Sansom Institute, University of South Australia, Adelaide, SA, Australia,
Drugs Aging. 2013 Oct;30(10):793-807. doi: 10.1007/s40266-013-0106-8.
Inappropriate medication use is common in the elderly and the risks associated with their use are well known. The term deprescribing has been utilised to describe the complex process that is required for the safe and effective cessation of inappropriate medications. Given the primacy of the consumer in health care, their views must be central in the development of any deprescribing process.
The aim of this study was to identify barriers and enablers that may influence a patient's decision to cease a medication.
A systematic search of MEDLINE, International Pharmaceutical Abstracts, EMBASE, CINAHL, Informit and Scopus was conducted and augmented with a manual search. Numerous search terms relating to withdrawal of medications and consumers' beliefs were utilised.
Articles were included if the barriers or enablers were directly patient/carer reported and related to long-term medication(s) that they were currently taking or had recently ceased.
Determination of relevance and data extraction was performed independently by two reviewers. Content analysis with coding was utilised for synthesis of results.
Twenty-one articles met the criteria and were included in the review. Three themes, disagreement/agreement with 'appropriateness' of cessation, absence/presence of a 'process' for cessation, and negative/positive 'influences' to cease medication, were identified as both potential barriers and enablers, with 'fear' of cessation and 'dislike' of medications as a fourth barrier and enabler, respectively. The most common barrier/enabler identified was 'appropriateness' of cessation, with 15 studies identifying this as a barrier and 18 as an enabler.
The decision to stop a medication by an individual is influenced by multiple competing barriers and enablers. Knowledge of these will aid in the development of a deprescribing process, particularly in approaching the topic of cessation with the patient and what process should be utilised. However, further research is required to determine if the proposed patient-centred deprescribing process will result in improved patient outcomes.
老年人中普遍存在用药不当的情况，且人们对其相关风险已有充分认识。“撤药”一词被用于描述安全有效停止使用不适当药物所需的复杂过程。鉴于患者在医疗保健中的首要地位，他们的意见必须成为任何撤药过程的核心。
本研究旨在确定可能影响患者停止用药决定的障碍和促进因素。
对 MEDLINE、国际药学文摘、EMBASE、CINAHL、Informit 和 Scopus 进行了系统检索，并辅以手动检索。使用了与药物撤回和患者信念相关的大量检索词。
如果障碍或促进因素是直接由患者/护理人员报告的，并且与他们正在服用或最近已停止的长期药物有关，则纳入研究。
两名评审员独立确定相关性并提取数据。采用内容分析法进行结果综合。
有 21 篇文章符合标准并纳入综述。确定了三个主题，即停止用药的“适当性”的意见分歧/一致、停止用药“过程”的存在/缺失，以及停止用药的“负面影响”/积极影响，这些既是潜在的障碍也是促进因素，“对停药的恐惧”和“对药物的厌恶”分别是第四大障碍和促进因素。最常见的障碍/促进因素是停止用药的“适当性”，有 15 项研究认为这是一个障碍，18 项研究认为这是一个促进因素。
个体停止用药的决定受到多种相互竞争的障碍和促进因素的影响。了解这些因素将有助于开发撤药流程，特别是在与患者讨论停药问题以及应采用何种流程时。然而，需要进一步研究来确定拟议的以患者为中心的撤药流程是否会改善患者结局。
