临床辅助决策系统降低老年多重用药与潜在不适当用药效果的系统评价

Using clinical decision support system to reduce potentially inappropriate medication and polypharmacy in elderly patients:a systematic review

目的系统评价临床辅助决策系统(CDSS)对老年多重用药及潜在不适当用药(PIM)的干预效果。方法使用计算机检索PubMed、Embase、Web of Science数据库,检索时间自建库至2022年4月,搜集CDSS干预多重用药或PIM的随机对照试验(RCT),由2位研究人员独立进行文献筛选、数据提取和质量评价。结果共纳入14个RCT,包括641143例老年病人,其中10个RCT是关于CDSS对老年PIM的干预效果,包括629599例老年病人,4个是关于CDSS对老年多重用药的干预效果,包括11544例病人。RCT研究的结局指标不一致,因此本系统评价无法提供Meta分析结果,综合文献结果,认为CDSS能够降低老年PIM的发生率,CDSS对多重用药的影响尚需要更精细的试验设计研究。结论CDSS的应用具有减少老年PIM的潜力。

Objective To systematically evaluate the intervention effect of clinical decision support system(CDSS)on potentially inappropriate medication(PIM)and polypharmacy in the elderly patients.Methods The database searches were carried out through PubMed,Embase and Web of Science to collect the randomized controlled trials(RCTs)data about the intervention effect of CDSS on polypharmacy and PIM in the elderly patients until April 2022.Two reviewers screened the literatures,extracted data and assessed the quality independently.Results A total of 14 studies involving 641143 patients were included.There were 10 studies involving 629599 patients analyzing the intervention effect of CDSS on PIM and 4 studies involving 11544 patients analyzing the intervention effect of CDSS on polypharmacy.A meta-analysis was not possible due to the significant heterogeneity among the systems used and the measurement outcomes.In general,CDSS could reduce the prevalence of PIM in the elderly and further data were needed on the effects of CDSS on polypharmacy.Conclusions The application of CDSS has potential to reduce PIM in the elderly patients.