Abrahamsen Bjarke, Hansen Rikke N, Rossing Charlotte
PhD, MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
MSc (Pharm). Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
Pharm Pract (Granada). 2020 Oct-Dec;18(4):1976. doi: 10.18549/PharmPract.2020.4.1976. Epub 2020 Oct 27.
A medication review is a possibility to assess and optimise a patient's medicine. A model that includes a medication review and a follow-up seem to provide the best results. However, it is not known whether specific subgroups of patients benefit more from a medication review than others.
This literature review summarises the evidence that is available on which patient subgroups exist positive outcomes from a medication review carried out in a primary care setting.
We performed a PICO analysis to identify keywords for setting, medication review and effect. We then conducted a search using the PubMed database (2004 to 2019) to identify studies relevant for our investigation. A screening process was carried out based on either title or abstract, and any study that matched the aim and inclusion criteria was included. All matching studies were obtained and read, and were included if they met predefined criteria such as study design, medication review and primary care. The studies were divided into subgroups. First, each subgroup was divided according to the studies' own definition. Secondly, each subgroup was allocated as either risk patients if the subgroup described a specific patient subgroup or risk medication, if the subgroup was defined as using a specific type of medication. This was done after discussion in the author group.
28 studies from a total of 935 studies were included. Identified studies were divided into either risk patients; frail, recently discharged or multimorbid patients, or risk medication; heart medication, antithrombotic medication, blood pressure lowering medication, antidiabetic medication, anti-Parkinson medication or medication increasing the risk of falls. The subgroups identified from a medication review in primary care were defined as being frail, recently discharged from hospital or multimorbid (risk patients), or defined as patients using anticoagulant or blood pressure lowering medication (risk medication). Most of the medication reviews in the studies that showed an economic effect included at least one follow-up and were delivered by a pharmacist.
The literature review demonstrates that medication reviews delivered by pharmacists to specific subgroups of patients are a way of optimising the economic effect of medication reviews in primary care. This is obtained by reducing health-related costs or the number of contacts with primary or secondary health care services.
药物评估是一种评估和优化患者用药的方法。包含药物评估和随访的模式似乎能产生最佳效果。然而，尚不清楚特定患者亚组是否比其他患者从药物评估中获益更多。
本综述总结了在基层医疗环境中开展的药物评估对哪些患者亚组产生积极结果的现有证据。
我们进行了PICO分析，以确定关于环境、药物评估和效果的关键词。然后使用PubMed数据库（2004年至2019年）进行检索，以识别与我们的研究相关的研究。基于标题或摘要进行筛选过程，任何符合目标和纳入标准的研究都被纳入。获取并阅读所有匹配的研究，如果它们符合预定义标准，如研究设计、药物评估和基层医疗，则被纳入。研究被分为亚组。首先，每个亚组根据研究自身的定义进行划分。其次，如果亚组描述的是特定患者亚组，则将每个亚组归类为风险患者；如果亚组被定义为使用特定类型的药物，则归类为风险药物。这是在作者小组讨论后完成的。
总共935项研究中有28项被纳入。确定的研究分为风险患者（体弱、近期出院或患有多种疾病的患者）或风险药物（心脏药物、抗血栓药物、降压药物、抗糖尿病药物、抗帕金森药物或增加跌倒风险的药物）。在基层医疗中通过药物评估确定的亚组被定义为体弱、近期出院或患有多种疾病（风险患者），或被定义为使用抗凝剂或降压药物的患者（风险药物）。大多数显示出经济效果的研究中的药物评估至少包括一次随访，并且由药剂师提供。
文献综述表明，药剂师对特定患者亚组进行的药物评估是优化基层医疗中药物评估经济效果的一种方式。这是通过降低与健康相关的成本或减少与初级或二级医疗服务的接触次数来实现的。
