针对老年初级保健患者潜在不适当处方的干预措施:系统性审查和元分析
Nav Persaud1,2,3, Aine Workentin1, Amal Rizvi1
1MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
JAMA network open
|June 27, 2025
概括
针对老年人可能不适当的处方的干预措施使每位患者的药物数量减少了约0.5%. 然而,这些干预措施并没有显著影响初级保健机构的药物危害,住院或死亡率.
科学领域:
- 老年医学 老年医学
- 药理学 药理学是指药理学的学科.
- 基于证据的医学基于证据的医学.
背景情况:
- 潜在不合适的药物 (PIM) 处方在老年人中很普遍,其风险可能超过其益处.
- 解决PIM对于改善健康结果和减少老年人群的医疗负担至关重要.
研究的目的:
- 评估针对老年初级保健患者潜在不适当处方的干预措施的影响.
- 确定与药物数量变化的关联,与药物相关的伤害,住院和死亡率.
主要方法:
- 进行了随机临床试验 (RCT) 的系统审查和元分析.
- 搜索包括MEDLINE,Embase和Cochrane控制试验中央注册表,截至2024年9月.
- 来自118个涉及417,412名患者的RCT的数据使用随机效应模型进行了合成.
主要成果:
- 干预与处方药物的数量显著减少有关 (SMD, -0.25),平均每名患者服用的药物减少了0.5.
- 在不严重的药物不良反应,伤害性跌倒,生活质量,医疗访问,急诊室入院,住院或全因死亡率方面没有观察到实质性的差异.
结论:
- 减少老年人潜在不适当处方的干预措施可以安全地降低药物负担.
- 建议使用标准化标准进行进一步的研究,以始终报告危害并捕捉生活质量和死亡率等关键结果.
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