处方精简在老年患者中的可行性与安全性分析

Feasibility and effect analysis of deprescribing in older adults

目的评价处方精简在老年患者中的可行性与安全性Meta分析。方法用Cochrane系统评价方法,检索Cochrane Library、PubMed、MedLine等数据库,根据干预措施的不同分为试验组(进行处方精简评估及干预并随访)和对照组(常规随访)。以死亡率和跌倒评价处方精简的可行性,以住院率、再入院率、药物不良反应和不良事件评价安全性。结果共纳入23篇文献研究,质量为高、中、低者分别有2,15和6篇,患者共10514例。Meta分析结果显示:处方精简未能改变死亡率(P>0.05);亚组分析:当患者人群特定(如患者认知功能正常)或由医务人员主导的处方精简时,死亡率显著降低(均P<0.05)。处方精简可以降低住院率、再入院率、药物不良反应和不良事件发生率(P<0.05或P<0.01)。结论处方精简未改变死亡率,但安全性良好,以医务人员主导的处方精简和针对认知功能正常患者的死亡率显著降低。

Objective To evaluate the feasibility and effect of deprescribing in older adults systematically.Methods The Cochrane review’s method was adopted and computer-based retrieval was performed on Cochrane Library,Pub Med,Med Line and other database.According to the different interventions,they were divided into experimental group(prescription streamlined evaluation and intervention and followed up)and control group(routine follow-up).The feasibility of simplified prescriptions was evaluated by mortality and falls,and the safety was evaluated by hospitalization rate,readmission rate,adverse drug reactions and adverse events.Results A total of 23 papers met the inclusion criteria,their quality evaluation results were 2 high,15 medium and 6 low,which included 10514 patients.Meta-analysis showed that prescription reduction did not change mortality(P>0.05);subgroup analysis showed that mortality significantly decreased when patients were specific(such as patients with normal cognitive function)or prescription reduction led by medical staff(all P<0.05).Deprescribing can reduce the incidence of admissions/readmission and adverse reactions/adverse events(P<0.05 or P<0.01).Conclusion Although deprescribing does not reduce mortality,it is safe.Mortality significantly reduces when applying patient-specific interventions or participants living with cognitively intact.