■目前,在老年住院患者中,临床上对多重用药的有效干预措施尚无共识。
■为了评估基于多学科团队的药物优化对生存的影响,计划外的医院访问,以及老年多重用药住院患者的再住院。
这项开放标签的随机临床试验是在日本一家社区医院的8个内科住院病房进行的。参与者包括65岁或以上的住院患者,他们正在接受5种或更多的常规药物治疗。入学时间为2019年5月21日至2022年3月14日。从2023年9月至2024年5月进行统计分析。
参与者被随机分配接受药物优化干预或常规治疗,包括药物和解。干预措施包括使用STOPP(老年人处方筛查工具)/START(提醒正确治疗的筛查工具)标准的药物审查。随后是由多学科团队为参与者及其主治医师制定的药物优化建议.出院时,将药物优化总结发送给患者的初级保健医师和社区药剂师.
■主要结局是死亡的复合结果,计划外的医院访问,12个月内再住院。次要结果包括处方药的数量,falls,和不良事件。
■在2019年5月21日至2022年3月14日之间,442名参与者(平均[SD]年龄,81.8[7.1]岁;223[50.5%]女性)被随机分配到干预(n=215)和常规护理(n=227)。出院时,干预组使用1种或更多种潜在不适当药物的患者比例明显低于常规护理组(26.2%vs33.0%;调整后比值比[OR],0.56[95%CI,0.33-0.94];P=0.03),6个月时(27.7%对37.5%;调整后OR,0.50[95%CI,0.29-0.86];P=0.01),12个月时(26.7%对37.4%;调整后OR,0.45[95%CI,0.25-0.80];P=.007)。主要复合结局发生在干预组的106名参与者(49.3%)和常规护理组的117名(51.5%)(分层风险比,0.98[95%CI,0.75-1.27])。两组之间的不良事件相似(干预组123[57.2%],常规护理组135[59.5%])。
■在这项针对老年多药住院患者的随机临床试验中,多学科去处方干预并没有减少死亡,计划外的医院访问,或12个月内再次住院。干预措施有效地减少了药物的数量,对临床结果没有明显的不利影响。甚至在老年多重用药的住院患者中。
■UMIN临床试验注册中心:UMIN000035265。
UNASSIGNED: There is currently no consensus on clinically effective interventions for polypharmacy among older inpatients.
UNASSIGNED: To evaluate the effect of multidisciplinary team-based medication optimization on survival, unscheduled hospital visits, and rehospitalization in older inpatients with polypharmacy.
UNASSIGNED: This open-label randomized clinical trial was conducted at 8 internal medicine inpatient wards within a community hospital in Japan. Participants included medical inpatients 65 years or older who were receiving 5 or more regular medications. Enrollment took place between May 21, 2019, and March 14, 2022. Statistical analysis was performed from September 2023 to May 2024.
UNASSIGNED: The participants were randomly assigned to receive either an intervention for medication optimization or usual care including medication reconciliation. The intervention consisted of a medication review using the STOPP (Screening Tool of Older Persons\' Prescriptions)/START (Screening Tool to Alert to Right Treatment) criteria, followed by a medication optimization proposal for participants and their attending physicians developed by a multidisciplinary team. On discharge, the medication optimization summary was sent to patients\' primary care physicians and community pharmacists.
UNASSIGNED: The primary outcome was a composite of death, unscheduled hospital visits, and rehospitalization within 12 months. Secondary outcomes included the number of prescribed medications, falls, and adverse events.
UNASSIGNED: Between May 21, 2019, and March 14, 2022, 442 participants (mean [SD] age, 81.8 [7.1] years; 223 [50.5%] women) were randomly assigned to the intervention (n = 215) and usual care (n = 227). The intervention group had a significantly lower percentage of patients with 1 or more potentially inappropriate medications than the usual care group at discharge (26.2% vs 33.0%; adjusted odds ratio [OR], 0.56 [95% CI, 0.33-0.94]; P = .03), at 6 months (27.7% vs 37.5%; adjusted OR, 0.50 [95% CI, 0.29-0.86]; P = .01), and at 12 months (26.7% vs 37.4%; adjusted OR, 0.45 [95% CI, 0.25-0.80]; P = .007). The primary composite outcome occurred in 106 participants (49.3%) in the intervention group and 117 (51.5%) in the usual care group (stratified hazard ratio, 0.98 [95% CI, 0.75-1.27]). Adverse events were similar between each group (123 [57.2%] in the intervention group and 135 [59.5%] in the usual care group).
UNASSIGNED: In this randomized clinical trial of older inpatients with polypharmacy, the multidisciplinary deprescribing intervention did not reduce death, unscheduled hospital visits, or rehospitalization within 12 months. The intervention was effective in reducing the number of medications with no significant adverse effects on clinical outcomes, even among older inpatients with polypharmacy.
UNASSIGNED: UMIN Clinical Trials Registry: UMIN000035265.