Deprescribing electronic case reviews for older veterans at risk for falls: Effects on drug burden and falls.
Deprescribing electronic case reviews for older veterans at risk for falls: Effects on drug burden and falls.
复制标题
对有跌倒风险的老年退伍军人取消电子病例审查：对药物负担和跌倒的影响。
DOI：
10.1111/jgs.18650
复制
发表时间：
2024
影响因子：
6.3
通讯作者：
Colon-Emeric,Cathleen
中科院分区：
文献类型：
--
作者：
Pavon,JuliessaM;Davidson,Spencer;Sloane,Richard;Pepin,Marc;Bryan,William;Bailey,Janine;Igwe,Ivuoma;Colon-Emeric,Cathleen
跌倒是老年人中最常见的药物相关安全性事件。取消跌倒风险增加药物（FRID）的处方可能会降低跌倒风险。本研究评估的影响，一个创新的取消处方计划在减少FRID负担和福尔斯相关的急性访问超过1 year.MethodsThe福尔斯评估药物在老年人（FAME）计划是一个试点取消处方计划，旨在提高用药安全性的退伍军人年龄≥65岁，筛选积极的高跌倒风险在达勒姆退伍军人事务部医疗保健系统。由一个跨学科团队完成中心病例发现和电子病例审查以及取消处方建议，转发给处方医生批准，然后由FAME团队在随访电话访视期间实施。主要结果是在FRID负担的变化计算的修改药物负担指数（DBI）在1年和探索性的结果是1年跌倒相关的急性visits.ResultsOverall，472例患者（236干预病例，236匹配对照）被纳入研究。在接受FAME取消处方计划的236例患者中，147例患者的建议得到了处方医生和患者的批准。在意向治疗分析中，干预队列中改良DBI的1年变化为-0.15（95% CI-0.23，-0.08），匹配对照队列中为-0.11（-0.21，-0.00）（p= 0.47）。FAME队列中DBI增加临床重要阈值0.5的几率显著较低（OR 0.37，0.21，0.66）。跌倒相关的急性事件发生在干预组的6.3%的患者与11.0%的对照组患者在一年的时间（p= 0.10）。电子病例审查和电话咨询计划有可能减少高风险老年人的药物相关福尔斯跌倒。
BackgroundFalls are the most common medication‐related safety event in older adults. Deprescribing fall risk‐increasing drugs (FRIDs) may mitigate fall risk. This study assesses the effects of an innovative deprescribing program in reducing FRID burden and falls‐related acute visits over 1 year.MethodsThe Falls Assessment of Medications in the Elderly (FAME) Program is a pilot deprescribing program designed to improve medication safety in Veterans aged ≥65, screening positive for high fall risk at the Durham Veterans Affairs Health Care System. Central case finding and electronic case reviews with deprescribing recommendations were completed by an interdisciplinary team, forwarded to prescribers for approval, then implemented during follow‐up telephone visits by FAME team. Primary outcome was change in FRID burden calculated by modified Drug Burden Index (DBI) at 1 year and an exploratory outcome was 1‐year fall‐related acute visits.ResultsOverall, 472 patients (236 intervention cases, 236 matched controls) were included in the study. Of the 236 patients receiving a FAME deprescribing plan, 147 had recommendations approved by prescriber and patient. In the intention‐to‐treat analysis, the 1‐year change in modified DBI was −0.15 (95% CI −0.23, −0.08) in the intervention cohort and −0.11 (−0.21, −0.00) in the matched control cohort (p= 0.47). The odds of increasing DBI by a clinically important threshold of 0.5 was significantly lower in the FAME cohort (OR 0.37, 0.21, 0.66). Fall‐related acute events occurred in 6.3% of patients in the intervention group versus 11.0% in control patients over a one‐year period (p= 0.10).ConclusionsThe program was associated with a significantly lower odds of further increasing FRID burden at 1 year compared to matched controls. An electronic case review and telephone counseling program has the potential to reduce drug‐related falls in high‐risk older adults.