Loh Z W R, Cheen M H H, Wee H L
Department of Pharmacy, Khoo Teck Puat Hospital, Singapore, Singapore.
Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.
J Clin Pharm Ther. 2016 Dec;41(6):621-633. doi: 10.1111/jcpt.12453. Epub 2016 Oct 1.
Recent reviews have shown that pharmacist-provided medication review in the elderly can improve clinical outcomes and reduce medication discrepancies compared with usual care. However, none determined whether these translate to improved humanistic and economic outcomes. This review sought to evaluate the effects of medication review on health-related quality of life (HRQoL) and healthcare costs in the elderly.
A systematic search of MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane library for studies published in English from inception to 31 August 2015 was conducted. The review included studies lasting at least 3 months that randomly assigned community-dwelling participants aged at least 65 years to receive either pharmacist-provided medication review or usual care. Studies set in nursing homes were excluded.
The review identified 25 studies that included 15 341 participants and lasted between 3 and 36 months. Twenty and 13 studies reported HRQoL and economic outcomes, respectively. Overall, there was no significant difference in HRQoL and healthcare costs between pharmacist-provided medication review and usual care. Meta-analysis of studies that reported the 36-item Short-Form Health Survey found significant differences in favour of usual care in the body pain (mean difference: 2·94, 95% CI: 0·54-5·34, P = 0·02) and general health perception (mean difference: 1·83, 95% CI: 0·16-3·50, P = 0·03) domains, whereas there were no significant differences in other domains. Meta-analysis of the EuroQol-5D utility (mean difference: -0·01, 95% CI: -0·02-0·01, P = 0·57) and visual analogue scale (mean difference: 0·01, 95% CI: -3·24-3·26, P = 1·00) found no significant differences. Costs of hospitalization, medication and other healthcare resources consumed were similar between groups.
Humanistic and economic outcomes of pharmacist-provided medication review were largely similar to those of usual care. Further research using more robust methodology is needed to determine whether improved medication management can improve HRQoL and reduce healthcare costs. Careful thought should be given to capturing relevant outcomes that reflect the potential benefits of this intervention.
近期综述表明，与常规护理相比，药剂师为老年人提供的用药评估可改善临床结局并减少用药差异。然而，尚无研究确定这些是否能转化为改善人文和经济结局。本综述旨在评估用药评估对老年人健康相关生活质量（HRQoL）和医疗保健成本的影响。
对MEDLINE、EMBASE、CINAHL、科学网和Cochrane图书馆进行系统检索，以查找自数据库建库至2015年8月31日发表的英文研究。纳入的研究持续时间至少为3个月，将年龄至少65岁的社区居住参与者随机分为两组，分别接受药剂师提供的用药评估或常规护理。排除在养老院开展的研究。
该综述共纳入25项研究，涉及15341名参与者，研究持续时间在3至36个月之间。分别有20项和13项研究报告了HRQoL和经济结局。总体而言，药剂师提供的用药评估与常规护理在HRQoL和医疗保健成本方面无显著差异。对报告36项简短健康调查问卷的研究进行荟萃分析发现，在身体疼痛（平均差：2.94，95%置信区间：0.54 - 5.34，P = 0.02）和总体健康感知（平均差：1.83，95%置信区间：0.16 - 3.50，P = 0.03）领域，常规护理具有显著优势，而在其他领域无显著差异。对欧洲五维健康量表效用值（平均差：-0.01，95%置信区间：-0.02 - 0.01，P = 0.57）和视觉模拟评分（平均差：0.01，95%置信区间：-3.24 - 3.26，P = 1.00）的荟萃分析未发现显著差异。两组在住院费用、药物费用及其他消耗的医疗资源方面相似。
药剂师提供的用药评估在人文和经济结局方面与常规护理基本相似。需要采用更可靠的方法进行进一步研究，以确定改善用药管理是否能提高HRQoL并降低医疗保健成本。应仔细考虑捕捉反映该干预潜在益处的相关结局。
