在长期护理中生活的老年人处方的电子决策支持:一个渐进的边缘集群随机试验
Emily G McDonald1,2, Justine L Estey3, Cody Davenport3
1Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
JAMA network open
|May 30, 2025
概括
电子决策支持显著改善了在长期护理院居住的老年人中可能不合适的药物 (PIM) 的处方. 这项技术使得抑郁症可扩展和有效,以获得更好的健康结果.
科学领域:
- 老年学和老年医学是老年学和老年医学.
- 临床药学和药理学 临床药学和药理学
- 医疗信息学和决策支持系统
背景情况:
- 潜在不适当的处方 (PIP) 在老年人中普遍存在,特别是在长期护理 (LTC) 环境中,影响高达88%的居民.
- 潜在不合适的药物 (PIMs) 导致不良健康结果,增加医疗保健成本,并降低老年人的生活质量.
- 停止PIM的处方是提高老年人群健康和福祉的关键策略.
研究的目的:
- 评估电子决策辅助系统在促进长期护理机构居民中减轻PIM的有效性.
- 确定是否将电子决策支持纳入常规药物审查可以提高老年人抑郁症的处方率.
主要方法:
- 在加拿大新不伦瑞克省的五个LTC家庭中进行了一项阶梯集群随机试验,涉及725名老年成人居民,至少有一名PIM.
- 这项干预涉及电子生成的个性化药物处方报告,并与现有的季度药物审查一起提交,通过安全查看器访问.
- 主要结局测量了至少有一个PIM被描述的居民比例,使用通用线性模型比较控制和干预阶段.
主要成果:
- 在干预阶段,36.4%的住户至少有一次PIM处方,而对照阶段的比例为12.7%,这表明电子支持的显著好处.
- 调整后的几率比率 (AOR) 对于减轻PIM的处方是1.58 (95% CI,1.07-2.34) 赞成干预.
- 该研究包括每位居民平均10种药物,中位数为3种PIM,突出显示了这种人群中药物管理的复杂性.
结论:
- 电子决策支持,当与现有工作流程集成时,提供了一个可扩展和有效的方法,用于在长期护理环境中解读PIM.
- 这些发现强烈表明,药物评价应该经常将抑郁症纳入老年人护理的标准组成部分.
- 实施此类系统可以改善弱势老年人群的药物安全和健康结果.
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