| Objectives:1.To systematically search relevant evidence on medication management in elderly patients with polypharmacy after PCI,and evaluate the best evidence.And initially construct a program for elderly patients with polypharmacy after percutaneous coronary intervention.2.To revise the program entries by Delphi expert inquiry method,and finally formed a program for elderly patients with polypharmacy after PCI that can provide practical guidance for clinical practice.3.Toinitially verify the clinical application effect of the program for elderly patients with polypharmacy after PCI.Methods:1.Computer searches were conducted on 14 evidence-based guideline websites,including Medical Pulse,National Guideline Clearinghouse(NCG),National Institute for Health and Care Excellence(NICE),Registered Nurses Association of Ontario(RNAO),Cochrane Library,BMJ Best Practice and so on.And 8 comprehensive databases,including Pub Med,Web of Science,OVID,EBSCO,China Knowledge Network,and Wanfang.Evidence related to the management of multiple medications in elderly post-PCI patients published from the date of database creation to February 1,2022 was searched.The AGREE II guideline evaluation tool was used to evaluate the quality of guidelines,and the evidence synthesis manual of the Australian JBI Centre for Evidence-Based Health Care was used to evaluate expert consensus,systematic reviews,and RCTs.To summarize the best evidence for multiple medication management in elderly patients after PCI and to develop a first draft of a multiple medication management protocol for elderly patients after PCI.2.Using the Delphi method,15 experts were invited to evaluate the multiple medication management protocol for elderly patients after PCI based on the initial evidence-based construction.After two rounds of expert consultation,the final draft of the multiple medication management protocol for elderly patients after PCI was established,which could provide theoretical basis and practical direction for clinical practice.3.A randomized controlled trial was conducted to select elderly patients with coronary heart disease who were hospitalized in the cardiology ward of a tertiary hospital in Jiangxi Province from July 2022 to December 2022 to validate the clinical application of the multiple medication management program in elderly patients after PCI,and to compare the medication management ability,medication compliance,incidence of adverse drug reactions,debilitating index,and unplanned readmission in the two study groups before and after the intervention.The incidence of unplanned readmission,and fall rate were compared.Results:1.Evidence summary results: 1143 pieces of literature were obtained from the initial review,and 11 pieces of literature were finally included,including 3 guidelines,5 expert consensus,2 systematic evaluations,and 1 randomized controlled trial.19 pieces of best evidence were finally formed through the extraction and integration of evidence,covering4 categories of medication safety assessment,management support,medication education,and self-management.2.The finalized protocol for multiple medication management in elderly patients after percutaneous coronary intervention included risk reduction,risk preparation,crisis response,and monitoring.Feedback 4 primary indicators,7 secondary indicators,and 23 tertiary indicators.3.Empirical findings: A total of 76 cases were included in this study,with sample attrition of 7 cases,an attrition rate of 9.2%,and an effective sample size of 69 cases,34 cases in the control group and 35 cases in the intervention group.The differences in baseline information between the two groups before the intervention were not statistically significant;the differences in medication management ability,medication adherence,incidence of adverse drug reactions,debilitation index,unplanned readmission rate and fall rate between the two groups after the intervention were statistically significant(p<0.05).Conclusion:1.The medication management program constructed in this study for elderly patients with multiple medications after PCI is scientific,comprehensive,and of clinical guidance value.2.The medication management program for elderly patients with multiple medications after PCI was constructed in this study to effectively improve medication management,enhance patient compliance with medications,and reduce the incidence of adverse events in elderly patients. |
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