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首页> 外文期刊>The Canadian journal of clinical pharmacology =: Journal canadien de pharmacologie clinique >Improving prescribing in the elderly: a study in the long term care setting.
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Improving prescribing in the elderly: a study in the long term care setting.

机译：改善老年人处方：长期护理环境中的一项研究。

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OBJECTIVES: To determine the prevalence and predictors of potentially inappropriate prescribing of medications in the long term care setting, and to determine the effectiveness of follow-up pharmacist letters to the prescribing physicians in improving prescribing. PATIENTS AND METHODS: The Improving Prescribing in the Elderly Tool was applied to the charts of all long term care patients aged 65 years and over at Parkwood Hospital, a rehabilitation hospital/long term care facility in London, Ontario. All potentially inappropriate prescriptions were verified by a consensus panel consisting of a family physician, a geriatric medicine specialist and a geriatric pharmacist. Follow-up letters to the prescribing physicians were developed that briefly described the concerns with the potentially inappropriate prescriptions and suggested safer alternatives. These letters were sent to the prescribing physicians, accompanied by a brief survey. Patient charts in which a potentially inappropriate prescription had been noted were reviewed for prescription changes two months after the prescribing physicians had received the follow-up letters. RESULTS: A total of 69 potentially inappropriate prescriptions were found in 65 of 355 long term care patients (18.3%). The most common types of potentially inappropriate prescriptions were anticholinergic drugs to manage antipsychotic side effects (17 cases), tricyclic antidepressants with active metabolites (16 cases), and long-acting benzodiazepines (14 cases). The total number of prescription medications (P<0.001), a history of mental illness (P=0.002) and a high minimum data set (MDS) score for depression (P=0.002) were all highly associated with potentially inappropriate prescribing. Variables that were not correlated with increased rates of potentially inappropriate prescribing included age, sex, code status, a diagnosis of dementia (as documented explicitly in the chart), high MDS scores for delirium or cognitive impairment, the date of the prescribing physician's graduation and the total Charlson comorbidity index score. Potentially inappropriate prescriptions were significantly less common in patients seen by a geriatric medicine specialist (P<0.001). In response to the follow-up letter suggesting safer alternatives, 37.9% of potentially inappropriate prescriptions were changed by the prescribing physician. Ninety-two per cent of responding physicians rated the follow-up letter as a "somewhat" or "very" helpful method for improving prescribing in elderly patients. CONCLUSIONS: Potentially inappropriate prescribing in the long term care setting is common and can be improved by the provision of a follow-up letter suggesting safer alternatives.
机译：目的：确定长期护理环境中可能不适当开处方的发生率和预测因素，并确定后续发给开处方医生的药师信对改善开处方的有效性。病人和方法：老年人工具中的改良处方被应用于所有65岁及65岁以上的长期护理患者的病历表，该患者位于安大略省伦敦的康复医院/长期护理机构Parkwood医院。由家庭医生，老年医学专家和老年药剂师组成的共识小组验证了所有可能不合适的处方。开发了给处方医生的后续信件，其中简要介绍了可能存在不合适处方的问题，并提出了更安全的替代方案。这些信件被发送给开处方的医生，并进行了简短的调查。在处方医生收到随访信后的两个月，检查了记录了可能不合适的处方的患者病历表，以检查处方变化。结果：在355名长期护理患者中，有65名发现了69种可能不合适的处方（占18.3％）。最常见的潜在不适当处方是控制抗精神病药物副作用的抗胆碱药（17例），具有活性代谢产物的三环类抗抑郁药（16例）和长效苯二氮卓类药物（14例）。处方药的总数（P <0.001），精神病史（P = 0.002）和抑郁症的最低数据集（MDS）得分高（P = 0.002）都与潜在的不合适处方有关。与可能不适当的开处方率增加无关的变量包括年龄，性别，代码状态，痴呆的诊断（如图表中明确记录），M妄或认知障碍的MDS高分，开处方的医生的毕业日期和总的Charlson合并症指数得分。老年医学专家所见的患者中潜在的不适当处方明显较少（P <0.001）。在后续信件中提出了更安全的选择时，处方医生更改了37.9％的不适当处方。 92％的回复医师将随访信评为改善老年患者处方的“某种”或“非常”有用的方法。结论：在长期护理环境中可能不适当的处方很普遍，并且可以通过提供后续信函来建议更安全的替代方案，从而改善这种情况。

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