| Summary: | 碩士 === 國防醫學院 === 藥學研究所 === 101 === Abstract
Background:
Frequent attenders (FA) (or high users) account for relative large proportion of ambulatory care visits and a large number of prescriptions. Most of FAs are elderly people (age≧65) with multiple diseases and polypharmacy. Potentially inappropriate medication (PIM) prescribing in elderly is quite prevalent because of their altered pharmacodynamics and pharmacokinetics, multiple drug uses, multiple comorbidities and poor adherence. Thus the Bureau of National Health Insurance (BNHI) and the Taiwan Pharmacist Association (TPA) in 2010 cooperated to conduct a pilot project allowing trained community pharmacists to go to FAs’ home and provided safe, effective and appropriate pharmaceutical care . And the TPA in 2011designed a computerized home care management system for the better pharmacy practice.
Objective:
The purpose of this study was to validate the efficiency of the computerized home pharmaceutical care management system to detect inappropriate medication in elderly patients. And to describe the drug therapy problems (DTP) found by the trained pharmacists and the prevalence of PIM using Beers criteria 2012 for the FA elderly.
Method:
Develop a computer program ,which would identify potentially inappropriate drug prescriptions based on Beers criteria 2012 .The database of computerized home pharmaceutical care management system was utilized for this cross-sectional study. There are four stages: (1) descriptive analysis of elderly FAs and their drug utilization situation, drug therapy problems. (2) The PIM detected by computer program as standard to validate the efficiency of the computerized home pharmaceutical care management system. (3) Analysis the prevalence of PIM of elderly patient of FAs. And the trend of PIM for the 8 home visits. (4) The PIM detected by computer program as standard to validate the efficiency of the PIM discovered by pharmacists.
Main results:
Total of 138 pharmacists took care of 2,805 elderly FAs. The average age of FAs were 77 ± 6.7 years old. Male accounted for 1, 513 ( 54 %), and the main reason for frequent attendance was unresolved physical problems ( 54.3 %).The average medication use was 9.48 ± 6.17for 4± 2.1 diseases. Top three diseases were hypertension (HBP) ( 65.1% ), skeletal diseases ( 54.3 % ), diabetes ( 35.4 %).
The 138 pharmacists discovered 1,421 drug therapy problems, 34% suggestions were accepted by the physicians and make drugs changed. The top three drug therapy problems were duplications ( 14%, n=205 ), need another drug to enhance therapy (10.8%, n=154), untreated emergency situation ( 10.5%, n=145 ). The PIMs discovered by pharmacists were 79 ( 5.5% ).
The efficiency of the computerized home pharmaceutical care management system was 11.9%. And the efficiency of pharmacists to find about inappropriate medication use of Beers criteria 2012 was 0.41%. The prevalence of PIM in elderly FAs was 66.31% . And the trend of PIM over total drugs was not significant changed by visits ( p = 0.135).
Conclusions:
Periodically updating drug items in computerized home pharmaceutical management system, the completeness of data that about elderly potential inappropriate medication,to improve the quality of medication use of the elderly.pharmacists keyed in, to key in diseases name instead of diseases system could mostly affect the efficiency of the computerized home pharmaceutical care management system to detect the PIMs. Thus, it should be updated and revised regularly to ensure its service. The revised home pharmaceutical care management system can detect PIMs accurately and rapidly. The professional medical persons should be educated more about elderly potential inappropriate medication,to improve the quality of medication use of the elderly.
Keyword :
frequent attenders, elderly people, potentially inappropriate medication, drug therapy problems, home pharmaceutical care
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