Despite efforts to reduce potentially inappropriate medication (PIM) use, prescribing quality has worsened in the nursing home setting. Twenty-seven percent to 71% of nursing home residents use at least 1 PIM, and PIM use is associated with increased risk for falls, delirium, and cognitive impairment (1). Medication use is particularly risky in nursing homes given that they have a frail population with a high prevalence of dementia and multimorbidity.

In this issue, Wouters and colleagues report the results of a deprescribing study targeting PIM use in nursing homes (2). In this cluster randomized trial, 426 nursing home residents recruited from 59 Dutch nursing home wards were randomly assigned to an intervention to reduce PIM use or to usual care. The intervention, the Multidisciplinary Multistep Medication Review (3MR), was performed once, with an evaluation 4 months later, and had 4 components: assessment of the patient's perspective and a comprehensive medical and medication review, identification of medications to stop on the basis of the STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) and Beers criteria, a meeting between the pharmacist and the physician, and implementation of medication changes based on an agreed-upon plan. Usual care included a pharmacist review mandated in Dutch nursing home wards. The primary outcome was discontinuation of use of at least 1 PIM at 4 months, and secondary outcomes included neuropsychiatric symptoms, cognitive function, and quality of life. More patients discontinued use of at least 1 PIM in the intervention group than the control group (39.1% vs. 29.5%; adjusted relative risk, 1.37 [95% CI, 1.02 to 1.75]). There was no between-group difference in adverse events or secondary outcomes. The authors powered the study for reductions in PIM use of 40% in the intervention group and 20% in the usual care group. They concluded that the 3MR resulted in favorable outcomes without adversely affecting patients.

尽管已努力减少可能不适当的药物（PIM）的使用，但疗养院的处方质量却有所下降。27％至71％的疗养院居民至少使用一种PIM，并且PIM的使用与跌倒，del妄和认知障碍的风险增加相关（1）。鉴于疗养院人口稀少，痴呆症和多发病率很高，因此在疗养院中使用药物特别危险。

在本期杂志中，Wouters及其同事报告了一项针对养老院中使用PIM的处方研究（2）。在该整群随机试验中，从59个荷兰疗养院病房招募的426名疗养院居民被随机分配到一项干预措施中，以减少PIM的使用或常规护理。一次干预，即多学科多步药物评审（3MR），进行了一次评估，并于4个月后进行了评估，该干预包括4个组成部分：评估患者的观点和全面的药物和药物复查，根据以下因素确定停止用药的方法： STOPP（老年人可能不合适的处方筛查工具）和Beers标准，药剂师和医生之间的会议以及根据商定的计划实施药物变更的情况。通常的护理包括荷兰疗养院病房中强制执行的药剂师审查。主要结局是在4个月后停止使用至少1个PIM，次要结局包括神经精神症状，认知功能和生活质量。与对照组相比，干预组中停止使用至少1种PIM的患者多于对照组（39.1％比29.5％；调整后的相对危险度为1.37 [95％CI，1.02至1.75]）。不良事件或次要结局之间没有组间差异。作者为这项研究提供了动力，以使干预组的PIM用量减少40％，而普通护理组的PIM用量减少20％。他们得出的结论是，3MR产生了令人满意的结果，而对患者没有不利影响。次要结果包括神经精神症状，认知功能和生活质量。与对照组相比，干预组中停止使用至少1种PIM的患者多于对照组（39.1％比29.5％；调整后的相对危险度为1.37 [95％CI，1.02至1.75]）。不良事件或次要结局之间没有组间差异。作者为这项研究提供了动力，以使干预组的PIM用量减少40％，而普通护理组的PIM用量减少20％。他们得出的结论是3MR产生了令人满意的结果而对患者没有不利影响。次要结果包括神经精神症状，认知功能和生活质量。与对照组相比，干预组中停止使用至少1种PIM的患者多于对照组（39.1％比29.5％；调整后相对危险度1.37 [95％CI，1.02至1.75]）。不良事件或次要结局之间没有组间差异。作者为这项研究提供了动力，以使干预组的PIM用量减少40％，而普通护理组的PIM用量减少20％。他们得出的结论是，3MR产生了令人满意的结果，而对患者没有不利影响。不良事件或次要结局之间没有组间差异。作者为这项研究提供了动力，以使干预组的PIM用量减少40％，而普通护理组的PIM用量减少20％。他们得出的结论是，3MR产生了令人满意的结果，而对患者没有不利影响。不良事件或次要结局之间没有组间差异。作者为这项研究提供了动力，以使干预组的PIM用量减少40％，而常规护理组的PIM用量减少20％。他们得出的结论是，3MR产生了令人满意的结果，而对患者没有不利影响。