Integrating palliative medicine into the care of persons with advanced dementia: Identifying appropriate medication use
Integrating palliative medicine into the care of persons with advanced dementia: Identifying appropriate medication use
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DOI：
10.1111/j.1532-5415.2008.01741.x
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发表时间：
2008-07-01
影响因子：
6.3
通讯作者：
Dale, William
中科院分区：
文献类型：
--
作者：
Holmes, Holly M.;Sachs, Greg A.;Dale, William
目的：为了评估的可行性，制定共识的建议，适当处方晚期痴呆症患者使用一个新的概念框架，并确定不适当的药物使用频率的基础上，这些建议在一个小样本的晚期dementia.DESIGN：用药数据，使用图表审查。适当的处方建议，实现了使用修改后的德尔菲共识panel.SETTING：三个长期护理facility.PARTICIPANTS：34例晚期痴呆症患者参加了姑息卓越的阿尔茨海默氏症护理努力计划被选中，以评估药物的使用。芝加哥大学的12名老年病学家参加了修改后的德尔菲共识panel.MEASUREMENTS：处方药和非处方药被记录为34名患者。经过修改后的德尔菲过程中，药物的特点是在晚期痴呆症的姑息治疗患者使用的四个类别之一：从来没有适当的，很少适当的，有时适当的，或总是appropriate.RESULTS：患者平均采取6.5药物在登记。6名患者每天服用10种或更多药物。在81种药物类别中，有69种对晚期痴呆患者的适当性进行了排名。总体而言，5%的221药物处方在登记被认为是从来没有适当的，和34例患者中的10例（29%）一直在服用药物被认为是从来没有appropriate.CONCLUSION：根据这些初步研究结果，共识的标准，在晚期痴呆症的处方需要减少多药，减少使用的药物是最小的好处或高风险。
OBJECTIVES: To evaluate the feasibility of developing consensus recommendations for appropriate prescribing for patients with advanced dementia using a new conceptual framework and to determine the frequency of inappropriate medication use based on these recommendations in a small sample of patients with advanced dementia.DESIGN: Medication data were obtained using chart review. Recommendations for appropriate prescribing were achieved using a modified Delphi consensus panel.SETTING: Three long-term care facilities.PARTICIPANTS: Thirty-four patients with advanced dementia enrolled in the Palliative Excellence in Alzheimer Care Efforts Program were selected to evaluate medication use. Twelve geriatricians at the University of Chicago participated in the modified Delphi consensus panel.MEASUREMENTS: Prescription and over-the-counter medications were recorded for the 34 patients. Following the modified Delphi process, medications were characterized into one of four categories for use in palliative care patients with advanced dementia: never appropriate, rarely appropriate, sometimes appropriate, or always appropriate.RESULTS: Patients were taking an average of 6.5 medications at enrollment. Six patients were taking 10 or more medications daily. Consensus was reached ranking the appropriateness of 69 of 81 medication classes for patients with advanced dementia. Overall, 5% of the 221 medications prescribed at enrollment were considered to be never appropriate, and 10 of 34 patients (29%) had been taking a medication considered to be never appropriate.CONCLUSION: Based on these preliminary findings, consensus criteria for prescribing in advanced dementia are needed to decrease polypharmacy and reduce the use of medications that are of minimal benefit or high risk.