A pharmacy led program to review anti-psychotic prescribing for people with dementia
A pharmacy led program to review anti-psychotic prescribing for people with dementia
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DOI：
10.1186/1471-244x-12-155
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发表时间：
2012-09-25
期刊：
影响因子：
4.4
通讯作者：
Maidment, Ian
中科院分区：
文献类型：
--
作者：
Child, Anne;Clarke, Amy;Maidment, Ian
背景：在英国，给痴呆症患者开的抗精神病药物与每年约1800例额外死亡有关。一个关键的公共卫生目标是限制这种抗精神病药物的处方。方法：该项目是在英国Medway初级保健信托基金(PCT)的初级保健范围内进行的。干预分两个阶段进行。首先，一名药房技术员搜索了包括痴呆症登记簿在内的初级保健信息系统，以识别开出抗精神病药物的痴呆症患者。其次，一位训练有素的专业药剂师对通过数据搜索确定的初级保健抗精神病药物启动的痴呆患者进行了有针对性的临床药物审查。结果：收集了59个实践的数据。在痴呆症登记的1,051人中，有161人(15.3%)接受了低剂量的抗精神病药物治疗。住在养老院的痴呆症患者接受抗精神病药物治疗的可能性几乎是住在自己家里的人的3.5%(P<；0.0001；费舍尔精确测试)。在26个实践中，没有人在痴呆症登记册上接受低剂量抗精神病药物治疗。在161名痴呆症患者中，91人正在接受当地二级护理精神健康服务或学习障碍小组的持续治疗。在其余70名患者中，43例(61.4%)在药房主导的药物审查后停用或减少了抗精神病药物的剂量。结论：总共有15.3%的痴呆症患者接受了低剂量的抗精神病药物治疗。然而，这样的数据，包括最近的国家审计，可能低估了痴呆症患者抗精神病药物的使用。抗精神病药物在疗养院环境中使用更普遍。药剂师领导的药物审查成功地将抗精神病药物的处方限制在痴呆症患者身上。
Background: Anti-psychotics, prescribed to people with dementia, are associated with approximately 1,800 excess annual deaths in the UK. A key public health objective is to limit such prescribing of anti-psychotics.Methods: This project was conducted within primary care in Medway Primary Care Trust (PCT) in the UK. There were 2 stages for the intervention. First, primary care information systems including the dementia register were searched by a pharmacy technician to identify people with dementia prescribed anti-psychotics. Second, a trained specialist pharmacist conducted targeted clinical medication reviews in people with dementia initiated on anti-psychotics by primary care, identified by the data search.Results: Data were collected from 59 practices. One hundred and sixty-one (15.3%) of 1051 people on the dementia register were receiving low-dose anti-psychotics. People with dementia living in residential homes were nearly 3.5 times more likely to receive an anti-psychotic [25.5% of care home residents (118/462) vs. 7.3% of people living at home (43/589)] than people living in their own homes (p < 0.0001; Fisher's exact test). In 26 practices there was no-one on the dementia register receiving low-dose anti-psychotics.Of the 161 people with dementia prescribed low-dose anti-psychotics, 91 were receiving on-going treatment from local secondary care mental health services or Learning Disability Teams. Of the remaining 70 patients the anti-psychotic was either withdrawn, or the dosage was reduced, in 43 instances (61.4%) following the pharmacy-led medication review.Conclusions: In total 15.3% of people on the dementia register were receiving a low-dose anti-psychotic. However, such data, including the recent national audit may under-estimate the usage of anti-psychotics in people with dementia. Anti-psychotics were used more commonly within care home settings. The pharmacist-led medication review successfully limited the prescribing of anti-psychotics to people with dementia.