Therapeutics Research Unit, School of Medicine, University of Queensland, Woolloongabba, Queensland, Australia.
Drugs Aging. 2009;26(12):1013-28. doi: 10.2165/11318890-000000000-00000.
Inappropriate prescribing of medicines may lead to a significant risk of an adverse drug-related event. In particular, prescribing may be regarded as inappropriate when alternative therapy that is either more effective or associated with a lower risk exists to treat the same condition. This review aims to identify interventions and strategies that can significantly reduce inappropriate prescribing in the elderly. The review is based on a search of electronic databases using synonyms of keywords such as 'elderly', 'interventions', 'optimized prescribing' and 'inappropriate prescribing' to identify reported interventions intended to improve inappropriate prescribing in the elderly. A total of 711 articles published in English were retrieved and considered. Of these, 24 original studies, involving 56 to 124,802 participants, met the inclusion criteria and were included in the systematic review. In 16 studies, the statistical power used to assess the impact of the intervention was >90% at a significance level of alpha=0.05. Various interventions were included in this study, such as educational interventions, medication reviews, geriatricians' services, multidisciplinary teams, computerized support systems, regulatory policies and multi-faceted approaches. Because of variability in assessment methodologies, mixed responses were found for education interventions aimed at improving inappropriate prescribing. For example, some studies did not assess what data were required to define whether a given level of intervention would be adequate, and others did not consider how many participants would be needed to demonstrate that a significant difference existed. Each of the three computerized support system interventions reported produced a significant enhancement in both prescribing and dispensing practices. Pharmacist interventions in community and hospital settings were evaluated in seven studies. However, variable criteria were used, with two studies using the Medication Appropriateness Index, another two studies using self-designed criteria for inappropriate prescribing, and the remaining three studies using Beers' criteria. A difficulty in assessing studies involving nursing home residents is that both consultant pharmacists and onsite pharmacist services may be involved, and, in one of the studies, only the role of the consultant pharmacist was considered. One of the most effective interventions appeared to be multidisciplinary case conferences involving a geriatrician, which resulted in a number of examples of reduced inappropriate prescribing in both community and hospital settings. As the effect of regulatory policies as an intervention is dependent on the target population involved, the effectiveness of this type of intervention was variable. Different strategies may be useful in reducing inappropriate prescribing in the elderly. It is not clear whether combined strategies undertaken simultaneously have a synergistic effect.
不适当的药物处方可能会导致严重的药物不良反应风险。特别是，当存在更有效或风险更低的替代疗法来治疗相同疾病时，处方可能被认为是不适当的。本综述旨在确定可以显著减少老年人不适当处方的干预措施和策略。该综述基于对电子数据库的搜索，使用同义词如“老年人”、“干预措施”、“优化处方”和“不适当处方”来识别旨在改善老年人不适当处方的报告干预措施。共检索到 711 篇以英文发表的文章，并进行了考虑。其中，24 项原始研究，涉及 56 至 124802 名参与者，符合纳入标准，并纳入系统评价。在 16 项研究中，用于评估干预措施影响的统计效力在统计学意义水平为α=0.05 时大于 90%。这项研究包括各种干预措施，如教育干预、药物审查、老年病学家服务、多学科团队、计算机支持系统、监管政策和多方面的方法。由于评估方法的可变性，针对旨在改善不适当处方的教育干预措施，得出了混合反应。例如，一些研究没有评估确定干预水平是否足够需要哪些数据，而另一些研究没有考虑需要多少参与者才能证明存在显著差异。报告的三种计算机支持系统干预措施中的每一种都显著提高了处方和配药实践。在七项研究中评估了社区和医院环境中的药剂师干预措施。然而，使用了不同的标准，两项研究使用了药物适宜性指数，另外两项研究使用了自行设计的不适当处方标准，其余三项研究使用了 Beers 标准。评估涉及养老院居民的研究存在一个困难，因为可能涉及顾问药剂师和现场药剂师服务，在一项研究中，只考虑了顾问药剂师的角色。最有效的干预措施之一似乎是涉及老年病学家的多学科病例会议，这导致在社区和医院环境中减少了许多不适当处方的例子。由于监管政策作为一种干预措施的效果取决于所涉及的目标人群，因此这种类型的干预措施的效果是可变的。不同的策略可能有助于减少老年人的不适当处方。尚不清楚同时进行联合策略是否具有协同效应。
