Construction The Process Of Medication Review In Elderly Inpatients With Polypharmacy

ObjectiveTo investigate the impact of pharmaceutical interventions on prescribing and clinical and relevant endpoints for elderly hospitialized patients with polypharmacy,identifyth e core elements of pharmaceutical interventions.Questionnaires were conducted on patients with polypharmacy in our elderly ward,to understand the characteristics of disease distribution,characteristics of medications,and incidence of adverse drug rea ctions.Three criteria were used to determine the prevelence of potentially inappropr iate medication and related factors.Based on the principle of safe,effective and rat ional drug use,combined with the characteristics of inpatients in the elderly ward,t he structured process of inappropriate medication system was constructed.Methods1.A systematic literature search in Pubmed,Embase,Web of Science,the Cochrane Library and CNKI(2018.4)with the targeting patients>65 years with polypharmacy(?4 drugs),focusing on patient-relevant outcome measures,was conducted.We included controlled studies aiming to reduce polypharmacy.Two reviewers independently assessed studies for eligibility,extracted data and evaluated study quality.2.Questionnaire and retrospective analysis:Questionnaire survey and retrospective analysis were conducted on 2017.5-2018.10 hospitalized patients with polypharmacy in our elderly ward.Multivariate regression analysis was used to analyse the main factors of inappropriate medication and the factors of adverse drug reactions.Results1.Twenty studies,including 16179 participants,were included 12 randomized controlle d trials.Compared with the control group,the OR of all-cause mortality(7 articles)in the intervention group was 0.93(0.71-1.20),with no significant differences.A greater reduction in MAI scores between baseline and follow-up was seen in the in tervention group when compared with the control group(5 articles;MD-4.65(-5.50,-3.81)).The number of inappropriate medication in the intervention group was s ignificantly reduced(4 articles;MD-0.09(-0.10-0.07)).2.A total of 398 were analysed;Potentially inappropriate medications were present in 72.36%,48.74%,and 80.65%of participants,according to the 2015 Beers criteri a,2014 STOPP/START criteria,and the Chinese PIM criteria respectively.The mos t frequent PIMs were intermediate and long-acting benzodiazepines,calcium channel blockers,clopidogrel according to the 2015 Beers criteria,2014 STOPP/START criter ia,and the Chinese PIM criteria respectively.The Chinese PIM criteria detected the h ighest number of PIM compared with the other two criterias.The 2015 Beers and th e Chinese PIM criteria indicated a moderate coherence,whereas the 2014 STOPP/S TART criteria showed poor concordance with the other two criteria.The most comm on factor associated with PIM by all three criterias was the symptom of insomnia.The length of hospitalized days,atrial fibrillation,and the number of long-term med ications were the factors of PIM by using Beers criteria;Length of hospitalized sta y,hypertension,and age>75 years were risk factors for PIM by the STOPP/STAR T criteria;The number of long-term medications,hypertension,and COPD are high-risk factors for screening PIM by the Chinese PIM criteria.The optimal cut-off for the n umber of medications prescribed for predicting PIM by using the Beers or the Chin ese PIM criteria was 13.After adjustment for co-variates,patients prescribed 13 me dications had a significantly higher risk of PIM,identified using Beers or Chinese PIM criteria,compared to patients prescribed<13 medications(both p<0.05).The opt imal cut-off for the length of hospitalized days to predicting PIM by using the Bee rs or STOPP/START criteria was 37.After adjustment for co-variates,patients prescri bed 37 medications had a significantly higher risk of PIM,identifiedusing Beers or STOPP/START criteria,compared to the length of hospitalized days<37(both p<0.05).3.Based on the first parts to determine the pharmaceutical intervention,based on th e second parts to determine the objective of medication review,build a structured p rocess of inappropriate medication system.ConclusionThe available evidence indicates that multidisciplinary intervention can not be reduced all-cause mortality in elderly hospitalized patients with polypharmacy but can improve medication appropriateness and reducing the number of inappropriate medications.The prevelence of PIM in patients with gediatric wards in our hospital is higher.The Chinese criteria had the highest detection rate but a moderate or poor concordance with the Beers and STOPP/START criteria,respectively,the use of both tools may be seen as complementary.To determine the risk factors for PIM in patients,a predictive model based on Beers or the Chinese PIM criteria for the number of prescribed medications>13,and a predictive model with the hospitalized days>37 based on Beers or STOPP/START have moderate sensitivity and positive predictive value.