Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults?
Can clinical pharmacy services have a positive impact on drug-related problems and health outcomes in community-based older adults?
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DOI：
10.1016/s1543-5946(04)90002-5
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发表时间：
2004-03-01
期刊：
影响因子：
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通讯作者：
Gray, Shelly L
中科院分区：
文献类型：
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作者：
Hanlon, Joseph T;Lindblad, Catherine I;Gray, Shelly L
背景技术背景：虽然药物治疗对老年人有益，但也可能导致药物相关问题（drug-related problems，DRPs），包括未经治疗的适应症、无适应症的药物使用、药物选择不当、亚治疗剂量、过量、用药错误、用药不依从、药物相互作用、药物不良反应、药物不良停药事件和治疗失败。目的：本文的目的是回顾来自随机对照研究的证据，以确定是否可以通过在社区为基础的设置中为老年人提供临床药学服务来修改DRPs和相关的健康结果。通过检索MEDLINE，确定了评估年龄≥ 65岁的患者在药剂师干预后的DRPs和健康结局的随机对照研究。（1970- 2003年3月）、科克伦系统评价数据库（至2003年3月）和国际药物文摘（1966- 2003年3月）。检索结合了临床药师、年龄、结局和随机对照试验等术语。手动搜索的参考文献列表中确定的文章和作者自己的材料也covered.RESULTS：这篇文献综述包括14随机对照研究：5涉及干预措施在家庭健康环境中，3人在出院时制定了家庭随访，3个诊所为基础，1个是在社区药房设置进行，2个是在长期护理设施。这些研究提供了相当多的证据表明，临床药学干预措施减少了老年人DRPs的发生，但这些干预措施降低了发病率，死亡率或医疗保健费用的证据有限。未来的大型多中心研究是必要的，以测试临床药学服务的成本效益，以社区为基础的老年人和这些服务的影响，如健康服务的使用，定时功能状态测量和药物不良反应。
BACKGROUND: Although pharmacotherapy can be beneficial in the elderly, it can also lead to drug-related problems (DRPs), including untreated indications, drug use without an indication, improper drug selection, subtherapeutic dosage, overdosage, medication error, medication nonadherence, drug interactions, adverse drug reactions, adverse drug withdrawal events, and therapeutic failure.OBJECTIVE: The goal of this article was to review evidence from randomized controlled studies to determine whether DRPs and the related health outcomes can be modified by providing clinical pharmacy services for the elderly in community-based settings.METHODS: Randomized controlled studies that assessed DRPs and health outcomes in persons aged > or =65 years after pharmacist interventions were identified through searches of MEDLINE (1970-March 2003), the Cochrane Database of Systematic Reviews (through March 2003), and International Pharmaceutical Abstracts (1966-March 2003). The search combined the terms clinical pharmacists, aged, outcomes, and randomized controlled trial. A manual search of the reference lists of identified articles and the authors' own materials was also conducted.RESULTS: This literature review included 14 randomized controlled studies: 5 involved interventions in the home health setting, 3 were instituted at hospital discharge with home follow-up, 3 were clinic based, 1 was conducted in the community pharmacy setting, and 2 were conducted in long-term care facilities. These studies provided considerable evidence that clinical pharmacy interventions reduced the occurrence of DRPs in the elderly but showed limited evidence that such interventions reduced morbidity, mortality, or health care costs.CONCLUSIONS: Future large multicenter studies are necessary to test the cost-effectiveness of clinical pharmacy services for the community-based elderly and the impact of these services on such health outcomes as use of health services, timed functional-status measures, and adverse drug reactions.