Meid Andreas D, Lampert Anette, Burnett Alina, Seidling Hanna M, Haefeli Walter E
Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Br J Clin Pharmacol. 2015 Oct;80(4):768-76. doi: 10.1111/bcp.12657. Epub 2015 Jun 12.
The aim of the present study was to conduct a meta-analysis of controlled trials assessing the impact of pharmaceutical care interventions (e.g. medication reviews) on medication underuse in older patients (≥65 years).
The databases MEDLINE and EMBASE were searched for controlled studies, and data on interventions, patient characteristics and exposure, and outcome assessment were extracted. Risk of bias was assessed using the Cochrane Collaboration's 'risk of bias' table. Results from reported outcomes were synthesized in multivariate random effects meta-analysis, subgroup meta-analysis and meta-regression.
From 954 identified articles, nine controlled studies, mainly comprising a medication review, were included (2542 patients). These interventions were associated with significant reductions in the mean number of omitted drugs per patient (estimate from six studies with 1469 patients: - 0.44; 95% confidence interval -0.61, -0.26) and the proportion of patients with ≥1 omitted drugs (odds ratio from eight studies with 1833 patients: 0.29; 95% confidence interval 0.13, 0.63). The only significant influential factor for improving success was the utilization of explicit screening instruments when conducting a medication review (P = 0.033).
Pharmaceutical care interventions, including medication reviews, can significantly reduce medication underuse in older people. The use of explicit screening instruments alone or in combination with implicit reasoning is strongly recommendable for clinical practice.
本研究旨在对评估药学服务干预措施（如药物重整）对老年患者（≥65岁）用药不足影响的对照试验进行荟萃分析。
检索MEDLINE和EMBASE数据库以查找对照研究，并提取有关干预措施、患者特征与暴露情况以及结局评估的数据。使用Cochrane协作网的“偏倚风险”表评估偏倚风险。对报告结局的结果进行多变量随机效应荟萃分析、亚组荟萃分析和荟萃回归分析。
从954篇已识别的文章中，纳入了9项对照研究，主要包括药物重整（2542例患者）。这些干预措施与每位患者遗漏药物的平均数量显著减少相关（来自6项研究1469例患者的估计值：-0.44；95%置信区间-0.61，-0.26），以及与≥1种遗漏药物的患者比例降低相关（来自8项研究1833例患者的优势比：0.29；95%置信区间0.13，0.63）。改善成功率的唯一显著影响因素是在进行药物重整时使用明确的筛查工具（P = 0.033）。
药学服务干预措施，包括药物重整，可以显著减少老年人的用药不足情况。强烈建议在临床实践中单独使用或与隐式推理结合使用明确的筛查工具。
