Implementing physician-led medication reviews for patients with diabetes and severe mental disorder: A randomized controlled trial.

IF 3.1 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Johan Frederik Mebus Meyer Christensen, Signe Wegmann Düring, Gesche Jürgens
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Abstract

Aims: Patients with severe mental disorder and diabetes may be exposed to inappropriate polypharmacy increasing the risk of side effects and drug interactions. Although medication reviews may facilitate short-term deprescribing, they are not known to affect clinical outcomes. We investigated whether implementing physician-led medication reviews through interdisciplinary dialogue can change prescription patterns and improve pharmacological efficacy and tolerability in psychiatric outpatients with diabetes.

Methods: Included in the study were 52 patients from an endocrinologist-psychiatrist outpatient clinic in Slagelse Region, Zealand, Denmark. Patients were allocated to an intervention group, where patients' pharmacological treatment was discussed at an interdisciplinary treatment conference based on a medication review conducted by a specialist in clinical pharmacology or a control group receiving standard care. All patients underwent psychometric testing, side effect screening, clinical interviews, and had drug regimens and biochemical test results extracted from the electronic health records at baseline and at 6 months follow up.

Results: The trial was completed by 48 patients. Average time to follow up was 7 months (range 5-11 months). The intervention group had a median reduction of 1 drug (interquartile range [IQR] -4.00, 0.00) and 1 potentially inappropriate prescription (IQR -2.00, 0.00) compared to a median increase of 2 drugs (IQR 1.00, 3.00) and 2 potentially inappropriate prescriptions (IQR 0.00, 3.00) in the control group. The usage of both somatic and psychiatric drugs was reduced. We found no differences in clinical outcomes.

Conclusion: Deprescribing can be achieved without worsening psychiatric symptoms in psychiatric outpatients by implementing physician-led medication reviews through interdisciplinary dialogue. This study was registered on ClinicalTrials.gov: NCT (05243160).

对糖尿病和严重精神障碍患者实施医生主导的药物审查:一项随机对照试验。
目的:严重精神障碍和糖尿病患者可能暴露于不适当的多种药物,增加了副作用和药物相互作用的风险。虽然药物审查可能促进短期处方的解除,但尚不清楚它们是否会影响临床结果。我们调查了通过跨学科对话实施医生主导的药物评价是否可以改变处方模式,提高糖尿病精神科门诊患者的药理学疗效和耐受性。方法:本研究纳入了来自丹麦西兰Slagelse地区内分泌科-精神科门诊的52例患者。患者被分配到干预组,患者的药物治疗在跨学科治疗会议上讨论,基于临床药理学专家进行的药物审查或接受标准治疗的对照组。所有患者在基线和6个月随访时均接受心理测试、副作用筛查、临床访谈,并从电子健康记录中提取药物方案和生化测试结果。结果:48例患者完成试验。平均随访时间为7个月(5-11个月)。干预组的中位数减少了1种药物(四分位数范围[IQR] -4.00, 0.00)和1种潜在不适宜处方(IQR -2.00, 0.00),而对照组的中位数增加了2种药物(IQR 1.00, 3.00)和2种潜在不适宜处方(IQR 0.00, 3.00)。躯体和精神药物的使用都减少了。我们没有发现临床结果的差异。结论:在精神科门诊患者中,通过跨学科对话实施医师主导的药物评审,可以在不加重精神症状的情况下实现处方的减少。该研究已在ClinicalTrials.gov注册:NCT(05243160)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.30
自引率
8.80%
发文量
419
审稿时长
1 months
期刊介绍: Published on behalf of the British Pharmacological Society, the British Journal of Clinical Pharmacology features papers and reports on all aspects of drug action in humans: review articles, mini review articles, original papers, commentaries, editorials and letters. The Journal enjoys a wide readership, bridging the gap between the medical profession, clinical research and the pharmaceutical industry. It also publishes research on new methods, new drugs and new approaches to treatment. The Journal is recognised as one of the leading publications in its field. It is online only, publishes open access research through its OnlineOpen programme and is published monthly.
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