Prescribing Optimization Method for Improving Prescribing in Elderly Patients Receiving Polypharmacy
Prescribing Optimization Method for Improving Prescribing in Elderly Patients Receiving Polypharmacy
复制标题
改善接受多种药物治疗的老年患者处方的处方优化方法
作者：
A. C. D. Drenth;Rob J. van Marum;W. Knol;Carolien M.J. van der Linden;Paul A.F. Jansen
背景优化多药疗法往往是困难的，药物使用的关键评价往往会导致一个或多个变化。我们开发了处方优化方法（POM），以协助医生，特别是全科医生（GP），在他们的尝试，以优化老年患者的多药治疗。POM基于六个问题：（i）是否存在治疗不足和需要添加药物;（ii）患者是否遵守其药物治疗计划;（iii）哪些药物可以停用或哪些药物不适合患者;（iv）存在哪些不良反应;（v）预期会发生哪些临床相关相互作用;及（vi）应否调整药物的剂量、给药次数及/或剂型？本研究的目的是评估的有用性的POM作为一种工具，用于改善适当的处方复杂的multipharmacy在elderly. MethodsForty五个GP被要求优化用药的两个案例的历史，随机选择从10个历史的老年患者入院到医院老年门诊与平均值± SD为7.9±1.2的问题，8.7±3.1药物治疗。第一种情况是在不知道POM的情况下优化的。经过2小时的POM讲座后，全科医生使用POM优化第二个病例的用药。允许GP进行20分钟的病例优化。药物建议进行了比较，由四名专门从事临床药理学的老年病专家组成的专家小组。数据进行了分析，使用线性混合效应model.ResultsOptimization是显着更好的全科医生使用POM。正确决策的比例从没有POM的34.7%增加到48.1%与POM（p=0.0037），和潜在的有害决定的数量从平均值±SD的3.3±1.8没有POM减少到2.4±1.4与POM（p=0.0046）。
BackgroundOptimizing polypharmacy is often difficult, and critical appraisal of medication use often leads to one or more changes. We developed the Prescribing Optimization Method (POM) to assist physicians, especially general practitioners (GPs), in their attempts to optimize polypharmacy in elderly patients. The POM is based on six questions: (i) is undertreatment present and addition of medication indicated; (ii) does the patient adhere to his/her medication schedule; (iii) which drug(s) can be withdrawn or which drugs(s) is/are inappropriate for the patient; (iv) which adverse effects are present; (v) which clinically relevant interactions are to be expected; and (vi) should the dose, dose frequency and/or form of the drug be adjusted?ObjectiveThe aim of this study was to evaluate the usefulness of the POM as a tool for improving appropriate prescribing of complex polypharmacy in the elderly.MethodsForty-five GPs were asked to optimize the medication of two case histories, randomly chosen from ten histories of geriatric patients admitted to a hospital geriatric outpatient clinic with a mean ± SD of 7.9±1.2 problems treated with 8.7±3.1 drugs. The first case was optimized without knowledge of the POM. After a 2-hour lecture on the POM, the GPs used the POM to optimize the medication of the second case history. The GPs were allowed 20 minutes for case optimization. Medication recommendations were compared with those made by an expert panel of four geriatricians specialized in clinical pharmacology. Data were analysed using a linear mixed effects model.ResultsOptimization was significantly better when GPs used the POM. The proportion of correct decisions increased from 34.7% without the POM to 48.1% with the POM (p=0.0037), and the number of potentially harmful decisions decreased from a mean ±SD of 3.3±1.8 without the POM to 2.4±1.4 with the POM (p=0.0046).ConclusionThe POM improves appropriate prescribing of complex polypharmacy in case histories.