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首页> 外文期刊>The American journal of hospice and palliative care >Are newer, more expensive pharmacotherapy options associated with superior symptom control compared to less costly agents used in a collaborative practice setting?
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Are newer, more expensive pharmacotherapy options associated with superior symptom control compared to less costly agents used in a collaborative practice setting?

机译：与协作实践中使用的成本较低的药物相比，更新的，更昂贵的药物治疗方法是否具有更好的症状控制能力？

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Innovative approaches to care may be necessary to provide the most effective symptom management to hospice patients. One approach is prescribing newer pharmacotherapy options with the potential to improve symptom management in hospice. Such therapies are sometimes prescribed outside of Food and Drug Administration indications and are typically more costly than older agents used for the same symptoms. Another approach is the collaborative practice (CP) care model, whereby clinical pharmacists are given prescriptive authority according to evidence-based protocols and algorithms within boundaries approved by a physician. The agents typically included in CP protocols are those with wide therapeutic indices and with substantial evidence to support their use. The purpose of this study was to examine both approaches to management of pain, insomnia, and nausea, comparing symptom scores for those patients who received noncollaborative drug therapies (transdermal fentanyl, zolpidem, and ondansetron) to those whoreceived agents under CP (oral sustained-release opioids, temazepam, and prochlorperazine). The object of the study was to investigate outcomes associated with newer drug therapy options as compared to older agents for the management of pain, insomnia, and nausea. A secondary goal is to compare symptom outcomes for patients receiving pharmaceutical care under CP and non-CP models. The study design was retrospective with a cohort. A total of 50 patients were randomly selected for each cohort of the pain and insomnia study arms. Only 45 patients prescribed oral ondansetron met inclusion criteria for the nausea group; 45 patients prescribed prochlorperazine were randomly selected as the comparator group. Patients were compared on their degree of response to the prescribed therapy. Response was classified as complete, partial, no improvement from baseline, worsened, or unknown. A complete response was defined as the symptom score improving to a 0 of 10, regardless of the previous value documented. A partial response was defined as any improvement in score that did not result in a 0 of 10. No improvement from baseline reflected a lack of overall change in score throughout the series of data points collected. A worsened response was any score found to be higher than the score documented at the time of dispense. The unknown category reflects any set of scores that had an "N/A " documented at the time of medication dispense or when documented for both attempts subsequent to dispensing the medication. A complete response was present in 14 of 50 (24 percent) of the patients prescribed fentanyl as compared with 12 of 50 (28 percent) of those prescribed oral therapy (p = .82). Responses defined as partial, no improvement over baseline, worsened, and unknown were also comparable between the two cohorts. A complete response was seen in 26 patients prescribed temazepam (52 percent), whereas only 11 (22 percent) of patients initially prescribed zolpidem achieved the same response (p = .0037). Both groups had a similar distribution of partial, no improvement over baseline, and worsened responses. For the nausea arm of the study, a difference was found in the number of complete responses, favoring prochlorperazine (22 of 45, 48.9 percent for prochlorperazine, 12 of 45, 26.7 percent for ondansetron, p = .0504), as well as an increased number of worse responses seen with ondansetron patients (p = .0513); however, neither difference was statistically significant. Newer pharmacotherapy options for the management of pain, insomnia, and nausea were not found to be superior when compared to older agents prescribed under CP.
机译：为临终关怀患者提供最有效的症状管理可能需要创新的护理方法。一种方法是开出新的药物疗法，以改善临终关怀的症状管理。此类疗法有时在食品药品监督管理局的适应症之外开出处方，并且通常比用于相同症状的旧药昂贵。另一种方法是协作实践（CP）护理模型，通过该模型，临床医师可以根据基于证据的方案和算法，在医生批准的范围内，根据临床方案给予处方药授权。 CP方案中通常包括的药物是那些具有广泛治疗指数并有充分证据支持其使用的药物。这项研究的目的是研究两种治疗疼痛，失眠和恶心的方法，比较接受非协同药物治疗（经皮芬太尼，唑吡坦和恩丹西酮）的患者与接受CP药物（口服持续治疗）的症状评分释放阿片类药物，替马西m和氯丙嗪）。该研究的目的是研究与较新的药物治疗方案相比，与较旧的药物治疗疼痛，失眠和恶心相关的结局。第二个目标是比较在CP和非CP模型下接受药物治疗的患者的症状结局。研究设计是一项回顾性研究。疼痛和失眠研究组的每个队列共随机选择了50名患者。只有45名处方口服恩丹西酮的患者符合恶心组的入选标准。随机选择45例处方氯丙嗪的患者作为比较组。比较患者对处方疗法的反应程度。反应分为完全，部分，基线无改善，恶化或未知。完全缓解定义为症状评分提高到10的0，而与先前记录的值无关。部分反应的定义是分数的任何改善都不会导致0等于10。从基线开始的改善没有反映出在整个收集的数据点系列中分数总体没有变化。较差的反应是发现任何分数高于分配时记录的分数。未知类别反映了在配药时或配药后两次尝试均记录为“ N / A”的任何分数集。 50例接受芬太尼治疗的患者中有14例（24％）完全反应，而50例接受口服疗法的患者中有12例（28％）有完全反应（p = .82）。在这两个队列中，定义为部分，相对基线无改善，恶化和未知的反应也相当。在26名开具替马西patients的患者中看到了完全缓解（52％），而最初开具唑吡坦的患者中只有11名（22％）获得了相同的缓解（p = 0.0037）。两组的局部分布相似，与基线相比无改善，且反应恶化。对于研究的恶心组，发现完全缓解的次数有所不同，偏向于氯丙嗪（45例中，氯丙嗪48.9％，恩丹西酮12例45.26.7％，p = .0504），以及恩丹西酮患者的不良反应增加（p = .0513）;但是，两者差异均无统计学意义。与CP规定的老年药物相比，较新的药物疗法对疼痛，失眠和恶心的治疗效果不佳。

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