Impact of deprescribing rounds on discharge prescriptions: an interventional trial
Impact of deprescribing rounds on discharge prescriptions: an interventional trial
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DOI：
10.1007/s11096-018-0753-2
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发表时间：
2019-02-01
影响因子：
2.4
通讯作者：
Martinusen, Dan
中科院分区：
文献类型：
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作者：
Edey, Rachel;Edwards, Nicholas;Martinusen, Dan
背景 成功的取消处方实践需要解决与复方用药相关的问题，但由于专业间合作最少、时间限制、对负面结果的担忧以及缺乏系统性和基于证据的方法而受到阻碍。目的 确定临床教学单位 (CTU) 内药剂师主导的取消处方查房对出院后停用的家庭药物数量的影响。设置加拿大三级护理医院。方法 2015年11月23日至2016年8月30日在单中心进行前瞻性、双臂、介入研究。所有入院的19岁CTU患者如果入院前正在服用药物则被考虑入组，如果患者未服用任何药物则被排除在外。研究组的分配每天在两个团队之间轮流进行。控制组按照标准操作，而干预组的药剂师在每日查房讨论之前使用处方取消指南和药物审查来确定适合停用的药物。出院文件向患者和初级医疗保健提供者传达了药物变化。这项研究的动力充足。主要结果指标 干预组和对照组之间出院时停用的家庭药物数量的差异。结果 171 名患者和 187 名患者分别分配到干预组和对照组。组间基线特征不存在显着差异。主要结果测量结果显示，与对照组相比，取消处方轮次导致取消处方的药物数量显着增加（65% vs. 38%；p=0.001）。干预组的再入院率和急诊科就诊率有所降低。结论 将取消处方查房纳入常规护理可显着提高停药率，但不会增加急诊科就诊或入院率。
Background Successful deprescribing practices are required to address issues associated with polypharmacy but are hindered by minimal interprofessional collaboration, time constraints, concern for negative outcomes, and absence of a systematic and evidence-based approach. Objective Determine the impact of pharmacist-led deprescribing rounds within a clinical teaching unit (CTU) the number of home medications discontinued upon hospital discharge. Setting Canadian tertiary care hospital. Methods Prospective, dual-arm, interventional study conducted in a single centre,from November 23rd, 2015 to August 30th, 2016. All patients 19years old admitted under the CTU were considered for enrolment if on medication(s) prior to admissionand patients were excluded if not taking any medications. Study arm allocation alternated daily between the two teams. The control arm operated as per standardwhereas the intervention arm's pharmacist used a deprescribing guide and medication review to identify medications eligible for discontinuation prior to discussing during daily rounds. Discharge documents communicated medication changes to patient and primary healthcare providers. The study was sufficiently powered. Main outcome measure The difference of number of home medications discontinued at discharge between the intervention and control groups. Results 171 and 187 patients were allocated to the intervention and control arms, respectively. No significant differences of baseline characteristics existed between groups. Main outcome measure results showed that deprescribing rounds resulted in significantly more medications deprescribed compared to control (65% vs. 38%; p=0.001). The rates of readmission and emergency department visits were reduced in the intervention arm. Conclusions Incorporating deprescribing rounds into routine care led to significantly greater discontinuation of medications without increasing rate of emergency department visits or hospital admissions.