多剤薬剤を処方する高齢者における共同意思決定の介入: スコーピング・レビュー
Soroush Fariman1, Arman Arabshomali2, Darshna Goordeen3
1Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA.
Journal of the American Geriatrics Society
|August 29, 2025
まとめ
高齢者への介入における 共有意思決定 (SDM) は,実施と測定の多様性を示しています. 満足度の向上と関連しているが,患者の健康状態への影響は定かではない.
科学分野:
- 高齢者医療
- 薬理学について
- 医療サービス研究
背景:
- 共同意思決定 (SDM) は,うつ病診断に不可欠ですが,介入への統合と患者の結果への影響は十分に研究されていません.
- ポリファーマシーを持つ高齢者は,しばしば抑止処置を必要とし,SDMの役割を理解する必要性を強調しています.
研究 の 目的:
- ポリファーマシーによる高齢者のうつ病処方のための共同意思決定 (SDM) の介入を調査する研究の範囲調査を実施する.
- SDMに関連するアウトカムを含むこれらの介入のコア機能と形態を分類し,測定されたアウトカムを分析する.
主な方法:
- 2023年9月まで,複数のデータベース (PubMed/MEDLINE,Embase,Scopus,PsycInfo) で包括的なスコーピングレビューが行われました.
- 対象となった研究は,ポリファーマシーによる高齢者のうつ病処方のためのSDM介入に焦点を当てた.
- データは2人の独立審査員によってスクリーニングされ抽象化され,その後に繰り返しの叙述合成が行われました.
主要な成果:
- 12つの異なる介入を対象とした14の研究は,主に主治医や薬剤師が率いる外来での試験で,入場基準を満たした.
- 共通の介入機能には,患者/薬の特定,SDM,意思決定支援,ケア調整が含まれていました.
- ほとんどの研究では,薬物使用とうつ病行為との正の関連が報告されましたが,SDMの発生を明示的に測定したのは3つだけです.
結論:
- 処方停止の介入は,SDMの組み込みと経験的測定において有意な変動を示しています.
- SDMは治療の満足度とプロセス改善に結びついているが,患者の行動と健康結果への影響に関する証拠は不確実である.
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