药师主导老年多重用药患者管理的思考和实践

doi:10.19803/j.1672-8629.20220518

中国药物警戒 ›› 2023, Vol. 20 ›› Issue (7): 817-821.
DOI: 10.19803/j.1672-8629.20220518

药师主导老年多重用药患者管理的思考和实践

朱愿超¹, 赵明¹, 胡欣¹, 施红^2,*

¹北京医院药学部,国家老年医学中心,中国医学科学院老年医学研究院,北京市药物临床风险与个体化应用评价重点实验室（北京医院）,北京 100730;
²北京医院老年科,北京 100730

收稿日期:2022-09-02 出版日期:2023-07-15 发布日期:2023-07-14
通讯作者: ^*施红,女,硕士,主任医师,老年医学和血液病学。Email：shihong100@126.com
作者简介:朱愿超,女,硕士,副主任药师,老年药学及抗感染药物治疗。
基金资助:
中央高水平医院临床科研业务费（BJ-2022-173）; 国家重点研发计划（2020YFC2008304、2021YFE0111800）

Pharmacist-led practice in the management of elderly patients with polypharmacy

ZHU Yuanchao¹, ZHAO Ming¹, HU Xin¹, SHI Hong^2,*

¹Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing 100730, China;
²Department of Geriatric, Beijing Hospital, Beijing 100730, China

Received:2022-09-02 Online:2023-07-15 Published:2023-07-14

摘要/Abstract

摘要： 目的阐明临床药师参与多重用药管理的重要性。方法本院建立了老年多学科合作（MDT）管理团队,并开展了老年多重用药患者的会诊,开设了老年多重用药门诊,共同提高药物治疗管理水平。结果根据本院药师在老年多重用药门诊患者和住院患者管理中的实践,探索建立了标准化的老年多重用药患者的用药适宜性评估流程。结论老年多重用药患者管理是老年药学的重要工作内容,应采取各种方法提高老年多重用药管理水平。

关键词: 多重用药, 老年, 多学科, 处方精简, 老年综合评估

Abstract: Objective To clarify the importance of clinical pharmacists participating in the management of elderly polypharmacy. Methods A multidisciplinary team (MDT) management team for the elderly has been established in our hospital. On this basis, an MDT consultation system and multi-drug clinic has been set up to improve the level of treatment management. Results According to the practice of pharmacists in our hospital in the management of elderly patients with polypharmacy, we explored and established a standardized medication appropriate assessment process, outpatient admission process and prescription streamlining process for patients with polypharmacy. Conclusion The management of elderly patients with polypharmacy is an important part of geriatric pharmacy, and various methods should be taken to improve the management level of elderly patients with polypharmacy.

Key words: polypharmacy, elderly, MDT, prescription streamlining, comprehensive geriatric assessment

中图分类号:

R969.3

朱愿超, 赵明, 胡欣, 施红. 药师主导老年多重用药患者管理的思考和实践[J]. 中国药物警戒, 2023, 20(7): 817-821.

ZHU Yuanchao, ZHAO Ming, HU Xin, SHI Hong. Pharmacist-led practice in the management of elderly patients with polypharmacy[J]. Chinese Journal of Pharmacovigilance, 2023, 20(7): 817-821.

参考文献

[1] United Nations International Population Society. Dictionary of Demography(人口学词典)[M].Beijing: The Commercial Press, 1992.
[2] Percentage of Total Population by Broad Age Groups. World Population Prospects2012[EB/OL]. (2018-11-21)[2021-10-01]. https://population.un.org/wpp/Download/Standard/Population/.
[3] National Bureau of Statistics of the People’s Republic of China. Communiqué of the Seventh National Population Census (No. 5)[EB/OL]. (2021-05-11)(2022-11-30).http://www.stats.gov.cn/tjsj/tjgb/rkpcgb/qgrkpcgb/202106/t20210628_1818824.html.
[4] FRIED TR, NIEHOFF K, TJIA J, et al.A delphi process to address medication appropriateness for older persons with multiple chronic conditions[J]. BMC Geriatr, 2016, 16: 67.
[5] KAUFMAN DW, KELLY JP, ROSENBERG L, et al.Recent patterns of medication use in the ambulatory adult population of the United States: the slone survey[J]. JAMA, 2002, 287(3): 337-344.
[6] WANG K, TANG J, YANG K, et al.A Cross-sectional study on the status of polypharmacy among older Chinese inpatients with chronic diseases in 27 hospitals from 14 provinces[J]. Chin J Pharmacoepidemiol(药物流行病学杂志), 2022, 31(1): 38-44.
[7] XUE ZL, LI H.Investigations of drug use in elderly inpatients[J].Chin J Clin Res(中国临床研究), 2012, 25(1): 79.
[8] YIN LX, ZHANG LH.Special Population Medication Guidance Series: Medication Guidance for the Elderly (特殊人群用药指导丛书:老年人用药指导)[M]. Beijing: People’s Health Publishing House, 2012.
[9] DONG M, ZOU T, XU L, et al.Effects of polypharmacy on long-term prognosis of elderly patients with coronary heart disease and atrial fibrillation[J]. Chin J Pharmacov(中国药物警戒), 2021, 18(2): 126-132.
[10] STEINMAN MA, LANDEFELD CS, ROSENTHAL GE, et al.Polypharmacy and prescribing quality in older people[J]. J Am Geriatr Soc, 2006, 54: 1516-1523.
[11] LIU JH,SHI H,XI H.Thinking about the problem of polypharmacy of the elderly and suggestions on the strategy of drug use for the elderly[J]. Chin J Clin Healthc(中国临床保健杂志), 2018, 21(2): 160-163.
[12] Rational Drug Use Branch of China Association of Geriatric Research. Criteria of potentially inappropriate medication for older adults in China[J]. Adverse Drug Reactions Journal(药物不良反应杂志), 2018, 20(1): 2-8.
[13] Geriatric Endocrinology and Metabolic Diseases Branch, Chinese Geriatric Health Care Medical Research Society. Expert consensus on the safety management of polypharmacy in the elderly[J]. Chin Gen Pract(中国全科医学), 2018, 21(29): 3533-3544.
[14] By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults[J]. J Am Geriatr Soc, 2019, 67(4):674-694.
[15] O’MAHONY D, O’SULLIVAN D, BYRNE S, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2[J]. Age Ageing, 2015, 44(2):213-218.
[16] MUTH C, HARDER S, UHLMANN L, et al.Pilot study to test the feasibility of a trial design and complex intervention on prioritising multi-medication in multi-morbidity in general practices(PRIMUM pilot)[J]. BMJ Open, 2016, 6(7): e011613.
[17] DRENTH-VAN AC, VAN MARUM RJ, KNOL W, et al.Prescribing optimization method for improving prescribing in elderly patients receiving polypharmacy: results of application to case histories by general practitioners[J]. Drugs Aging, 2009, 26(8): 687-701.
[18] HAQUE R.ARMOR: a tool to evaluate polypharmacy in elderly persons[J]. Annals of Long-Term Care, 2009, 17(6): 26.
[19] KOMAGAMINE J, SUGAWARA K, KAMINAGA M, et al.Study protocol for a single-center, prospective, non-blinded, randomised, 12-month, parallel-group superiority study to compare the efficacy of pharmacist intervention versus usual care for elderly patients hospitalised in orthopaedic wards[J]. BMJ Open, 2018, 8(7): e021924.
[20] SHIM YW, CHUA SS, WONG HC, et al.Collaborative intervention between pharmacists and physicians on elderly patients: a randomized controlled trial[J]. Ther Clin Risk Manag, 2018, 14: 1115-1125.
[21] SCOTT IA, HILMER SN, REEVE E, et al.Reducing inappropriate polypharmacy: the process of deprescribing[J]. JAMA Intern Med, 2015, 175(5): 827-834.
[22] SCOTT IA, PILLANS PI, BARRAS M, et al.Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review[J]. Ther Adv Drug Saf, 2018, 9(9): 559-573.
[23] LI WJ, YAN YY, YI ZM, et al.Retrospective study on the effect of deprescribing in elderl y inpatients with polypharmcy[J]. Chin Hosp Pharm J(中国医院药学杂志), 2021, 41(9): 944-947.
[24] KALUNGIA AC, KAMANGA T.Patients’satisfaction with outpatient pharmacy services at the University Teaching Hospital and Ndola Central Hospital in Zambia[J]. J Prevent Rehabilitat Med, 2016, 15: 229-230.
[25] ZHAI WJ, WANG S, GUO BR, et al.Investigation and analysis of satisfaction of patients in pharmacy outpatients[J]. Chinese Remedies & Clinics(中国药物与临床), 2022, 22(5): 439-442.
[26] National Health Commission of the People's Republic of China, National Administration of Traditional Chinese Medicine. Opinions on accelerating the high-quality development of pharmaceutical services[EB/OL]. (2018-11-21)[2021-10-01]. http://www.nhc.gov.cn/yzygj/s7659/201811/ac342952cc114bd094fec1be086d2245.shtml.
[27] WANG CY, HUANG YK, XI XY, et al.Literature review on implementation modes of practicing for clinical pharmacists in China[J]. Chin J Hosp Pharm(中国医院药学杂志), 2021, 41(16): 1595-1600.
[28] YANG LH, WEN ZY, LIU MC, et al.Experience of multi-disciplinary team mode in 40 tertiary public hospitals in China[J]. Chin J Hosp Admin(中华医院管理杂志), 2021, 37(6): 505-508.
[29] DAI J, JI C, LI LT, et al.Effect of multi-disciplinary cooperative blood glucose management model involving clinical pharmacists on perioperative glucose controls[J]. Chin Hosp Pharm J(中国医院药学杂志), 2021, 41(2): 215-219.
[30] HU XL, ZHAN SP, WANG Y, et al.Polypharmacy management and pharmaceutical care of clinical pharmacists participating in the team of comprehensive geriatric assessment[J]. Chin Pharm J(中国药学杂志), 2017, 52(4): 323-326.
[31] LIU H, XIA W, CHEN WJ, et al.Quality improvement of home-based pharmaceutical care[J]. Chin Pharm(中国药业), 2022, 31(4): 32-36.
[32] JIA BY, ZHOU S, ZHOU Y, et al.Systematic evaluation and meta-analysis of the effect of home pharmaceutical care in elderly patients with poypharmacy[J]. Chin Hosp Pharm J(中国医院药学杂志), 2022, 2: 189-195.

药师主导老年多重用药患者管理的思考和实践

Pharmacist-led practice in the management of elderly patients with polypharmacy

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