通过伞式综述为初级保健中的减药提供证据。
Evidence for deprescription in primary care through an umbrella review.
机构信息
Andalusian School of Public Health (Spanish acronym EASP), Granada, Spain.
Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Spain.
出版信息
BMC Fam Pract. 2020 Jun 8;21(1):100. doi: 10.1186/s12875-020-01166-1.
BACKGROUND
There is a high prevalence of potentially inappropriate prescriptions in primary care. This is associated with more frequent adverse events, lower quality of life and more frequent visits to hospital accident & emergency departments. The aim of the present study is to summarise available evidence on the effectiveness of deprescription interventions in primary care, and to describe the barriers and enablers of the process from the point of view of patients and healthcare professionals.
METHODS
We designed an umbrella review which includes nine systematic reviews. More than 50% of included studies were performed with adults in primary care. Two reviewers independently performed data extraction and analysis.
RESULTS
In considering studies of the effectiveness of interventions, it can be observed that the educational component of deprescription procedures is a key factor, whilst procedures tailored towards the patient's situation offer better results. With regards to studies involving healthcare professionals, the main explored areas were the balance between risks and benefits, and the need to improve communication with patients as well as other colleagues involved in patient care. Amongst the identified barriers we found lack of time, inability to access all information, being stuck in a routine, resistance to change and a lack of willingness to question the prescription decisions made by healthcare colleagues. With regards to patients, it is clear that they have worries and doubts. In order to overcome these issues, a good relationship with healthcare professionals and receipt of their support is required during the process.
CONCLUSIONS
Optimizing medication through targeted deprescribing is an important part of managing chronic conditions, avoiding adverse effects and improving outcomes. The majority of deprescription interventions in primary care are effective. Good communication between healthcare professionals is a key element for success in the deprescription process.
背景
初级保健中潜在不适当处方的患病率很高。这与更频繁的不良事件、更低的生活质量和更频繁地访问医院急诊部门有关。本研究旨在总结初级保健中减药干预措施的有效性的现有证据，并从患者和医疗保健专业人员的角度描述该过程的障碍和促进因素。
方法
我们设计了一项伞式综述，其中包括九项系统评价。超过 50%的纳入研究是在初级保健中的成年人中进行的。两名审查员独立进行数据提取和分析。
结果
在考虑干预措施有效性的研究时，可以观察到减药程序的教育组成部分是一个关键因素，而针对患者情况量身定制的程序则提供更好的结果。关于涉及医疗保健专业人员的研究，主要探讨的领域是风险和收益之间的平衡，以及需要改善与患者以及参与患者护理的其他同事的沟通。在所确定的障碍中，我们发现缺乏时间、无法获取所有信息、陷入常规、对变革的抵制以及不愿意质疑医疗保健同事做出的处方决策。对于患者，很明显他们有担忧和疑虑。为了克服这些问题，在这个过程中，他们需要与医疗保健专业人员建立良好的关系，并得到他们的支持。
结论
通过有针对性的减药来优化药物治疗是管理慢性病、避免不良反应和改善治疗效果的重要组成部分。初级保健中大多数减药干预措施是有效的。医疗保健专业人员之间的良好沟通是减药过程成功的关键要素。
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