Comprehensive geriatric pharmaceutical care among hospitalized elderly patients
| Autor: | Jiann-HorngKuo, 郭建宏 |
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| Rok vydání: | 2015 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 103 Summary Using method of the comprehensive geriatric pharmaceutical care group (CGPC) as the research framework, this research aimed: to compare difference of medication problems among elderly patients that were either visited directly by pharmacists using comprehensive geriatric pharmaceutical assessment or not. Our study found that medication problems in elderly, including the geriatric syndrome and recommended to the geriatric medical team for the discussion and then applied it to patients. To reduce problems and risk of medication. Introduction Because of age-related physiological changes, decline in activities of daily living, multiple comorbid diseases with polypharmacy, as well as psychological conditions and lack support from family and society, medication prolems become more complex. When geriatric syndrome occurs, the consideration of medication use must be more serious. Methods From September to December 2014, patients aged ≧65 years hospitalized to geriatric ward and general medical ward of a medical center in southern Taiwan, were recruited. By dividing into the intervention group with comprehensive pharmaceutical care in geriatric ward and the control group with routine pharmaceutical care in the general medical ward, a total of 240 patients (120 each) with informed consents will be enrolled. The process of clinic visits included: (1) To record the admission medications and comprehensive geriatric assessment; (2) To clarify STOPP and START criteria assessment; (3) To collect pharmaceutical care problem; (4) To discuss with geriatric team members. Medication problems were compared between intervention group and control group, of which conditions and medications were reviewed on the computer system in hospital. Results Among 240 enrolled individuals, their mean age was 81.5 years, 48% were male. The reasons of hospitalization were fever, dyspnea and limb pain. The most common diagnoses of diseases were hypertension, chronic kidney disease and diabetes mellitus, with an average of 5.1 diagnoses per patient. Numbers of prescribed medications among comprehensive geriatric pharmaceutical care group (CGPC) and general pharmaceutical care group (GPC) were 1547 and 1412, with averages of 12.9±5.5 and 11.8±5.4 medications, respectively. A total of 75 and 28 among the CGPC and GPC groups, respectively. Among CGPC cases, 45 medication problems were found by clinic visit. Overall, the most common types of medication problems were unnecessary medication use, non-crushed medications, dosage adjustment for renal impairment, not recommended for renal impairement, medication related laboratory data to be followed up. The 45 CGPC medication problems found by clinic visit included general dosage adjustment, delirium assessment, limited clinical benefit, inappropriate use, questionable usage of medications, previous medications needed to be continued but not prescribed after admission. Medication education for patients were poor adherence to medication use and use of medications incorrect. By STOPP criteria, 36 CGPC cases and the 21 GPC cases had been prescribed 49 and 23 inappropriate medications, respectively. Overall, most common STOPP medications were calcium channel blockers in patients with chronic constipation, aspirin, clopidogrel, dipyridamole or warfarin in patients with concurrent bleeding disorder, benzodiazepines and first generation antihistamines in patients who are prone to falls. By START criteria, 15 CGPC cases and 23 GPC cases had 20 and 32 potential medications to be suggested to initiate. Conclusion Comprehensive geriatric pharmaceutical care might be used to evaluate a variety of potential medication problems among hospitalized elderly patients with multi-comorbidities. After further discussion with physicians, such problems and risk of medication use might be reduced among hospitalized elderly patients. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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