Reeve Emily, Shakib Sepehr, Hendrix Ivanka, Roberts Michael S, Wiese Michael D
Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia; Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Br J Clin Pharmacol. 2014 Oct;78(4):738-47. doi: 10.1111/bcp.12386.
Inappropriate use of medication is widespread, especially in older people, and is associated with risks, including adverse drug reactions, hospitalization and increased mortality. Optimization of appropriate medication use to minimize these harms is an ongoing challenge in healthcare. The term 'deprescribing' has been used to describe the complex process that is required for safe and effective cessation of medication. Patients play an important role in their own health and, while they may complain about the number of medications they have to take, they may also be reluctant to cease a medication when given the opportunity to do so. A review of previously proposed deprescribing processes and relevant literature was used to develop the patient-centred deprescribing process, which is a five-step cycle that encompasses gaining a comprehensive medication history, identifying potentially inappropriate medications, determining whether the potentially inappropriate medication can be ceased, planning the withdrawal regimen (e.g. tapering where necessary) and provision of monitoring, support and documentation. This is the first deprescribing process developed using knowledge of the patients' views of medication cessation; it focuses on engaging patients throughout the process, with the aim of improving long-term health outcomes. Despite a comprehensive review of the literature, there is still a lack in the evidence base on which to conduct deprescribing. The next step in broadening the evidence to support deprescribing will be to test the developed process to determine feasibility in the clinical setting.
药物的不当使用很普遍，尤其是在老年人中，并且与包括药物不良反应、住院和死亡率增加在内的风险相关。优化合理用药以将这些危害降至最低是医疗保健领域持续面临的挑战。“减药”一词已被用于描述安全有效地停止用药所需的复杂过程。患者在自身健康中起着重要作用，虽然他们可能会抱怨自己必须服用的药物数量，但当有机会停药时，他们也可能不愿意停药。通过回顾先前提出的减药过程和相关文献，制定了以患者为中心的减药过程，这是一个包含获取全面用药史、识别潜在不适当药物、确定是否可以停用潜在不适当药物、规划撤药方案（例如在必要时逐渐减量）以及提供监测、支持和记录的五步循环。这是首个利用患者对停药看法的知识开发的减药过程；它注重在整个过程中让患者参与，旨在改善长期健康结果。尽管对文献进行了全面回顾，但开展减药的证据基础仍然不足。扩大支持减药证据的下一步将是测试已制定的过程，以确定其在临床环境中的可行性。
