Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, 3508 TB Utrecht, The Netherlands.
Drugs Aging. 2013 Feb;30(2):91-102. doi: 10.1007/s40266-012-0048-6.
Many studies have investigated the effect of medication review on a variety of outcomes, but the elements of the interventions have been quite diverse. Moreover, implementation rates of recommendations also vary widely between studies.
The objective of this study was to investigate how the extent of collaboration between the general practitioner (GP) and the pharmacist impacts on the implementation of recommendations arising from medication review.
MEDLINE, EMBASE and Web of Science were searched for studies published between January 2000 and April 2012. Keywords included medication review, medication therapy management, pharmaceutical services and drug utilization review. Sixteen articles (describing 14 randomized controlled trials [RCTs]) out of 620 titles met the inclusion criteria. Inclusion criteria for the review were medication review, RCT design, involvement of both pharmacist and GP, and home-dwelling patients (mean age >70 years) who had not been recently discharged. After quality assessment of the article, the presence of the following eight key elements reflecting collaboration were scored for each intervention: pharmacist with clinical experience, own pharmacist involved, sharing of medical records, patient interview by pharmacist, invitation of patients by GP, case conference between GP and pharmacist, action plan, follow-up. The primary outcome was the implementation rate of recommendations. Meta-regression analysis was used to assess the association between the implementation rate and the number of key elements present.
Twelve RCTs were included after quality assessment. The mean number of key elements within the intervention was 5.2 (range 1-8). The mean implementation rate of recommendations was 50 % (range 17-86). The association between the number of key elements present in the intervention and the implementation rate of recommendations was significant: β = 0.085 (95 % CI 0.052-0.128; p < 0.0001).
This systematic review shows a significant association between the number of key elements of the intervention reflecting collaborative aspects in medication review and the implementation rate of recommendations.
许多研究已经调查了药物审查对各种结果的影响，但干预措施的要素却大不相同。此外，研究之间建议的实施率也有很大差异。
本研究旨在探讨全科医生（GP）与药剂师之间合作的程度如何影响药物审查建议的实施。
检索了 2000 年 1 月至 2012 年 4 月期间发表的研究，使用 MEDLINE、EMBASE 和 Web of Science。关键词包括药物审查、药物治疗管理、药学服务和药物利用审查。在 620 篇标题中，有 16 篇文章（描述了 14 项随机对照试验 [RCT]）符合纳入标准。综述的纳入标准为药物审查、RCT 设计、药剂师和全科医生共同参与以及居住在家庭中的患者（平均年龄 >70 岁）且最近未出院。对文章进行质量评估后，对每个干预措施的以下 8 个反映合作的关键要素进行评分：有临床经验的药剂师、有自己的药剂师参与、共享医疗记录、药剂师对患者进行访谈、由 GP 邀请患者、GP 和药剂师的病例会议、行动计划、随访。主要结局是建议的实施率。使用元回归分析评估实施率与存在的关键要素数量之间的关系。
质量评估后，有 12 项 RCT 被纳入。干预措施中关键要素的平均数量为 5.2（范围 1-8）。建议的实施率平均为 50%（范围 17-86）。干预措施中存在的关键要素数量与建议实施率之间存在显著关联：β=0.085（95%CI 0.052-0.128；p<0.0001）。
本系统评价显示，药物审查中反映合作方面的干预措施的关键要素数量与建议的实施率之间存在显著关联。
