Acceptability of patient-centered, multi-disciplinary medication therapy management recommendations: results from the INCREASE randomized study.
Acceptability of patient-centered, multi-disciplinary medication therapy management recommendations: results from the INCREASE randomized study.
复制标题
DOI：
10.1186/s12877-023-03876-4
复制
发表时间：
2023-03-10
期刊：
影响因子：
4.1
通讯作者：
Moga, Daniela C. C.
中科院分区：
文献类型：
--
作者：
Smith, Noah I. I.;Martinez, Ashley I. I.;Huffmyer, Mark;Eckmann, Lynne;George, Rosmy;Abner, Erin L. L.;Jicha, Gregory A. A.;Moga, Daniela C. C.
服用多种药物和不适当的药物可能是阿尔茨海默病和相关痴呆(ADRD)的一个可改变的危险因素。药物治疗管理(MTM)干预可以减轻药物引起的认知功能障碍，延迟症状性功能障碍的发生。本研究的目的是描述一项旨在延缓ADRD症状发作的随机对照试验(RCT)中以患者为中心的团队干预(药剂师和非药剂师临床医生)的MTM方案。65 + 岁的非痴呆、使用 ≥ 1潜在不适当药物(PIM)的社区居住成年人参加了一项随机对照试验，以评估MTM干预在改善药物适当性和认知方面的效果(NCT02849639)。MTM干预包括三个步骤：(1)药剂师识别潜在的药物相关问题(MRP)，并为处方药和非处方药、维生素和补充剂提出初步建议；(2)研究小组与参与者一起审查所有初步建议，允许在最终建议之前进行修改；(3)记录参与者对最终建议的反应。在这里，我们描述最初的建议、团队参与过程中的变化以及参与者对最终建议的反应。在90名参与者中，每个参与者报告的平均 ± 为6.7MRP±3.6MRP。在为治疗组参与者(N = 46)提出的259项初步MTM建议中，40%在第二步中进行了修订。参与者报告愿意采纳46%的最终建议，并表示需要针对38%的最终建议提供额外的初级保健投入。当提供治疗切换和/或使用抗胆碱能药物时，采用最终建议的意愿最高。对MTM建议修改的评估表明，药剂师最初的MTM建议经常在参与纳入患者偏好的多学科决策过程后发生变化。该团队受到鼓舞，看到了患者参与度与参与者接受最终MTM建议的总体积极反应之间的相关性。研究注册号：Clinicaltrial.gov NCT02849639，注册日期：2016年7月29日。网上版载有补充材料，可在10.1186/s12877-023-03876-4查阅。
Polypharmacy and inappropriate medications may be a modifiable risk factor for Alzheimer’s Disease and Related Dementias (ADRD). Medication therapy management (MTM) interventions may mitigate medication-induced cognitive dysfunction and delay onset of symptomatic impairment. The objective of the current study is to describe an MTM protocol for a patient-centered team intervention (pharmacist and non-pharmacist clinician) in a randomized controlled trial (RCT) directed at delaying the symptomatic onset of ADRD. Community dwelling adults 65 + years, non-demented, using ≥ 1 potentially inappropriate medications (PIM) were enrolled in an RCT to evaluate the effect of an MTM intervention on improving medication appropriateness and cognition (NCT02849639). The MTM intervention involved a three-step process: (1) pharmacist identified potential medication-related problems (MRPs) and made initial recommendations for prescribed and over-the-counter medications, vitamins, and supplements; (2) study team reviewed all initial recommendations together with the participants, allowing for revisions prior to the finalized recommendations; (3) participant responses to final recommendations were recorded. Here, we describe initial recommendations, changes during team engagement, and participant responses to final recommendations. Among the 90 participants, a mean 6.7 ± 3.6 MRPs per participant were reported. Of the 259 initial MTM recommendations made for the treatment group participants (N = 46), 40% percent underwent revisions in the second step. Participants reported willingness to adopt 46% of final recommendations and expressed need for additional primary care input in response to 38% of final recommendations. Willingness to adopt final recommendations was highest when therapeutic switches were offered and/or with anticholinergic medications. The evaluation of modifications to MTM recommendations demonstrated that pharmacists’ initial MTM recommendations often changed following the participation in the multidisciplinary decision-making process that incorporated patient preferences. The team was encouraged to see a correlation between engaging patients and a positive overall response towards participant acceptance of final MTM recommendations. Study registration number: clinicaltrial.gov NCT02849639 registered on 29/07/2016. The online version contains supplementary material available at 10.1186/s12877-023-03876-4.
登录
查看更多内容
DOI：
10.1161/hcq.0000000000000057
发表时间：
2019-11
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Casey DE Jr;Thomas RJ;Bhalla V;Commodore-Mensah Y;Heidenreich PA;Kolte D;Muntner P;Smith SC Jr;Spertus JA;Windle JR;Wozniak GD;Ziaeian B
通讯作者：
Ziaeian B
影响因子：
4.1
作者：
Isetts BJ;Buffington DE;Carter BL;Smith M;Polgreen LA;James PA
通讯作者：
James PA
影响因子：
--
作者：
Barnett, Mitchell J.;Frank, Jessica;Perry, Paul J.
通讯作者：
Perry, Paul J.
影响因子：
6.3
作者：
Radcliff, Sue;Yue, Jirong;Beers, Mark H.
通讯作者：
Beers, Mark H.
DOI：
10.2337/cd18-0105
发表时间：
2019-01-01
期刊：
Clinical diabetes : a publication of the American Diabetes Association
影响因子：
--
作者：
通讯作者：
--