運用評估工具探討居家護理患者用藥問題

The Use of Assessment Tools to Explore the Prescription to Care for Patients in the Home Setting

背景:多重藥物會對患者的健康構成威脅,而多種疾病和多重用藥常見於老年患者。潛在不適當的藥物亦常見於此族群。接受居家護理服務患者大多高齡且生活無法自理,需依賴外籍照護工;選擇適當藥物評估工具進行居家護理患者處方審視,評估在此族群是否存在不適當的藥物。
方法:本研究共納入 90 位居家護理患者(平均年齡 82.5 歲),進行系統性藥物評估。條列式準則已經發展為評估老年患者處方的重要臨床工具,所以在此是選擇 STOPP(Screening Tool of Older Person’s potentially inappropriate Prescriptions)準則做為評估居家護理患者是否存在潛藏不適當藥物的工具。
結果:使用 STOPP 準則進行處方評估,發現 43.3% 的居家護理患者至少存在一種潛在不適當的藥物。最常見的不適當藥物是苯二氮平類(benzodiazepines)、抗精神病藥(antipsychotics)和抗血小板藥(antiplatelet agents)。其他藥物相關問題如劑型處方不適當,藥物和藥物相互作用也有觀察到。
討論:對居家護理患者用藥進行評估可找出潛藏不適當藥物的類型。藥師和護理師協調合作能有效地解決和預防藥物相關問題。選擇適合的藥物評估工具可以幫助藥師對處方進行系統性審視,提高藥事照護品質。

Background: Polypharmacy poses a threat to patients’ health. Multiple disease and polypharmacy are frequent in older people. Potentially inappro-priate medications are common. Elderly home care patients, most of whom could not take care themselves and were therefore dependent on foreign caregivers, used assessment tools to evaluate prescrip-tions as to whether there were inappropriate medications in home care patient.
Methods: This study included 90 home care patients (mean [SD] age,82.5[7.8] years) to perform a systematic review of prescriptions.Explicit criteria have evolved as important clinical tools to assess prescribing in older patients. They used the Screening Tool of Older Person’s potentially inappropriate Prescriptions criteria to look for potentially inappropriate medications in home care patients.
Result: Using the STOPP criteria, 43.3% of the subjects showed at least one potentially inappropriate prescription. The most frequent poten-tially inappropriate used drugs detected were benzodiazepines, anti-psychotic drugs and antiplatelet agents. A lot of dosage forms were not appropriate and drug-drug interactions were also detected.
Conclusion: The finding identified the genre of potentially inappropriate prescriptions in home care patients. Pharmacists and nurses were effective in resolving and preventing drug –related problems. The use of assessment tools can assist pharmacists in managing inappro-priate prescriptions and increase the quality of care.