评估药剂师主导的药物系统评价的有效性:潜在不适当的药物(PIM),健康结果和成本。
预期,打开,对照和整群随机对照临床试验。
来自巴利阿里群岛的六个初级保健诊所。
42个集群(每组21个),纳入549例年龄≥65岁且≥5种慢性药物治疗的患者;其中277例被分配到干预组(IG),272例被分配到对照组(CG).如果患者被排除在外:制度化,暂时流离失所,在私人医疗保健下例行监测,或家庭护理。
药剂师使用显式和隐式方法的组合进行PIM检测;并向医生传达最合适的治疗策略。
PIM患者的比例和PIM/患者的平均数量(主要结果);和发病率,死亡率,和成本(次要结局)进行评估.
遵循意向治疗方法,定量和定性结果变量通过T-Student和卡方检验进行比较,分别。结果提供了定性结果的比例差异和定量结果的平均值差异,分别具有95%置信区间(95%CI)。
干预后,与CG相比,IG中PIM患者的比例下降了13.7%(95%CI:9.3;18.2)。与CG相比,IG的PIM/患者的平均数量和PIM/患者的平均费用减少了0.43(95%CI:0.32;0.54)和72.11€(95%CI:26.15;118.06),分别。然而,在发病率方面没有观察到统计学上的显著差异,死亡率或医疗资源成本。
PIM检测和药剂师提供的建议有助于显著降低PIM和药物支出;但发病率没有达到统计学上的显著差异,死亡率,和医疗资源成本。
To assess the effectiveness of a pharmacist-led systematic review of medications on: potentially inappropriate medications (PIM), health outcomes and costs.
Prospective, open, controlled and cluster-randomized clinical trial.
Six primary care clinics from Balearic Islands.
Forty-two clusters (21 per group), and 549 patients aged ≥65 years and ≥5 chronic medications were included; of which 277 were allocated to Intervention Group (IG) and 272 to Control Group (CG). Patients were excluded if they were: institutionalized, temporarily displaced, routinely monitored under private healthcare, or home care.
PIM detection by the pharmacist using a combination of explicit and implicit methods; and communication of the most appropriate therapeutic strategies to the physician.
Proportion of patients with PIM and mean number of PIM/patient (main outcomes); and morbidity, mortality, and costs (secondary outcomes) were assessed.
Following an intention-to-treat approach, quantitative and qualitative outcomes variables were compared by T-Student and Chi-square tests, respectively. Results were providing as difference in proportions for qualitative outcomes and difference in means for quantitative outcomes with respective 95% confidence intervals (95% CI).
After intervention, proportion of patients with PIM decreased by 13.7% (95% CI: 9.3; 18.2) more in IG than CG. Mean number of PIM/patient and mean cost of PIM/patient decreased by 0.43 (95% CI: 0.32; 0.54) and 72.11€ (95% CI: 26.15; 118.06) more in IG than CG, respectively. However, no statistically significant differences were observed in morbidity, mortality or costs of healthcare resources.
PIM detection and recommendations provided by pharmacist could contribute to reduce significantly PIM and drug expenditure; but without reaching statistically significant differences in morbidity, mortality, and healthcare resources costs.