老年醫學科住院患者實施藥物整合成效分析

The effectiveness of medication reconciliation among inpatients in the geriatrics department

目的通過分析和比較老年醫學科住院患者實施藥物整合前後,發生藥物相關問題(drug related problems,DRPs)平均次數的變化,評價藥物整合成效。方法納入2021.11.01~2022.07.31期間老年醫學科住院患者,收集年齡、性別等一般資料、慢性基礎疾病、肝腎功能等實驗室指標以及臨床用藥情況。以2022.2.1實施藥物整合為界點,分為整合前期、整合1期和整合2期,每3個月1期。由同一藥劑師進行藥物整合並記錄DRPs次數,比較藥物整合前後DRPs次數變化。結果259名患者納入研究,平均年齡86.59±9.33歲,80.69%的患者有3種以上慢性疾病;88.88%的患者用藥種類超過5種。DRPs分類中以藥物劑量問題最常見,佔40.44%。實施藥物整合後,入院和出院時DRPs發生次數均明顯下降(P<0.001)。入院時整合2期比整合前期和1期DRPs平均次數分別減少0.45次(P<0.001)和0.38次(P=0.013)。出院時整合1期和2期DRPs平均次數較整合前期分別減少0.48次(P<0.001)和0.44次(P<0.001)。結論老年患者住院期間DRPs常見,藥劑師主導的藥物整合能顯著降低DRPs發生率,提高老年患者用藥安全。

Objective To evaluate the effectiveness of medication reconciliation by analyzing and comparing the average number of drug-related problems(DRPs)that occur in elderly patients in the geriatrics department before and after the implementation of medication integration.Methods Patients who were admitted to the geriatric departments between November 1,2021,and July 31,2021,were included in the study.General information,chronic underlying diseases,laboratory indicators such as liver and kidney function,and clinical medication usage were collected.The time period was divided into three phases:Pre-stage,Stage 1,and Stage 2.Each phase lasted three months,and February 1st,2022,was used as the time point for medication reconciliation.DRPs were recorded by the same pharmacist before and after medication reconciliation,and the changes in DRPs were compared.Results A total of 259 patients were included in the study;the mean age was 86.59±9.33 years,80.69%of the patients had more than three chronic underlying diseases,and 88.88%of the patients were taking more than five medications.The most common type of DRP was related to medication dosage,accounting for 40.44%.After medication reconciliation,the number of DRPs decreased significantly both at admission and at discharge(P<0.001).At admission,the average number of DRPs in Stage 2 was 0.45(P<0.001)and 0.38(P=0.013)lower than that in Pre-stage and Stage 1,respectively.At discharge,compared with those in Pre-stage,the average number of DRPs in Stages 1 and 2 was 0.48(P<0.001)and 0.44(P<0.001),respectively.Conclusion DRPs are common in elderly patients during hospitalization,and pharmacist-led medication integration can significantly reduce the incidence of DRPs,improving medication safety in elderly patients.