Effect of the Tool to Reduce Inappropriate Medications on Medication Communication and Deprescribing.
Effect of the Tool to Reduce Inappropriate Medications on Medication Communication and Deprescribing.
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DOI：
10.1111/jgs.15042
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发表时间：
2017-10
影响因子：
6.3
通讯作者：
Fenton BT
中科院分区：
文献类型：
--
作者：
Fried TR;Niehoff KM;Street RL;Charpentier PA;Rajeevan N;Miller PL;Goldstein MK;O'Leary JR;Fenton BT
多种用药和处方可能不适当的药物（PIMs）在老年人中很常见。适当的处方需要强有力的沟通和关于药物的共同决策。本研究考察了TRIM（减少不当药物治疗工具）对药物沟通和处方的影响，TRIM是一种将电子健康记录（EHR）与临床决策支持系统连接起来的网络工具。随机临床试验在VA医疗中心的初级保健诊所，128名65岁及以上的退伍军人处方≥7种药物，随机接受TRIM或常规治疗。TRIM从电子病历中提取药物和慢性病，并包含从简短图表审查和电话患者评估中获得的信息的数据输入屏幕。这些数据作为自动算法的输入，用于识别药物调和差异、pim和潜在的不适当方案。临床医生反馈报告总结差异并提供处方建议。患者反馈报告总结了差异和自我报告的用药问题。主要研究：慢性病患者护理评估（PACIC）中与共同决策、医患沟通相关的分量表；其次：药物的变化。虽然29.7%的TRIM参与者和15.6%的对照组参与者提供了最高的PACIC评分，但差异并不显著。调整协变量和临床医生内患者的聚类，TRIM与更积极的患者沟通和促进临床医生沟通，以及两者之间更多的药物相关沟通显著相关。TRIM与药物差异的纠正显著相关，但对药物数量或pim的减少没有影响。TRIM改善了关于药物的沟通和文件的准确性。虽然与处方没有关联，但小样本量为检查药物相关结果提供了有限的力量。
Polypharmacy and prescribing potentially inappropriate medications (PIMs) are common among older persons. Appropriate prescribing requires robust communication and shared decision making about medications. This study examines the effect of TRIM (Tool to Reduce Inappropriate Medications), a web tool linking the electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. Randomized clinical trial Primary care clinics at a VA Medical Center 128 Veterans age 65 years and older prescribed ≥ 7 medications, randomized to receipt of TRIM or usual care. TRIM extracts medications and chronic conditions from the EHR and contains data entry screens for information obtained from brief chart review and telephonic patient assessment. These data serve as input for automated algorithms identifying medication reconciliation discrepancies, PIMs, and potentially inappropriate regimens. Clinician feedback reports summarize discrepancies and provide recommendations for deprescribing. Patient feedback reports summarize discrepancies and self-reported medication problems. Primary: subscales of the Patient Assessment of Care for Chronic Conditions (PACIC) related to shared decision making, clinician and patient communication; secondary: changes in medications. While 29.7% of TRIM participants versus 15.6% of control participants provided the highest PACIC ratings, the difference was nonsignificant. Adjusting for covariates and clustering of patients within clinicians, TRIM was associated with significantly more active patient communication and facilitative clinician communication, and with more medication-related communication among both. TRIM was significantly associated with correction of medication discrepancies, but had no effect on number of medications or reduction in PIMs. TRIM improved communication around medications and accuracy of documentation. While there was no association with prescribing, the small sample size provided limited power to examine medication-related outcomes.
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影响因子：
3
作者：
Glasgow, RE;Wagner, EH;Greene, SA
通讯作者：
Greene, SA
影响因子：
3.3
作者：
Gnjidic, Danijela;Le Couteur, David G.;Hilmer, Sarah N.
通讯作者：
Hilmer, Sarah N.
影响因子：
4.1
作者：
Niehoff, Kristina M.;Rajeevan, Nallakkandi;Fried, Terri R.
通讯作者：
Fried, Terri R.
影响因子：
3.9
作者：
Street, RL;Millay, B
通讯作者：
Millay, B
影响因子：
--
作者：
Kerr, Eve A.;Lucatorto, Michelle A.;Holleman, Rob;Hogan, Mary M.;Klamerus, Mandi L.;Hofer, Timothy P.
通讯作者：
Hofer, Timothy P.