A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy

被引:415
作者
Hanlon, JT
Weinberger, M
Samsa, GP
Schmader, KE
Uttech, KM
Lewis, IK
Cowper, PA
Landsman, PB
Cohen, HJ
Feussner, JR
机构
[1] DUKE UNIV, MED CTR, DIV GERIATR, DURHAM, NC 27710 USA
[2] DUKE UNIV, MED CTR, DIV GEN INTERNAL MED, DURHAM, NC 27710 USA
[3] DUKE UNIV, MED CTR, DIV CARDIOL, DURHAM, NC 27710 USA
[4] DUKE UNIV, MED CTR, DEPT MED, DURHAM, NC 27710 USA
[5] DUKE UNIV, MED CTR, DIV BIOMETRY & MED INFORMAT, DURHAM, NC 27710 USA
[6] VET AFFAIRS MED CTR, CTR HLTH SERV RES PRIMARY CARE, DURHAM, NC 27705 USA
[7] VET AFFAIRS MED CTR, CTR GERIATR RES EDUC & CLIN, DURHAM, NC 27705 USA
[8] VET AFFAIRS MED CTR, DEPT PHARM SERV, DURHAM, NC 27705 USA
[9] UNIV N CAROLINA, SCH PHARM, CHAPEL HILL, NC USA
关键词
D O I
10.1016/S0002-9343(97)89519-8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
PURPOSE: TO evaluate the effect of sustained clinical pharmacist interventions involving elderly outpatients with polypharmacy and their primary physicians. PATIENTS AND METHODS: Randomized, controlled trial of 208 patients aged 65 years or older with polypharmacy (greater than or equal to 5 chronic medications) from a general medicine clinic of a Veterans Affairs Medical Center. A clinical pharmacist met with intervention group patients during all scheduled visits to evaluate their drug regimens and make recommendations to them and their physicians. Outcome measures were prescribing appropriateness, health-related quality of life, adverse drug events, medication compliance acid knowledge, number of medications, patient satisfaction, and physician receptivity. RESULTS: Inappropriate prescribing scores declined significantly more in the intervention group than in the control group by 3 months (decrease 24% versus 6%, respectively; P = 0.0006) and was sustained at 12 months (decrease 28% versus 5%, respectively; P = 0.0002). There was no difference between groups at closeout in health-related quality of life (P = 0.99). Fewer intervention than control patients (30.2% versus 40.0%; P = 0.19) experienced adverse drug events. Measures for most other outcomes remained unchanged in both groups. Physicians were receptive to the intervention and enacted changes recommended by the clinical pharmacist more frequently than they enacted changes independently for control patients (55.1% versus 19.8%; P <0.001). CONCLUSIONS: This study demonstrates that a clinical pharmacist providing pharmaceutical care for elderly primary care patients can reduce inappropriate prescribing and possibly adverse drug effects without adversely affecting health-related quality of life.
引用
收藏
页码:428 / 437
页数:10
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