盲态审查者评价处方的适当性（使用药物适当性指数）在入院和出院时，并评估了药物相关问题是任何患者在出院后3个月内再次入院或急诊的原因的可能性（使用世界卫生组织因果关系标准）对于两个意向治疗人群，干预组中不适当药物的数量比对照组减少更多{51% [95%置信区间（CI）43-58%]与39%（95% CI 30-48%）; p = 0.0446}和符合方案人群[60%（95% CI 51-67%）与44%（95% CI 34-52%）; p = 0.0106）]。干预组中有6次被判定为“可能、很可能或肯定与药物相关”的复诊，而对照组中有12次（p = 0.0469）。在本研究中，由临床药师在多专业团队中提供的药物协调和审查显著减少了老年患者中不适当药物和计划外药物相关复诊的数量。
To examine the impact of systematic medication reconciliations upon hospital admission and of a medication review while in hospital on the number of inappropriate medications and unscheduled drug-related hospital revisits in elderly patients.This was a prospective, controlled study in 210 patients, aged 65 years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden. Intervention patients received the complete Lund Integrated Medicines Management model (medication reconciliation upon admission and discharge, and medication review and monitoring) provided by a multi-professional team, including a clinical pharmacist. Control patients received standard care and medication reconciliation upon discharge. Blinded reviewers evaluated the appropriateness of the prescribing (using the Medication Appropriateness Index) on admission and discharge, and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within 3 months of discharge (using World Health Organisation causality criteria).There was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population {51% [95% confidence interval (CI) 43-58%] vs. 39% (95% CI 30-48%); p = 0.0446} and the per-protocol population [60% (95% CI 51-67%) vs. 44% (95% CI 34-52%); p = 0.0106)]. There were six revisits to hospital in the intervention group which were judged as 'possibly, probably or certainly drug-related', compared with 12 in the control group (p = 0.0469).In this study, medication reconciliation and review provided by a clinical pharmacist in a multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits among elderly patients.