Suboptimal pharmacotherapy in a tribal nursing home.
Suboptimal pharmacotherapy in a tribal nursing home.
复制标题
部落疗养院的药物治疗效果不佳。
DOI：
10.1016/j.jamda.2006.03.010
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发表时间：
2007
影响因子：
7.6
通讯作者：
Manson,SperoM
中科院分区：
文献类型：
--
作者：
Jervis,LoriL;Shore,Jay;Hutt,Evelyn;Manson,SperoM
目的 疗养院 (NH) 居民中药物使用不理想的情况很常见。新罕布什尔州居民往往年龄较大，患有多种疾病，并服用多种药物，这增加了他们发生严重并发症的风险。本文研究了农村部落拥有的 NH 的药物治疗。设计由医学人类学家、精神病学家和老年病学家组成的团队审查了医疗记录并进行了案例研究。设置美国北部平原的美国印第安人拥有的农村 NH。参与者 40 名美洲印第安人和 5 名欧洲美洲 NH 居民。测量最小数据集评估、入院记录、护理计划、社会历史、处方列表和行为咨询报告。结果 潜在的使用不足影响了近 75% 的居民；抑郁和精神病/激越症状治疗不足的情况尤其常见。潜在的不当使用，尤其是镇痛药、精神药物和抗组胺药，影响了 30% 的居民。一小部分居民（21%）经历了潜在的过度使用，但数量仍然不少，其中大部分涉及抗惊厥药物、抗生素、心血管药物和精神药物。 10 种或更多药物的处方与潜在的药物相互作用以及使用不足、药物使用不当和过度使用显着相关。结论精神药物是最有可能出现问题的药物类别，并且与潜在使用不足、不当使用和过度使用密切相关。减少药物用量；停止使用已知对新罕布什尔州居民有潜在问题的药物；修改精神药物治疗方案；适当时使用认知增强药物；实施电子病历系统；更多地使用非药物行为干预措施可能会大大改善居民的治疗方案。
OBJECTIVESuboptimal medication use among nursing home (NH) residents is common. NH residents tend to be older, suffer from multiple conditions, and take numerous medications, increasing their risk of serious complications. This article examines pharmacotherapy in a rural, tribally owned NH.DESIGNMedical records were reviewed and case studies were conducted by a team composed of a medical anthropologist, psychiatrist, and geriatrician.SETTINGA rural, American Indian–owned NH in the US northern plains.PARTICIPANTS40 American Indian and 5 EuroAmerican NH residents.MEASUREMENTSMinimum Data Set assessments, admission records, care plans, social histories, prescription lists, and behavioral consultation reports.RESULTSPotential underuse affected almost 75% of residents; undertreatment of depressive and psychotic/agitated symptoms was especially common. Potential inappropriate use, especially of analgesics, psychotropics, and antihistamines, affected 30% of residents. A smaller, but still substantial, number of residents (21%) experienced potential overuse, much of which involved anticonvulsants, antibiotics, cardiovascular, and psychotropic agents. The prescription of 10 or more medications was significantly associated with potential drug interactions, as well as underuse, inappropriate medication use, and overuse.CONCLUSIONSPsychotropic medications were the most potentially problematic medication category, and were strongly implicated in potential underuse, inappropriate use, and overuse. Fewer medications; the discontinuation of drugs known to be potentially problematic for NH residents; modification of psychotropic medication regimens; use of cognitive-enhancing medications where appropriate; implementation of an electronic medical record system; and greater use of nonpharmacological behavioral interventions may have substantially improved residents’ treatment regimens.