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Abstract：
BACKGROUND: Polypharmacy is common in older adults with psychiatric disorders, but no consensus has reached about the reliable indicators evaluating the benefits and risks of drug-drug interactions (DDIs) in polypharmacy. We aimed to identify indicators suitable for evaluating the clinical significance of DDIs in polypharmacy in older adults with psychiatric disorders.
METHODS: The online tools were used to distribute and collect the questionnaires. The Delphi method was applied to analyze experts\' opinions. The degree of authority and coordination of experts were analyzed using the coefficient of variation, coefficient of coordination, expert\'s judgment factor, familiarity with the study content factor, and Kendall coordination coefficient. Statistical analysis was conducted using the IBM SPSS® Statistics Package version 26.0.
RESULTS: After three rounds of expert consultation, five primary and eleven secondary indicators were identified. The primary \"pharmacodynamic indicator\" included \"severity of adverse drug reactions\", \"duration of adverse drug reaction\", \"symptom relief\", \"time to onset of symptomatic relief\", \"number of days in hospital\", and \"duration of medication\". The secondary \"pharmacokinetic indicator\" contained \"dosage administered\" and \"dosing intervals\". The primary \"patient tolerance indicator\" contained one secondary indicator of \"patient tolerability\". The primary indicator \"patient adherence\" contained one secondary indicator of \"patient adherence to medication\". The primary indicator \"cost of drug combination\" contained one secondary indicator of \"readmission\". These indicators were used to determine the clinical significance of DDIs during polypharmacy.
CONCLUSIONS: The clinical significance of drug combinations should be taken into account when polypharmacy is used in the elderly. The five primary indicators and eleven secondary indicators might be preferred to evaluate their risks and benefits. Medication management in this population requires a multidisciplinary team, in which nurses play a key role. Future research should focus on how to establish efficient multidisciplinary team workflows and use functional factors to assess DDIs in polypharmacy for psychiatric disorders.
METHODS: The online tools were used to distribute and collect the questionnaires. The Delphi method was applied to analyze experts\' opinions. The degree of authority and coordination of experts were analyzed using the coefficient of variation, coefficient of coordination, expert\'s judgment factor, familiarity with the study content factor, and Kendall coordination coefficient. Statistical analysis was conducted using the IBM SPSS® Statistics Package version 26.0.
RESULTS: After three rounds of expert consultation, five primary and eleven secondary indicators were identified. The primary \"pharmacodynamic indicator\" included \"severity of adverse drug reactions\", \"duration of adverse drug reaction\", \"symptom relief\", \"time to onset of symptomatic relief\", \"number of days in hospital\", and \"duration of medication\". The secondary \"pharmacokinetic indicator\" contained \"dosage administered\" and \"dosing intervals\". The primary \"patient tolerance indicator\" contained one secondary indicator of \"patient tolerability\". The primary indicator \"patient adherence\" contained one secondary indicator of \"patient adherence to medication\". The primary indicator \"cost of drug combination\" contained one secondary indicator of \"readmission\". These indicators were used to determine the clinical significance of DDIs during polypharmacy.
CONCLUSIONS: The clinical significance of drug combinations should be taken into account when polypharmacy is used in the elderly. The five primary indicators and eleven secondary indicators might be preferred to evaluate their risks and benefits. Medication management in this population requires a multidisciplinary team, in which nurses play a key role. Future research should focus on how to establish efficient multidisciplinary team workflows and use functional factors to assess DDIs in polypharmacy for psychiatric disorders.
摘要：
背景：多重用药在患有精神疾病的老年人中很常见，但是对于评估多重用药中药物-药物相互作用（DDI）的益处和风险的可靠指标尚未达成共识。我们旨在确定适合评估DDI在患有精神疾病的老年人多重用药中的临床意义的指标。
方法：使用在线工具分发和收集问卷。采用德尔菲法分析专家意见。利用变异系数分析了专家的权威性和协调性,协调系数，专家的判断因素，熟悉学习内容因素，和肯德尔协调系数。使用IBMSPSS®StatisticsPackage版本26.0进行统计分析。
结果：经过三轮专家咨询，确定了5个主要指标和11个次要指标。主要的“药效学指标”包括“药物不良反应的严重程度”，“药物不良反应的持续时间”，“症状缓解”，“症状缓解开始的时间”，\"住院天数\",和“药物持续时间”。次要“药代动力学指标”包含“给药剂量”和“给药间隔”。主要的“患者耐受性指标”包含一个次要指标“患者耐受性”。主要指标“患者依从性”包含一个次要指标“患者对药物的依从性”。主要指标“药物组合成本”包含一个次要指标“再接纳”。这些指标用于确定在多重用药期间DDI的临床意义。
结论：老年患者使用复方制剂时，应考虑联合用药的临床意义。五个主要指标和11个次要指标可能是评估其风险和收益的首选。该人群的药物管理需要多学科团队，其中护士起着关键作用。未来的研究应该集中在如何建立有效的多学科团队工作流程，并使用功能因素来评估多药治疗精神疾病的DDI。
方法：使用在线工具分发和收集问卷。采用德尔菲法分析专家意见。利用变异系数分析了专家的权威性和协调性,协调系数，专家的判断因素，熟悉学习内容因素，和肯德尔协调系数。使用IBMSPSS®StatisticsPackage版本26.0进行统计分析。
结果：经过三轮专家咨询，确定了5个主要指标和11个次要指标。主要的“药效学指标”包括“药物不良反应的严重程度”，“药物不良反应的持续时间”，“症状缓解”，“症状缓解开始的时间”，\"住院天数\",和“药物持续时间”。次要“药代动力学指标”包含“给药剂量”和“给药间隔”。主要的“患者耐受性指标”包含一个次要指标“患者耐受性”。主要指标“患者依从性”包含一个次要指标“患者对药物的依从性”。主要指标“药物组合成本”包含一个次要指标“再接纳”。这些指标用于确定在多重用药期间DDI的临床意义。
结论：老年患者使用复方制剂时，应考虑联合用药的临床意义。五个主要指标和11个次要指标可能是评估其风险和收益的首选。该人群的药物管理需要多学科团队，其中护士起着关键作用。未来的研究应该集中在如何建立有效的多学科团队工作流程，并使用功能因素来评估多药治疗精神疾病的DDI。
