Patient Polypharmacy use Following a Multi-Disciplinary Dementia Care Program in a Memory Clinic: A Retrospective Cohort Study.
Patient Polypharmacy use Following a Multi-Disciplinary Dementia Care Program in a Memory Clinic: A Retrospective Cohort Study.
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DOI：
10.17161/kjm.vol16.20976
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Mudaranthakam, Dinesh Pal
中科院分区：
文献类型：
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作者：
Perales-Puchalt, Jaime;Burkhardt, Crystal;Baker, Jordan;Cernik, Colin;Townley, Ryan;Niedens, Michelle;Burns, Jeffrey M;Mudaranthakam, Dinesh Pal
痴呆症增加了多种药物的风险。及时发现和最佳护理可以稳定或延缓痴呆症状的进展，这反过来可能会减少多药治疗。我们的目的是评估与那些没有参加痴呆症护理计划的患者相比，患有痴呆症的记忆诊所患者使用多种药物的变化。我们假设，与未接受标准治疗的患者相比，接受痴呆症护理计划的患者将减少使用多种药物。我们回顾性分析了从大学记忆诊所的电子病历中提取的数据。共有381名患者的数据被纳入研究：107名患者在该计划中，274名患者在标准治疗中。我们使用调整后的比值比来评估该计划的登记与随访时的多种药物使用（五种或更多种合并药物）之间的关联，控制基线多种药物使用和按处方和非处方药（OTC）分层的多种药物使用。两组在随访时使用五种或五种以上的总体药物和处方药物方面没有差异，控制了基线时使用五种或五种以上的相应药物和协变量。在控制基线时使用5种或5种以上OTC药物和协变量后，参与该项目与随访时使用5种或5种以上OTC药物的几率降低3倍相关（调整后的比值比= 0.30; p <0.001; 95%置信区间= 0.15-0.58）。痴呆症护理可能会减少OTC药物的多药化，从而可能减少危险的药物相互作用。需要更多的研究来推断因果关系，并了解如何减少处方药多药。
Dementia increases the risk of polypharmacy. Timely detection and optimal care can stabilize or delay the progression of dementia symptoms, which may in turn reduce polypharmacy. We aimed to evaluate the change in polypharmacy use among memory clinic patients living with dementia who participated in a dementia care program compared to those who did not. We hypothesized that patients in the dementia care program would reduce their use of polypharmacy compared to those who were not in standard care. We retrospectively analyzed data extracted from electronic medical records from a university memory clinic. Data from a total of 381 patients were included in the study: 107 in the program and 274 matched patients in standard care. We used adjusted odds ratios to assess the association between enrollment in the program and polypharmacy use at follow-up (five or more concurrent medications), controlling for baseline polypharmacy use and stratified polypharmacy use by prescription and over-the-counter (OTC). The two groups did not differ in the use of five or more overall and prescription medications at follow-up, controlling for the use of five or more of the respective medications at baseline and covariates. Being in the program was associated with a three-fold lower odds of using five or more OTC medications at follow-up (adjusted odds ratio = 0.30; p <0.001; 95% Confidence interval = 0.15–0.58) after controlling for using five or more OTC medications at baseline and covariates. Dementia care may reduce polypharmacy of OTC medications, potentially reducing risky drug-drug interactions. More research is needed to infer causality and understand how to reduce prescription medication polypharmacy.