薬剤師-看護師主体の認知症ケアラウンドの活動とその減薬への効果

抄録

In dementia care, pharmacists play a crucial role in pharmacotherapy and are expected to apply their expertise effectively. The objective of this study was to elucidate the characteristics of pharmacist-nurse principal dementia rounds (PDR) by comparing them with multidisciplinary dementia rounds (MDR) and assessing their utility. The number of rounds, additional points, and the nature of prescription suggestions were investigated for MDR and PDR from April 2022 to March 2023. The median number of rounds (remuneration points) per month was 7.5 (2,289 points) for MDR and 69.0 (22,244 points) for PDR. Regarding the proposed medications, anti-dementia drugs were the most common recommendations in MDR (36.4％), while sleep aids such as suvorexant were the most frequently suggested in PDR (41.3％). PDR predominantly proposed dosage adjustments (28.6％), along with new prescriptions (25.4％) and drug reductions (19.4％). Among patients with a prescription suggestion for drug reduction (57 patients), the diazepam equivalent decreased significantly from 5 [2.1 – 9.4] mg (median [interquartile range]) at admission to 0 [0 – 2.4] mg at discharge (P = 0.003). The anticholinergic score also decreased from 1 [1 – 3] at admission to 1 [0 – 1] at discharge (P = 0.006). PDR allowed for a broader range of interventions compared to MDR. Specifically, PDRs played a significant role in ensuring the appropriate utilization of sleeping pills and anticholinergic drugs.