Pharmacist-led medication assessment and deprescribing intervention for older adults with cancer and polypharmacy: a pilot study
Pharmacist-led medication assessment and deprescribing intervention for older adults with cancer and polypharmacy: a pilot study
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DOI：
10.1007/s00520-018-4281-3
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发表时间：
2018-12-01
影响因子：
3.1
通讯作者：
Ramsdale, Erika
中科院分区：
文献类型：
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作者：
Whitman, Andrew;DeGregory, Kathlene;Ramsdale, Erika
目的本研究的目的是比较三种老年药物筛选工具与单独使用Beers标准进行潜在不适当药物定量的应用，并确定在老年肿瘤临床中由药剂师领导的多药物评估的可行性。方法对65岁及以上的成年癌症患者进行全面的老年评估。一名药剂师完成了一项多药房评估，其中包括对所有药物疗法的审查。使用Beers标准、提醒医生正确治疗/筛查老年人处方的筛查工具和药物适当性指数来筛选潜在的不适当药物。在与药剂师、老年肿瘤学家、患者和护理员讨论后，停药。平均用药数量为12种。仅根据比尔斯标准就确定了38种可能不合适的药物，相比之下，三种工具评估发现了119种可能不合适的药物；平均每个患者确定了5种可能不合适的药物。在应用三种工具评估后，73%的潜在不适当药物被停药，导致平均每个患者停药3种。大约三分之二的患者报告在停药干预后症状有所减轻。由于停药，每个患者可能避免了4282.27美元的医疗支出。结论我们的三工具评估识别出的潜在不适当药物比单独使用Beers标准多三倍。药剂师主导的停药干预是可行的，并可能导致改善患者结果和节省成本。这三种工具的评估过程应该被纳入对老年癌症患者的跨学科评估中，并在未来的研究中得到验证。
PurposeThe aims of this study were to compare the application of three geriatric medication screening tools to the Beers Criteria alone for potentially inappropriate medication quantification and to determine feasibility of a pharmacist-led polypharmacy assessment in a geriatric oncology clinic.Methods Adult patients with cancer aged 65 and older underwent a comprehensive geriatric assessment. A polypharmacy assessment was completed by a pharmacist and included a review of all drug therapies. Potentially inappropriate medications were screened using the Beers Criteria, Screening Tool to Alert doctors to Right Treatment/Screening Tool of Older Persons' Prescriptions, and the Medication Appropriateness Index. Deprescribing occurred after discussion with the pharmacist, geriatric oncologist, patient, and caregiver.Results Data were collected for 26 patients. The mean number of medications was 12. The Beers Criteria alone identified 38 potentially inappropriate medications compared to 119 potentially inappropriate medications with the three-tool assessment; a mean of 5 potentially inappropriate medications were identified per patient. After the application of the three-tool assessment, 73% of potentially inappropriate medications identified were deprescribed, resulting in a mean of 3 medications deprescribed per patient. Approximately two thirds of patients reported a reduction in symptoms after the deprescribing intervention. Healthcare expenditures of $4282.27 per patient were potentially avoided as a result of deprescribing.Conclusions Our three-tool assessment identified three times more potentially inappropriate medications than the Beers Criteria alone. Pharmacist-led deprescribing interventions are feasible and may lead to improved patient outcomes and cost savings. This three-tool assessment process should be incorporated into interdisciplinary assessments of older patients with cancer and validated in future studies.