PDF(Pubmed)
Abstract：
Backgrounds and Objectives: Using certain medications during an intercurrent illness can increase the risk of drug related problems (DRP) occurring such as acute kidney injury (AKI). Medications that increase this risk include sulfonylureas, angiotensin converting enzyme inhibitors, diuretics, metformin, angiotensin receptor blockers, non-steroidal anti-inflammatories drugs, and sodium glucose co-transporter 2 inhibitors (SADMANS). Sick day medication guidance (SDMG) recommends withholding SADMANS medications during an intercurrent illness where adequate fluid intake cannot be maintained. But uptake of these recommendations is poor, and it is not known whether Australian pharmacists currently provide these recommendations during home medicine reviews (HMR) as per SDMG. We aimed to gain an understanding of the characteristics of DRP identified by pharmacists during HMR, especially those relating to SADMANS medications. Materials and Methods: We conducted a retrospective audit of 201 randomly selected HMR reports, conducted by accredited pharmacists from 2020 to 2022, that were analysed in 2023. All DRP and recommendations were categorised using a modified DOCUMENT system. Results: Overall, over 98% of participants experienced a DRP and a total of 710 DRP were found, where participants experienced an average of 4.0 ± 2.0 DRP each. Non-SADMANS medications accounted for 83.1% of all DRPs, with nervous system medications contributing the most. Common problems seen in non-SADMANS medications were related to toxicity, over/underdosing and undertreating. Diuretics contributed most to DRP in SADMANS medications. Problems with SADMANS were mainly related to toxicity and contraindications. No pharmacists provided SDMG despite 71.1% of participants using at least one SADMANS medication. Conclusions: We conclude that DRP remain prevalent in community pharmacy settings. Sick day recommendations were not provided in the HMRs included in our study, possibly due to lack of pharmacist knowledge and awareness. To ensure best practice, more research should be conducted to determine pharmacists\' knowledge of and barriers to provision of sick day recommendations.
摘要：
背景和目的：在并发疾病期间使用某些药物会增加发生药物相关问题（DRP）的风险，例如急性肾损伤（AKI）。增加这种风险的药物包括磺酰脲类，血管紧张素转换酶抑制剂，利尿剂,二甲双胍,血管紧张素受体阻滞剂，非甾体类抗炎药,和钠葡萄糖共转运蛋白2抑制剂（SADMANS）。病假用药指导（SDMG）建议在无法维持足够的液体摄入量的并发疾病期间，不要使用SADMANS药物。但是对这些建议的理解很差，目前尚不清楚澳大利亚药剂师是否根据SDMG在家庭医学评论（HMR）中提供了这些建议。我们的目标是了解药剂师在HMR期间确定的DRP的特征，特别是那些与萨多曼人有关的药物。材料和方法：我们对随机选择的201份HMR报告进行了回顾性审计，由认可的药剂师于2020年至2022年进行，并于2023年进行了分析。所有DRP和建议均使用改良的DOCUMENT系统进行分类。结果：总体而言，超过98%的参与者经历了DRP，总共发现了710个DRP，参与者平均每人经历4.0±2.0DRP。非SADMANS药物占所有DRPs的83.1%，神经系统药物的作用最大。在非SADMANS药物中常见的问题与毒性有关，过量/不足和治疗不足。利尿剂在SADMANS药物中对DRP的贡献最大。SADMANS的问题主要与毒性和禁忌症有关。尽管71.1%的参与者使用至少一种SADMANS药物，但没有药剂师提供SDMG。结论：我们得出的结论是，DRP在社区药房环境中仍然很普遍。我们研究中的HMR中没有提供病假建议，可能是由于缺乏药剂师的知识和意识。为了确保最佳实践，应该进行更多的研究，以确定药剂师对提供病假建议的知识和障碍。
