紧急部门计划支持老年人药物安全:系统审查和元分析
Rachel M Skains1,2, Jane M Hayes3, Katherine Selman4
1Department of Emergency Medicine, Heersink School of Medicine, The University of Alabama at Birmingham.
JAMA network open
|March 11, 2025
概括
使用临床药剂师和计算机化临床决策支持系统 (CDSS) 的急救部门 (ED) 计划提高了老年人药物安全. 这些干预措施减少了潜在不合适的药物 (PIMs),增强了处方和停止处方的做法.
科学领域:
- 老年医学 老年医学
- 临床药房 临床药房
- 医疗保健服务研究 医疗服务研究
背景情况:
- 老年人对药物不良事件 (ADEs) 的敏感度很高.
- 老年人药物计划旨在通过改进订购,处方和减缓处方来优化药物安全性.
研究的目的:
- 确定与减少潜在不合适药物 (PIM) 和ADEs相关的基于急诊室 (ED) 的老年人药物治疗计划.
主要方法:
- 在多个数据库 (Scopus,Embase,PubMed等) 中进行系统的文献搜索. 在2024年2月14日进行.
- 包括基于ED的老年人药物治疗计划 (≥65岁) 的随机临床试验和观察性研究.
- 数据抽象和质量评估遵循PRISMA指南和Cochrane偏差风险工具.
主要成果:
- 包括25项研究 (44,640名参与者),分为临床药剂师评论,老年医生电话咨询,临床医生教育干预,计算机化临床决策支持系统 (CDSS) 和降低风险增加药物 (FRID) 评论.
- 临床药剂师审查显示,通过减缓处方,PIMs减少了32%.
- 临床教育干预减少了19%的PIM处方,计算机化的CDSS减少了40%的PIM订单.
结论:
- 在ED的多学科团队 (临床药剂师,老年医生) 改善了PIM的处方.
- 计算机化CDSS,与或没有临床医师教育,增强老年人药物订购和处方.
- 调查结果将为老年ED指南的更新提供信息.
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