Reeve Emily, Gnjidic Danijela, Long Janet, Hilmer Sarah
Br J Clin Pharmacol. 2015 Dec;80(6):1254-68. doi: 10.1111/bcp.12732.
AIMS: The aim of this study was to identify what definitions have been published for the term 'deprescribing', and determine whether a unifying definition could be reached. A secondary aim was to uncover patterns between the published definitions which could explain any variation. METHODS: Systematic literature searches were performed (earliest records to February 2014) in MEDLINE, Embase, CINAHL, Informit, Scopus and Google Scholar. The terms deprescrib* or de-prescrib* were employed as a keyword search in all fields. Conventional content analysis and word frequencies were used to identify characteristics of the definitions. Network analysis was conducted to visualize characteristic distribution across authors and articles. RESULTS: Following removal of duplicates, 231 articles were retrieved, 37 of which included a definition. Eight characteristics of the definitions were identified: use of the term stop/withdraw/cease/discontinue (35 articles), aspect of prescribing included e.g. long term therapy/inappropriate medications (n = 18), use of the term 'process' or 'structured' (n = 13), withdrawal is planned/supervised/judicious (n = 11), involving multiple steps (n = 7), includes dose reduction/substitution (n = 7), desired goals/outcomes described (n = 5) and involves tapering (n = 4). Network analysis did not reveal patterns responsible for variations in previously used definitions. CONCLUSIONS: These findings show that there is lack of consensus on the definition of deprescribing. This article proposes the following definition: 'Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes'. This definition has not yet been externally validated and further work is required to develop an internationally accepted and appropriate definition.
目的:本研究旨在确定已发表的“撤药处方”一词的定义,并判断是否能达成统一的定义。次要目的是揭示已发表定义之间的模式,以解释其中的差异。 方法:在MEDLINE、Embase、CINAHL、Informit、Scopus和谷歌学术中进行了系统的文献检索(最早记录至2014年2月)。使用“撤药处方*”或“减量处方*”作为所有字段的关键词搜索。采用传统的内容分析和词频分析来确定定义的特征。进行网络分析以直观呈现作者和文章之间的特征分布。 结果:去除重复项后,共检索到231篇文章,其中37篇包含定义。确定了定义的八个特征:使用“停用/撤药/停止/终止”一词(35篇文章)、处方方面包括例如长期治疗/不适当药物(n = 18)、使用“过程”或“结构化”一词(n = 13)、撤药是有计划的/受监督的/审慎的(n = 11)、涉及多个步骤(n = 7)、包括剂量减少/替代(n = 7)、描述了期望的目标/结果(n = 5)以及涉及逐渐减量(n = 4)。网络分析未揭示导致先前使用定义存在差异的模式。 结论:这些发现表明,对于撤药处方的定义缺乏共识。本文提出以下定义:“撤药处方是由医疗保健专业人员监督的停用不适当药物的过程,目的是管理多重用药并改善治疗效果”。该定义尚未经过外部验证,需要进一步开展工作以制定国际认可且合适的定义。
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