Croke Aisling, James Oscar, Clyne Barbara, Moriarty Frank, Cardwell Karen, Smith Susan M
Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.
NI Centre for Pharmacy Learning & Development, Queens University, Belfast, UK.
HRB Open Res. 2020 Mar 12;2:32. doi: 10.12688/hrbopenres.12966.2. eCollection 2019.
Coordinating prescribing for patients with polypharmacy is a challenge for general practitioners. Pharmacists may improve management and outcomes for patients with polypharmacy. This systematic review aims to examine the clinical and cost-effectiveness of pharmacist interventions to optimise prescribing and improve health outcomes in patients with polypharmacy in primary care settings. The review will be reported using the PRISMA guidelines. A comprehensive search of 10 databases from inception to present, with no language restrictions will be conducted. Studies will be included where they evaluate the clinical or cost-effectiveness of a clinical pharmacist in primary care on potentially inappropriate prescriptions using validated indicators and number of medicines. Secondary outcomes will include health related quality of life measures, health service utilisation, clinical outcomes and data relating to cost effectiveness. Randomised controlled trials, non-randomised controlled trials, controlled before-after, interrupted-time-series and health economic studies will be eligible for inclusion. Titles, abstracts and full texts will be screened for inclusion by two reviewers. Data will be extracted using a standard form. Risk of bias in all included studies will be assessed using the Effective Practice and Organisation of Care (EPOC) criteria. Economic studies will be assessed using the Consensus Health Economic Criteria (CHEC) list as per the Cochrane Handbook for critical appraisal of methodological quality. A narrative synthesis will be performed, and the certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Where data support quantitative synthesis, a meta-analysis will be performed. This systematic review will give an overview of the effectiveness of pharmacist interventions to improve prescribing and health outcomes in a vulnerable patient group. This will provide evidence to policy makers on strategies involving clinical pharmacists integrated within general practice, to address issues which arise in polypharmacy and multimorbidity. CRD42019139679 (28/08/19).
协调多重用药患者的处方开具对全科医生来说是一项挑战。药剂师可以改善多重用药患者的管理和治疗效果。本系统评价旨在研究药剂师干预措施在基层医疗环境中优化多重用药患者处方开具及改善健康结局的临床和成本效益。本评价将按照PRISMA指南进行报告。将对10个数据库从创建至今进行全面检索，无语言限制。纳入的研究需评估基层医疗中临床药剂师对潜在不适当处方使用经过验证的指标和药物数量的临床或成本效益。次要结局将包括与健康相关的生活质量测量、卫生服务利用、临床结局以及与成本效益相关的数据。随机对照试验、非随机对照试验、前后对照试验、中断时间序列试验和卫生经济学研究均符合纳入标准。两名评审员将对标题、摘要和全文进行筛选以确定是否纳入。数据将使用标准表格提取。所有纳入研究的偏倚风险将使用有效实践和医疗组织（EPOC）标准进行评估。经济研究将根据Cochrane手册中对方法学质量进行批判性评价的共识卫生经济标准（CHEC）清单进行评估。将进行叙述性综合分析，并使用推荐分级评估、制定和评价（GRADE）标准评估证据的确定性。若数据支持定量综合分析，将进行荟萃分析。本系统评价将概述药剂师干预措施在改善弱势患者群体处方开具和健康结局方面的有效性。这将为政策制定者提供证据，以制定涉及将临床药剂师纳入全科医疗实践的策略，从而解决多重用药和多种疾病并存时出现的问题。CRD42019139679（2019年8月28日）
