Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland.
Age Ageing. 2018 Sep 1;47(5):670-678. doi: 10.1093/ageing/afy086.
computerised interventions have been suggested as an effective strategy to reduce potentially inappropriate prescribing (PIP) for hospitalised older adults. This systematic review and meta-analysis examined the evidence for efficacy of computerised interventions designed to reduce PIP in this patient group.
an electronic literature search was conducted using eight databases up to October 2017. Included studies were controlled trials of computerised interventions aiming to reduce PIP in hospitalised older adults (≥65 years). Risk of bias was assessed using Cochrane's Effective Practice and Organisation of Care criteria.
of 653 records identified, eight studies were included-two randomised controlled trials, two interrupted time series analysis studies and four controlled before-after studies. Included studies were mostly at a low risk of bias. Overall, seven studies showed either a statistically significant reduction in the proportion of patients prescribed a potentially inappropriate medicine (PIM) (absolute risk reduction {ARR} 1.3-30.1%), or in PIMs ordered (ARR 2-5.9%). However, there is insufficient evidence thus far to suggest that these interventions can routinely improve patient-related outcomes. It was only possible to include three studies in the meta-analysis-which demonstrated that intervention patients were less likely to be prescribed a PIM (odds ratio 0.6; 95% CI 0.38, 0.93). No computerised intervention targeting potential prescribing omissions (PPOs) was identified.
this systematic review concludes that computerised interventions are capable of statistically significantly reducing PIMs in hospitalised older adults. Future interventions should strive to target both PIMs and PPOs, ideally demonstrating both cost-effectiveness data and clinically significant improvements in patient-related outcomes.
计算机干预措施已被认为是减少住院老年患者潜在不适当处方（PIP）的有效策略。本系统评价和荟萃分析检查了旨在减少该患者群体 PIP 的计算机干预措施的疗效证据。
使用八个数据库进行了电子文献搜索，截至 2017 年 10 月。纳入的研究是针对住院老年患者（≥65 岁）减少 PIP 的计算机干预措施的对照试验。使用 Cochrane 的有效实践和组织护理标准评估偏倚风险。
在 653 条记录中，有 8 项研究被纳入-2 项随机对照试验、2 项中断时间序列分析研究和 4 项对照前后研究。纳入的研究大多偏倚风险较低。总体而言，有 7 项研究表明，患者接受潜在不适当药物（PIM）处方的比例（绝对风险降低 {ARR} 1.3-30.1%）或 PIM 处方（ARR 2-5.9%）均有统计学意义降低。然而，迄今为止，没有足够的证据表明这些干预措施可以常规改善患者相关结局。只有 3 项研究可纳入荟萃分析-表明干预组患者不太可能开处方 PIM（比值比 0.6；95%CI 0.38，0.93）。没有发现针对潜在处方遗漏（PPO）的计算机干预措施。
本系统评价得出结论，计算机干预措施能够在统计学上显著减少住院老年患者的 PIM。未来的干预措施应努力同时针对 PIM 和 PPO，理想情况下既要展示成本效益数据，又要在患者相关结局方面显示出显著的临床改善。
