BACKGROUND:The Australian Government Department of Veterans' Affairs (DVA) Veterans' Medicines Advice and Therapeutics Education Services (Veterans' MATES) programme conducted two intervention (March 2009, follow-up intervention June 2012) both of which aimed to reduce hypnotic use among Australian veterans. We evaluated the effectiveness of the interventions, and estimated the associated health consequences. METHODS:Both interventions targeted veterans who had been dispensed hypnotics prior to the intervention. Patient-specific prescriber feedback containing patient details and the volume of hypnotics dispensed, along with tailored educational information, was mailed to general practitioners. Veterans, pharmacists and directors of care in residential aged care facilities were mailed tailored educational information. Interrupted time-series and segmented regression modelling were used to determine the effect of the two interventions on the rate of hypnotics dispensing. The cumulative patient-months of hypnotic treatment avoided as a result of the interventions was calculated. We estimated improvements in health consequences of as a result of hypnotic treatment avoided based on the results of cohort studies in the same population identifying the association between hypnotic and sedative use on the outcomes of falls, and confusion. RESULTS:After the first Veterans' MATES intervention in March 2009, hypnotic use declined by 0.2% each month, when compared to the baseline level (p = 0.006). The intervention effect was attenuated after one year, and use of hypnotics was found to increase by 0.2% per month after March 2010. Following the second intervention in June 2012, there was a further significant decline in use of 0.18% each month over the 12 months of follow up (p = 0.049). The cumulative effect of both interventions resulted in 20,850 fewer patient-months of treatment with hypnotics. This cumulative reduction in hypnotic use was estimated to lead to a minimum of 1 fewer hospital admissions for acute confusion and 7 fewer hospital admissions due to falls. CONCLUSIONS:The Veterans' MATES insomnia interventions which involved multiple stakeholders were effective in reducing hypnotic use among older Australians. Repetition of key messages led to sustained practice change.

译文

背景:澳大利亚政府退伍军人事务部(DVA)退伍军人医学咨询和治疗教育服务(Veterans'MATES)计划实施了两项干预措施(2009年3月,2012年6月进行了后续干预),均旨在减少使用催眠药的人澳大利亚退伍军人。我们评估了干预措施的有效性,并估计了相关的健康后果。
方法:两种干预措施均针对在干预之前已分配催眠药的退伍军人。包含患者详细信息和分配的催眠药的量以及针对性的教育信息的针对患者的处方开具反馈已邮寄给全科医生。退伍军人,药剂师和住宅老年护理机构中的护理主管都收到了量身定制的教育信息。中断时间序列和分段回归模型用于确定两种干预措施对催眠药分配速度的影响。计算了由于干预而避免的累计催眠治疗患者月数。根据同一人群的队列研究结果,我们确定了使用催眠治疗可避免因服用催眠药和镇静剂对跌倒的后果和精神错乱之间的联系,从而避免因服用催眠药而对健康产生的影响。
结果:在2009年3月进行第一次退伍军人的MATES干预后,与基线水平相比,催眠药的使用每月下降了0.2%(p = 0.006)。一年后干预作用减弱,发现催眠药的使用在2010年3月之后每月增加0.2%。在2012年6月进行第二次干预之后,在12个月中每月进一步减少0.18%的使用个月的随访时间(p = 0.049)。两种干预措施的累积效果使使用催眠药的患者治疗时间减少了20,850个月。据估计,这种催眠药使用量的累积减少导致因急性精神错乱住院的病人最少减少1次,而因摔倒而住院的人数最少减少7次。
结论:涉及多个利益相关者的退伍军人队的MATES失眠干预措施有效地减少了澳大利亚老年人的催眠使用。关键信息的重复导致了持续的实践改变。

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