Reeve Emily, Thompson Wade, Farrell Barbara
NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, University of Sydney, NSW, Australia; Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Capital Health, Nova Scotia Health Authority, NS, Canada.
Bruyère Research Institute, Ottawa, ON, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, ON, Canada.
Eur J Intern Med. 2017 Mar;38:3-11. doi: 10.1016/j.ejim.2016.12.021. Epub 2017 Jan 5.
Deprescribing can be defined as the process of withdrawal or dose reduction of medications which are considered inappropriate in an individual. The aim of this narrative review is to provide an overview of "deprescribing"; firstly discussing the potential benefits and harms followed by the barriers to and enablers of deprescribing. We also provide practical recommendations to recognise opportunities and strategies for deprescribing in practice. Studies focused on minimizing polypharmacy indicate that deprescribing may be associated with potential benefits including resolution of adverse drug reactions, improved quality of life and medication adherence and a reduction in drug costs. While the data on the benefits is inconsistent, deprescribing appears to be safe. There are, however, potential harms including return of medical conditions or symptoms and adverse drug withdrawal reactions which emphasise the need for the process to be supervised and monitored by a health care professional. Taking action on deprescribing can be facilitated by knowledge of potential barriers, implementing a deprescribing process (utilising developed tools and resources) and identifying opportunities for deprescribing through engaging with patients and caregivers and other health care professionals and considering deprescribing in a variety of populations. Important areas for future research include the suitability of deprescribing of certain medications in specific populations, how to implement deprescribing processes into clinical care in a feasible and cost effective manner and how to engage consumers throughout the process to achieve positive health and quality of life outcomes.
减药可定义为停用或减少被认为对个体不合适的药物的过程。本叙述性综述的目的是概述“减药”；首先讨论潜在的益处和危害，然后探讨减药的障碍和促成因素。我们还提供实际建议，以识别实践中减药的机会和策略。专注于尽量减少多重用药的研究表明，减药可能带来潜在益处，包括解决药物不良反应、改善生活质量和用药依从性以及降低药物成本。虽然关于益处的数据并不一致，但减药似乎是安全的。然而，也存在潜在危害，包括病情或症状复发以及药物撤药不良反应，这凸显了该过程需要由医疗保健专业人员进行监督和监测。了解潜在障碍、实施减药流程（利用已开发的工具和资源）以及通过与患者、护理人员和其他医疗保健专业人员合作并在各类人群中考虑减药来识别减药机会，有助于推动减药行动。未来研究的重要领域包括特定人群中某些药物减药的适用性、如何以可行且具有成本效益的方式将减药流程纳入临床护理，以及如何在整个过程中让消费者参与进来以实现积极的健康和生活质量结果。
