在初级保健中取消不适当的二二类药物处方:由行为框架为基础的系统审查的概述
Giuliano Duarte-Anselmi1, Modesta Pousada Fernández2, Beni Gómez-Zúñiga2
1Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Av. Libertador Bernardo O'Higgins 3363, Estación Central, Santiago, Chile. giuliano.duarte@usach.cl.
Implementation science communications
|February 20, 2026
概括
多方面的干预措施,包括患者教育和药剂师参与,有效地减少了初级保健中不适当的二 (BZD) 处方. 基于理论的方法可以提高干预设计和可持续性,以实现更安全的BZD解写.
科学领域:
- 药理学和治疗学 药理学和治疗学
- 初级医疗保健医学 一级医疗保健医学
- 行为科学 行为科学
背景情况:
- 长期使用二胺 (BZD) 对健康构成重大风险,包括认知障碍,跌倒和依赖.
- 目前的指导方针建议不要长时间使用BZD,但关于初级保健中有效的抑郁症策略的证据是分散的.
- 解决不适当的BZD处方对于患者安全和有效的医疗管理至关重要.
研究的目的:
- 综合从对减少初级保健中不适当的BZD处方的干预措施的系统审查中获得的证据.
- 识别影响BZD减记的障碍和促进因素.
- 评估干预措施的有效性,并评估行为理论的作用.
主要方法:
- 在四个主要数据库中对系统评论进行全面的文献搜索,截至2024年9月15日.
- 包括系统审查评估针对初级保健专业人员的抑郁症描述策略.
- 使用AMSTAR-2进行干预特征,行为变化技术,结果和方法质量评估的数据提取.
主要成果:
- 包括14项系统性审查,包括279项初级研究.
- 常见的策略包括逐渐减少剂量 (71%),患者教育 (50%) 和药剂师主导的干预 (36%).
- 综合患者教育和药剂师参与的多方面的干预措施显示出更大的持续有效性;很少有研究使用行为理论.
结论:
- 多方面的干预措施,特别是涉及患者教育,审计和反以及药剂师参与的干预措施,对于减少不适当的BZD使用是最有效的.
- 基于理论的干预,即使是短暂的干预,也可以适度有效,强调需要明确的理论框架.
- 未来的研究应该优先考虑以患者为中心的策略,长期坚持,以及BZD减记的多样化的社会经济环境.
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