自动化剂量配药服务在基层医疗患者中的应用：系统评价。
Automated dose dispensing service for primary healthcare patients: a systematic review.
机构信息
Assessment of Pharmacotherapies, Finnish Medicines Agency, PO Box 55, 00034 FIMEA, Kuopio, Finland.
出版信息
Syst Rev. 2013 Jan 8;2:1. doi: 10.1186/2046-4053-2-1.
BACKGROUND
An automated dose dispensing (ADD) service has been implemented in primary healthcare in some European countries. In this service, regularly used medicines are machine-packed into unit-dose bags for each time of administration. The aim of this study is to review the evidence for ADD's influence on the appropriateness of medication use, medication safety, and costs in primary healthcare.
METHODS
A literature search was performed in April 2012 in the most relevant databases (n = 10), including the Medline, Embase, and Cochrane Library. The reference lists of the studies selected were manually searched. A study was included in the review if the study was conducted in primary healthcare or nursing home settings and medicines were dispensed in unit-dose bags.
RESULTS
Out of 328 abstracts, seven studies met the inclusion and reporting quality criteria, but none applied a randomized controlled study design. Of the four controlled studies, one was a national register-based study. It showed that the patient group in the ADD scheme more often used three or more psychotropic drugs and anticholinergics than patients using the standard dispensing procedure, while women in the ADD group used less long-acting benzodiazepines and both genders had fewer drug-drug interactions. In another, regional controlled study, the ADD group consisted of patients with higher risk of inappropriate drug use, according to all indicators applied. The third controlled study indicated that ADD user drug treatments were more likely to remain unchanged than in patients using a standard dispensing procedure. A controlled study from Norway showed that ADD reduced discrepancies in the documentation of patient medication records. Costs were not investigated in any of the studies.
CONCLUSIONS
A very limited number of controlled studies have explored ADD in primary healthcare. Consequently, the evidence for ADD's influence on appropriateness and safety of medication use is limited and lacking in information on costs. The findings of this review suggest that patients using the ADD have more inappropriate drugs in their regimens, and that ADD may improve medication safety in terms of reducing the discrepancies in medication records. Further evidence is needed to draw sound conclusions on ADD's outcomes.
背景
在一些欧洲国家，初级卫生保健中已经实施了自动化剂量配给（ADD）服务。在这项服务中，经常使用的药物被机器包装成每个给药时间的单位剂量袋。本研究的目的是综述 ADD 对药物使用的适当性、药物安全性和成本的影响的证据。
方法
在 2012 年 4 月，在最相关的数据库（n=10）中进行了文献检索，包括 Medline、Embase 和 Cochrane 图书馆。手动检索了所选研究的参考文献列表。如果研究在初级保健或护理院环境中进行，并且药物以单位剂量袋分发，则将研究纳入综述。
结果
在 328 篇摘要中，有 7 篇研究符合纳入和报告质量标准，但没有一项研究采用随机对照研究设计。在四项对照研究中，有一项是全国基于登记的研究。结果表明，ADD 方案中的患者组使用三种或三种以上精神药物和抗胆碱能药物的比例高于使用标准配药程序的患者，而 ADD 组中的女性使用的长效苯二氮䓬类药物较少，两性的药物-药物相互作用也较少。在另一项区域性对照研究中，根据所有应用指标，ADD 组的患者具有更高的药物使用不当风险。第三项对照研究表明，与使用标准配药程序的患者相比，ADD 用户的药物治疗更有可能保持不变。来自挪威的一项对照研究表明，ADD 减少了患者用药记录中用药差异。在任何研究中都没有调查成本。
结论
很少有对照研究探索了初级卫生保健中的 ADD。因此，ADD 对药物使用适当性和安全性的影响的证据有限，缺乏关于成本的信息。本综述的研究结果表明，使用 ADD 的患者的治疗方案中存在更多不适当的药物，并且 ADD 可能通过减少用药记录中的差异来提高用药安全性。需要进一步的证据来得出关于 ADD 结果的正确结论。
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