在欧洲临床实践指南中支持减缓处方:系统性审查
Diana Lopes1, Óscar Passos2, André Santa Cruz3,4
1Internal Medicine, Unidade Local de Saude de Braga, Braga, Portugal diana.lopes@ulsb.min-saude.pt.
概括
欧洲临床指南很少涉及老年人的药物停用. 准则需要优先考虑以患者为中心的抑郁症处方策略,以减少多药和提高患者安全.
科学领域:
- 老年医学 老年医学
- 临床药理学 临床药理学
- 基于证据的医学基于证据的医学.
背景情况:
- 多药在患有慢性疾病的老年人中很普遍.
- 临床指南通常侧重于开始,而不是停止,药物.
- 这导致过度处方,治疗惯性和患者伤害.
研究的目的:
- 评估欧洲慢性病指南中关于停止治疗的建议的频率和质量.
- 专注于2019年至2024年间发布的指导方针.
主要方法:
- 按照PRISMA 2020标准进行系统审查.
- 搜索了欧洲成年慢性病指南的Trip医疗数据库 (不包括瘤学,急性护理,儿科,产科,息治疗).
- 提取了关于停药建议的存在,理由和强度的数据.
主要成果:
- 724条指南符合纳入标准;只有49条提到停止治疗.
- 停止治疗的提及通常与毒性或缺乏疗效有关.
- 很少有指导方针提供明确的抑郁症描述算法或以患者为中心的框架.
结论:
- 在当前的欧洲临床指南中,处方不足.
- 迫切需要转向以患者为中心的护理,并制定明确的抑郁症治疗策略.
- 科学协会必须制定基于证据的个性化建议,以安全地停止药物使用.
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