How Is Medication Prescribing Ceased?: A Systematic Review
How Is Medication Prescribing Ceased?: A Systematic Review
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药物处方如何停止？：系统回顾
DOI：
10.1097/mlr.0b013e3181ef9a7e
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发表时间：
2011
期刊：
影响因子：
3
通讯作者：
S. Tett
中科院分区：
文献类型：
--
作者：
R. Ostini;C. Jackson;D. Hegney;S. Tett
背景：药物处方是一个复杂的过程，重点往往是开始新的药物，改变药物方案，并继续药物方案。有时，谨慎的处方方法可能需要结束正在进行的药物治疗过程，因为它不应该首先开始;因为它的继续使用会造成伤害;或者因为药物不再有效。目的：确定在临床上不再需要继续处方的情况下停止既有处方的有效策略。研究设计：在PubMed（1951- 2009年11月）、EMBASE（1966- 2008年9月）和International Pharmaceutical Abstract B（1970- 2008年9月）中系统检索实验和准实验研究的英文报告。还对相关综述文章进行了手动检索，并对先前系统检索处方影响和干预研究产生的当地数据库进行了关键词检索。研究选择和数据提取：在对相关性进行初步标题筛选后，2名审查员使用正式评估和数据提取工具，在从入选研究中提取数据之前，独立评估摘要的相关性和完整研究的质量。结果：在1306篇文献中，12篇被评估为相关的高质量研究。在纳入的研究中检查了各种药物，其中苯二氮卓类药物最常见。该综述中包括的研究测试了9种不同类型的干预措施。有效的干预措施包括患者介导的干预措施、处方医生的手动提醒、向患者提供的教育材料、处方医生的面对面干预以及监管干预。部分有效的干预措施包括审计和反馈，电子提醒，教育材料单独发送给处方，远程通信结合教育材料发送给处方。结论：通过一系列干预措施，似乎可以停止各种药物的处方。有效干预的一个共同主题是患者参与停止过程。然而，很少报告在个体患者水平上开处方的情况，数据通常汇总为每单位人口的剂量或药物数量，将任何减少归因于戒烟。这些研究并没有测量实际需要的结果（停止处方），这可能反映了关于何时或为什么结束处方可能很重要的更广泛的模糊性。需要对停止预先存在的处方的过程进行更多的研究，特别注意改善测量的结果。
Background:Medication prescribing is a complex process where the focus tends to be on starting new medication, changing a drug regimen, and continuing a drug regimen. On occasion, a prudent approach to prescribing may necessitate ending an ongoing course of medication, either because it should not have been started in the first place; because its continued use would cause harm; or because the medication is no longer effective. Objective:To identify effective strategies for stopping pre-existing prescribing in situations where continued prescribing may no longer be clinically warranted. Research design:Systematic searches for English-language reports of experimental and quasi-experimental research were conducted in PubMed (1951–November 2009), EMBASE (1966–September 2008), and International Pharmaceutical Abstract b (1970–September 2008). A manual search for relevant review articles and a keyword search of a local database produced by a previous systematic search for prescribing influence and intervention research were also conducted. Study selection and data extraction:Following initial title screening for relevance 2 reviewers, using formal assessment and data extraction tools, independently assessed abstracts for relevance and full studies for quality before extracting data from studies selected for inclusion. Results:Of 1306 articles reviewed, 12 were assessed to be of relevant, high-quality research. A variety of drugs were examined in the included studies with benzodiazepines the most common. Studies included in the review tested 9 different types of interventions. Effective interventions included patient-mediated interventions, manual reminders to prescribers, educational materials given to patients, a face-to-face intervention with prescribers, and a case of regulatory intervention. Partially effective interventions included audit and feedback, electronic reminders, educational materials alone sent to prescribers, and distance communication combined with educational materials sent to prescribers. Conclusions:It appears possible to stop the prescribing of a variety of medications with a range of interventions. A common theme in effective interventions is the involvement of patients in the stopping process. However, prescribing at the level of individual patients was rarely reported, with data often aggregated to number of doses or number of drugs per unit population, attributing any reduction to cessation. Such studies are not measuring the actual required outcome (stopping prescribing), and this may reflect the broader ambiguity about when or why it might be important to end a prescription. Much more research is required into the process of stopping pre-existing prescribing, paying particular attention to improving the outcomes that are measured.