打破障碍:集群随机试验的可行性,评估用于识别和改善药物不良反应的工具
Vera Logan1, David Hughes1, Adam Turner1
1Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, UK.
BMJ open
|January 27, 2026
概括
一项试点研究发现,ADRe Profile系统可用于监测英国初级保健中的老年患者,成功识别了许多健康问题. 尽管在招聘一般医师方面存在挑战,但患者的招聘和留住率很高,显示出改善患者安全的潜力.
科学领域:
- 老年医学 老年医学
- 药物监督 药物监督 药物监督
- 医疗保健服务研究 医疗服务研究
背景情况:
- 药物不良反应 (ADRs) 具有重大风险,特别是在多种药物治疗的老年患者中.
- 该ADRe Profile系统旨在主动识别和管理ADR和相关问题,以防止临床恶化.
- 之前的研究强调了在初级保健机构需要有效的患者监测系统.
研究的目的:
- 评估在英国初级保健中对ADRe Profile系统进行集群随机对照试验 (RCT) 的可行性.
- 评估该系统在识别和解决老年人药物不良反应和相关问题的潜力.
- 确定关键可行性指标,包括招聘,留住,坚持,临床影响和成本.
主要方法:
- 一个集群RCT的初步可行性研究在英国西南威尔士的一般实践 (GPs) 中进行.
- 20名年龄在64岁以上的参与者被录取,他们被处方了四种以上的长期药物.
- 参与者使用ADRe档案,在研究人员的支持下,报告健康问题,生命体征和症状,捕获不总是存在于现有记录中的数据.
主要成果:
- 招聘全科医生实践是具有挑战性的 (<1%的联系人),但患者招聘 (51.3%的接触) 和留住 (100%) 取得了成功.
- 该ADRe档案的完成率达到了98.29%,确定了289个临床问题,包括疼痛,呼吸不良,头,出血/伤和跌倒.
- 大多数确定的问题 (90%) 和生命体征 (78%) 没有出现在现有的患者记录中,有大量的调查和干预建议.
结论:
- 在英国的初级保健中,ADRe Profile的集群RCT是可行的,尽管临床医生参与和实践招聘存在挑战.
- ADRe Profile 系统显示了在弱势老年人群中积极识别和管理ADR相关问题的巨大潜力.
- 该系统符合世界卫生组织的患者安全目标,并可以通过解决患者报告的问题来提高医疗保健结果.
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