NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, UK.
NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, UK.
J Am Med Dir Assoc. 2014 Oct;15(10):706-18. doi: 10.1016/j.jamda.2014.06.012. Epub 2014 Aug 8.
Antipsychotic medications are commonly used to manage the behavioral and psychological symptoms of dementia. Several large studies have demonstrated an association between treatment with antipsychotics and increased morbidity and mortality in people with dementia.
To assess the effectiveness of interventions used to reduce inappropriate prescribing of antipsychotics to the elderly with dementia in residential care.
Systematic searches were conducted in 12 electronic databases. Reference lists of all included studies and forward citation searching using Web of Science were also conducted. All quantitative studies with a comparative research design and studies in which recognized methods of qualitative data collection were used were included. Articles were screened for inclusion independently by 2 reviewers. Data extraction and quality appraisal were performed by 1 reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary.
Twenty-two quantitative studies (reported in 23 articles) were included evaluating the effectiveness of educational programs (n = 11), in-reach services (n = 2), medication review (n = 4), and multicomponent interventions (n = 5). No qualitative studies meeting our inclusion criteria were identified. Eleven studies were randomized or controlled in design; the remainder were uncontrolled before and after studies. Beneficial effects were seen in 9 of the 11 studies with the most robust study design with reductions in antipsychotic prescribing levels of between 12% and 20%. Little empirical information was provided on the sustainability of interventions.
Interventions to reduce inappropriate prescribing of antipsychotic medications to people with dementia resident in care homes may be effective in the short term, but longer more robust studies are needed. For prescribing levels to be reduced in the long term, the culture and nature of care settings and the availability and feasibility of nondrug alternatives needs to be addressed.
抗精神病药物常用于治疗痴呆患者的行为和心理症状。几项大型研究表明，抗精神病药物治疗与痴呆患者的发病率和死亡率增加之间存在关联。
评估用于减少养老院中痴呆老年人不合理使用抗精神病药物的干预措施的效果。
在 12 个电子数据库中进行了系统搜索。还对所有纳入研究的参考文献列表和使用 Web of Science 的正向引文搜索进行了搜索。所有具有比较研究设计的定量研究和使用公认的定性数据收集方法的研究均被纳入。由 2 位评审员独立筛选纳入的文章。由 1 位评审员进行数据提取和质量评估，并由第 2 位评审员进行检查，如有分歧，必要时通过与第 3 位讨论解决。
纳入了 22 项评估教育计划（n=11）、上门服务（n=2）、药物审查（n=4）和多组分干预措施（n=5）效果的定量研究（报告在 23 篇文章中）。未发现符合我们纳入标准的定性研究。11 项研究采用随机或对照设计；其余研究为无对照的前后研究。在设计最严谨的 9 项研究中观察到有益效果，抗精神病药物处方量减少了 12%至 20%。干预措施的可持续性提供的实证信息很少。
减少养老院中痴呆患者不合理使用抗精神病药物的干预措施在短期内可能有效，但需要进行更长期、更有力的研究。为了长期降低处方量，需要解决护理环境的文化和性质以及非药物替代方案的可用性和可行性。
