Publication: Serbest eczanelerde yaşlılarda uygun olmayan ilaç kullanımını belirlemeye yönelik bir klinik karar destek sisteminin değerlendirilmesi
Abstract
Amaç: Bu çalışmada serbest eczanelerinde yaşlılarda uygunsuz reçete kalıplarının belirlenmesine olanak sağlayan bir klinik karar destek sistemi (KKDS) tasarlanması ve değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Çalışma, 20 serbest eczanede 65 yaş ve üstü hastalarda yürütülmüştür. Yaşlı hastaların reçetelerinin potansiyel uygunsuz ilaçlar (PUİ) varlığı açısından otomatik olarak kontrol edilmesine olanak sağlayan bir KKDS geliştirilmiş ve eczane otomasyon sistemlerine entegre edilmiştir. Eczacının tercihine bağlı olarak öneriler reçeteyi yazan doktora iletilmiş ya da iletilmemiştir. PUİ'lerin sayısı ve özellikleri, PUİ varlığı ve sayısı ile ilişkili faktörler, reçete yazan doktorların önerileri kabul etme durumu ve KKDS'nin kullanılabilirliği değerlendirilmiştir.Bulgular: Saha çalışmasının gerçekleştiği altı aylık dönem boyunca her biri ayrı bir hastaya ait 1250 reçete değerlendirilmiştir. Hastaların medyan (ÇAA) yaşı 73 (68-81) idi ve %59'unda en az bir adet PUİ tespit edildi. Toplam PUİ sayısı 1359 idi; PUİ’lerde en sık karşılaşılan ilaçlar proton pompası inhibitörleri (%16) ve selektif beta-blokörlerdi (%11,9). Eczacılar, PUİ içeren reçetelerin %24,4'ü ile ilgili olarak reçeteyi yazan doktorla iletişim kurmuş ve önerilerin %85,8'i doktorlar tarafından kabul etmiştir. KKDS'nin kullanılabilirliği iyi olarak bulunmuştur.Sonuç: Bu ürünün yaygın kullanımının ilaca bağlı advers olayları, hastaneye yatışları, morbiditeleri ve mortaliteleri önleyebileceği, hastaların klinik durumlarında ve yaşam kalitelerinde iyileşmelere yol açarken, sağlık çıktılarına ekonomik düzeyde de katı yapabileceği öngörülmektedir.
Objective: This study aimed to develop and evaluate a clinical decision support system (CDSS) which identifies inappropriate prescription patterns in the elderly to be used at community pharmacy setting.Materials and Methods: The study was carried out in 20 community pharmacies on patients ≥ 65 years. A CDSS was developed and integrated into the pharmacy automation systems to automatically check the medications of the patients for the presence of any potentially inappropriate medications (PIMs). Depending on the preference of the pharmacist the recommendations were communicated with the prescriber or not. The number and characteristics of the PIMs, factors associated with the presence and number of PIMs, prescribers’ acceptance status of the recommendations, and usability of the CDSS were recorded.Results: During the 6-month field-study period, 1250 prescriptions each from an individual patient were evaluated. The median (IQR) age of the patients was 73 (68-81) years. The total number of PIMs was 1359 and 59% of the patients had at least one PIM. Drugs most frequently involved in PIMs were proton pump inhibitors (16%) and selective beta-blockers (11.9%). The pharmacists communicated with the prescribers regarding 24.4% of the PIM-involving prescriptions and 85.8% of the prescribers accepted the recommendations. The usability of the CDSS was found to be good.Conclusion: It is anticipated that the widespread use of this product would prevent drug-related adverse events, hospitalizations, morbidities, and mortalities; thus, would improve patients’ clinical status and quality of life, as well as lead to better economic health outcomes.
Objective: This study aimed to develop and evaluate a clinical decision support system (CDSS) which identifies inappropriate prescription patterns in the elderly to be used at community pharmacy setting.Materials and Methods: The study was carried out in 20 community pharmacies on patients ≥ 65 years. A CDSS was developed and integrated into the pharmacy automation systems to automatically check the medications of the patients for the presence of any potentially inappropriate medications (PIMs). Depending on the preference of the pharmacist the recommendations were communicated with the prescriber or not. The number and characteristics of the PIMs, factors associated with the presence and number of PIMs, prescribers’ acceptance status of the recommendations, and usability of the CDSS were recorded.Results: During the 6-month field-study period, 1250 prescriptions each from an individual patient were evaluated. The median (IQR) age of the patients was 73 (68-81) years. The total number of PIMs was 1359 and 59% of the patients had at least one PIM. Drugs most frequently involved in PIMs were proton pump inhibitors (16%) and selective beta-blockers (11.9%). The pharmacists communicated with the prescribers regarding 24.4% of the PIM-involving prescriptions and 85.8% of the prescribers accepted the recommendations. The usability of the CDSS was found to be good.Conclusion: It is anticipated that the widespread use of this product would prevent drug-related adverse events, hospitalizations, morbidities, and mortalities; thus, would improve patients’ clinical status and quality of life, as well as lead to better economic health outcomes.
Description
Keywords
Klinik Karar Destek Sistemi, serbest eczane, yaşlı, geriatrik, potansiyel uygunsuz ilaç Clinical Decision Support System, community pharmacy, elderly, geriatric, potentially inappropriate medication