DEFEAT-polypharmacy: deprescribing anticholinergic and sedative medicines feasibility trial in residential aged care facilities
DEFEAT-polypharmacy: deprescribing anticholinergic and sedative medicines feasibility trial in residential aged care facilities
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DOI：
10.1007/s11096-019-00784-9
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发表时间：
2019-02-01
影响因子：
2.4
通讯作者：
Nishtala, Prasad S.
中科院分区：
文献类型：
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作者：
Ailabouni, Nagham;Mangin, Dee;Nishtala, Prasad S.
背景长期使用抗胆碱能药物和镇静药物与认知功能恶化和身体功能下降有关。取消处方是一种拟议的干预措施，可以帮助最大限度地减少多种药物，同时可能改善老年人的几种健康结果。目的本研究旨在探讨实施以患者为中心的药师主导的干预模式的可行性，以解决主要的取消处方的挑战，如全科医生的时间限制和缺乏可访问的取消处方的指南和流程。设置三个住宿护理设施。方法干预涉及新西兰注册药剂师利用同行评审的处方指南，建议有针对性地取消处方抗胆碱能和镇静药物的全科医生。主要结果测量在实施取消处方干预后3个月和6个月，评估参与者的总药物负担指数（DBI）和按需DBI（PRN）的变化。结果70%的潜在参与者被招募的研究（n=46），和72%的建议，由药剂师建议的取消处方实施的一般pratiformers（p=0.01; Fisher精确检验）。96%的居民同意取消处方的建议，强调以病人为中心的方法的重要性。停药后6个月，受试者的DBI评分、福尔斯次数和药物不良反应显著降低0.34。此外，参与者在停药后6个月报告了较低的抑郁评分和较低的虚弱评分。然而，认知并没有改善;参与者报告的生活质量也没有改善。结论这种以患者为中心的取消处方方法，表现出较高的取消处方建议和成功率。6个月后，在一系列重要的健康指标上，包括情绪、虚弱、福尔斯和减少不良反应，都有显著的益处。这进一步支持取消处方作为改善老年人健康结果的可能必要条件。
Background Prolonged use of anticholinergic and sedative medicines is correlated with worsening cognition and physical function decline. Deprescribing is a proposed intervention that can help to minimise polypharmacy whilst potentially improving several health outcomes in older people. Objective This study aimed to examine the feasibility of implementing a deprescribing intervention that utilises a patient-centred pharmacist-led intervention model; in order to address major deprescribing challenges such as general practitioner time constraints and lack of accessible deprescribing guidelines and processes. Setting Three residential care facilities. Methods The intervention involved a New Zealand registered pharmacist utilising peer-reviewed deprescribing guidelines to recommend targeted deprescribing of anticholinergic and sedative medicines to GPs. Main outcome measure The change in the participants' Drug Burden Index (DBI) total and DBI as required' (PRN) was assessed 3 and 6months after implementing the deprescribing intervention. Results Seventy percent of potential participants were recruited for the study (n=46), and 72% of deprescribing recommendations suggested by the pharmacist were implemented by General Pratitioners(p=0.01; Fisher's exact test). Ninety-six percent of the residents agreed to the deprescribing recommendations, emphasising the importance of patient centred approach. Deprescribing resulted in a significant reduction in participants' DBI scores by 0.34, number of falls and adverse drug reactions, 6months post deprescribing. Moreover, participants reported lower depression scores and scored lower frailty scores 6months after deprescribing. However, cognition did not improve; nor did participants' reported quality of life. Conclusion This patient-centred deprescribing approach, demonstrated a high uptake of deprescribing recommendations and success rate. After 6months, significant benefits were noted across a range of important health measures including mood, frailty, falls and reduced adverse reactions. This further supports deprescribing as a possible imperative to improve health outcomes in older adults.