A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy
A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy
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DOI：
10.1016/s0002-9343(97)89519-8
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发表时间：
1996-04-01
影响因子：
5.9
通讯作者：
Feussner, JR
中科院分区：
文献类型：
--
作者：
Hanlon, JT;Weinberger, M;Feussner, JR
目的：评估持续临床药师干预的效果，涉及使用多种药物的老年门诊患者及其主治医生。 患者和方法：对来自退伍军人事务医疗中心的普通医学诊所的 208 名 65 岁或以上使用多种药物（大于或等于 5 种慢性药物）的患者进行随机对照试验。临床药剂师在所有预定访视期间会见干预组患者，评估他们的药物治疗方案并向他们及其医生提出建议。结果指标包括处方适当性、健康相关生活质量、药物不良事件、用药依从性、酸知识、药物数量、患者满意度和医生接受度。 结果：干预组不适当处方评分的下降幅度比对照组显着更多（分别下降 24% 和 6%；P = 0.0006），并持续 12 个月（分别下降 28% 和 5%；P = 0.0002）。结束时各组之间的健康相关生活质量没有差异（P = 0.99）。与对照患者相比，干预较少（30.2% vs 40.0%；P = 0.19），经历了药物不良事件。两组中大多数其他结果的衡量标准均保持不变。与对照患者独立实施变更相比，医生更愿意接受干预并实施临床药剂师建议的变更（55.1% 对比 19.8%；P
PURPOSE: TO evaluate the effect of sustained clinical pharmacist interventions involving elderly outpatients with polypharmacy and their primary physicians.PATIENTS AND METHODS: Randomized, controlled trial of 208 patients aged 65 years or older with polypharmacy (greater than or equal to 5 chronic medications) from a general medicine clinic of a Veterans Affairs Medical Center. A clinical pharmacist met with intervention group patients during all scheduled visits to evaluate their drug regimens and make recommendations to them and their physicians. Outcome measures were prescribing appropriateness, health-related quality of life, adverse drug events, medication compliance acid knowledge, number of medications, patient satisfaction, and physician receptivity.RESULTS: Inappropriate prescribing scores declined significantly more in the intervention group than in the control group by 3 months (decrease 24% versus 6%, respectively; P = 0.0006) and was sustained at 12 months (decrease 28% versus 5%, respectively; P = 0.0002). There was no difference between groups at closeout in health-related quality of life (P = 0.99). Fewer intervention than control patients (30.2% versus 40.0%; P = 0.19) experienced adverse drug events. Measures for most other outcomes remained unchanged in both groups. Physicians were receptive to the intervention and enacted changes recommended by the clinical pharmacist more frequently than they enacted changes independently for control patients (55.1% versus 19.8%; P