Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review.
Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review.
复制标题
DOI：
10.1136/bmjopen-2015-009235
复制
发表时间：
2015-12-09
期刊：
影响因子：
2.9
通讯作者：
Hughes CM
中科院分区：
文献类型：
--
作者：
Cooper JA;Cadogan CA;Patterson SM;Kerse N;Bradley MC;Ryan C;Hughes CM
总结一项更新的科克伦综述，旨在改善老年人适当使用多种药物的干预措施。科克伦系统评价。检索了多个电子数据库，包括MEDLINE、EMBASE和对照试验的科克伦中心登记（从开始到2013年11月）。还进行了参考文献的手动检索。如果使用了经验证的处方适当性指标，则纳入了报告针对任何医疗环境中老年人适当多药治疗干预措施的随机对照试验（RCT）、对照临床试验、对照前后研究和中断时间序列分析。使用科克伦偏倚风险工具和GRADE（推荐、评估、发展和评价等级）评估证据质量。所有的医疗机构。患有≥1种长期疾病并接受多种药物治疗（≥4种常规药物）的老年人（≥65岁）。主要结果是适当的多种药物和住院率的变化。药物相关问题（如药物不良反应）、药物依从性和生活质量作为次要结局。纳入12项研究：8项RCT，2项整群RCT和2项对照前后研究。1项研究涉及计算机化决策支持，11项研究包括各种环境中的药学服务方法。适当性使用经过验证的工具进行测量，包括药物适当性指数、Beers标准和老年人处方筛选工具（STOPP）/提醒医生正确治疗的筛选工具（START）。干预措施表明，减少不适当的处方。对住院和药物相关问题的影响证据相互矛盾。未报告健康相关生活质量的差异。纳入的干预措施表明，在减少不适当处方的基础上，适当的多种药物治疗有所改善。然而，目前尚不清楚干预是否导致临床显著改善（例如，在住院方面）。未来的干预研究将受益于现有的指导干预开发，评估和报告，以促进在临床实践中的复制。
To summarise the findings of an updated Cochrane review of interventions aimed at improving the appropriate use of polypharmacy in older people. Cochrane systematic review. Multiple electronic databases were searched including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (from inception to November 2013). Hand searching of references was also performed. Randomised controlled trials (RCTs), controlled clinical trials, controlled before-and-after studies and interrupted time series analyses reporting on interventions targeting appropriate polypharmacy in older people in any healthcare setting were included if they used a validated measure of prescribing appropriateness. Evidence quality was assessed using the Cochrane risk of bias tool and GRADE (Grades of Recommendation, Assessment, Development and Evaluation). All healthcare settings. Older people (≥65 years) with ≥1 long-term condition who were receiving polypharmacy (≥4 regular medicines). Primary outcomes were the change in prevalence of appropriate polypharmacy and hospital admissions. Medication-related problems (eg, adverse drug reactions), medication adherence and quality of life were included as secondary outcomes. 12 studies were included: 8 RCTs, 2 cluster RCTs and 2 controlled before-and-after studies. 1 study involved computerised decision support and 11 comprised pharmaceutical care approaches across various settings. Appropriateness was measured using validated tools, including the Medication Appropriateness Index, Beers’ criteria and Screening Tool of Older Person's Prescriptions (STOPP)/ Screening Tool to Alert doctors to Right Treatment (START). The interventions demonstrated a reduction in inappropriate prescribing. Evidence of effect on hospital admissions and medication-related problems was conflicting. No differences in health-related quality of life were reported. The included interventions demonstrated improvements in appropriate polypharmacy based on reductions in inappropriate prescribing. However, it remains unclear if interventions resulted in clinically significant improvements (eg, in terms of hospital admissions). Future intervention studies would benefit from available guidance on intervention development, evaluation and reporting to facilitate replication in clinical practice.