Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials.
Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials.
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DOI：
10.1186/s12875-016-0577-x
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发表时间：
2017-01-17
影响因子：
2.9
通讯作者：
van den Bemt BJ
中科院分区：
文献类型：
--
作者：
Huiskes VJ;Burger DM;van den Ende CH;van den Bemt BJ
经常建议进行药物审查以优化药物使用。在临床实践中，它主要是作为一种干预措施在短期干预期间进行操作，而没有共同干预。然而，大多数系统性评价还包括联合干预和延长的药物优化干预。此外，大多数系统性综述关注特定患者组（例如，多种药物治疗、老年人、住院患者）和/或特定结局指标（例如，住院和死亡率）。因此，本研究的目的是评估药物审查作为一种孤立的短期干预措施的有效性，无论患者人群和使用的结局指标如何。在MEDLINE、EMBASE和Web of Science中进行了从开始到2015年9月的文献检索。纳入了随机对照试验（RCT），药物审查作为孤立的短期干预（<3个月）。对患者特征和结局指标没有限制。一名审查员提取数据，另一名审查员检查数据。研究偏倚风险由两名评价者独立评估。对一项以上试验中使用的每项结局指标进行最佳证据合成。在二元变量的情况下，除了最佳证据合成外，还进行了荟萃分析，以量化效果。本系统性综述纳入了31项RCT（偏倚风险低55%）。对22项结局指标进行了最佳证据综合。除了每例患者的福尔斯次数减少外，未发现药物审查对临床结局（死亡率、住院/医疗保健使用、跌倒患者数量、身体和认知功能）的影响。然而，在使用更严格的偏倚风险阈值的敏感性分析中，对福尔斯次数的影响的结论变为不确定。此外，未发现对生活质量的影响，对经济结局指标影响的证据也不确定。然而，在大多数药物相关问题上发现了一种效果：药物审查导致药物相关问题数量减少，药物变化更多，药物剂量减少的药物更多，药物数量减少或增加较少。短期干预期间的单独药物审查对大多数药物相关结局有影响，对临床结局的影响极小，对生活质量无影响。无法得出关于对经济结局指标影响的结论。因此，应考虑停止将横断面药物审查作为标准治疗。本文的在线版本（doi：10.1186/s12875-016-0577-x）包含补充材料，可供授权用户使用。
Medication review is often recommended to optimize medication use. In clinical practice it is mostly operationalized as an intervention without co-interventions during a short term intervention period. However, most systematic reviews also included co-interventions and prolonged medication optimization interventions. Furthermore, most systematic reviews focused on specific patient groups (e.g. polypharmacy, elderly, hospitalized) and/or on specific outcome measures (e.g. hospital admissions and mortality). Therefore, the objective of this study is to assess the effectiveness of medication review as an isolated short-term intervention, irrespective of the patient population and the outcome measures used. A literature search was performed in MEDLINE, EMBASE and Web of Science from their inception through September 2015. Randomized controlled trials (RCTs) with medication review as isolated short term intervention (<3 months) were included. There were no restrictions with regard to patient characteristics and outcome measures. One reviewer extracted and a second checked data. The risk of bias of studies was evaluated independently by two reviewers. A best evidence synthesis was conducted for every outcome measure used in more than one trial. In case of binary variables a meta-analysis was performed in addition to the best evidence synthesis, to quantify the effect. Thirty-one RCTs were included in this systematic review (55% low risk of bias). A best evidence synthesis was conducted for 22 outcome measures. No effect of medication review was found on clinical outcomes (mortality, hospital admissions/healthcare use, the number of patients falling, physical and cognitive functioning), except a decrease in the number of falls per patient. However, in a sensitivity analysis using a more stringent threshold for risk of bias, the conclusion for the effect on the number of falls changed to inconclusive. Furthermore no effect was found on quality of life and evidence was inconclusive about the effect on economical outcome measures. However, an effect was found on most drug-related problems: medication review resulted in a decrease in the number of drug-related problems, more changes in medication, more drugs with dosage decrease and a greater decrease or smaller increase of the number of drugs. An isolated medication review during a short term intervention period has an effect on most drug-related outcomes, minimal effect on clinical outcomes and no effect on quality of life. No conclusion can be drawn about the effect on economical outcome measures. Therefore, it should be considered to stop performing cross-sectional medication reviews as standard care. The online version of this article (doi:10.1186/s12875-016-0577-x) contains supplementary material, which is available to authorized users.