Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK.
Fam Pract. 2021 Jul 28;38(4):509-523. doi: 10.1093/fampra/cmaa146.
Few studies have evaluated roles of general practice-based pharmacists (PBPs), particularly in optimizing medicines management for older people with both multimorbidity and polypharmacy.
To explore the types and effectiveness of services provided by PBPs, either alone or in collaboration with other primary health care professionals, that sought to optimize medicines management for older people with multimorbidity and polypharmacy.
Eight electronic databases and three trial registries were searched for studies published in English until April 2020. Inclusion criteria were randomized controlled trials, non-randomized controlled trials and controlled before-and-after studies of services delivered by PBPs in primary care/general practice, for patients aged ≥65 years with both multimorbidity and polypharmacy that focused on a number of outcomes. The Cochrane risk of bias tool for randomized trials (RoB 1) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) assessment tool were used for quality assessment. A narrative synthesis was conducted due to study heterogeneity.
Seven studies met inclusion criteria. All included studies employed PBP-led medication review accompanied by recommendations agreed and implemented by general practitioners. Other patient-level and practice-level interventions were described in one study. The limited available evidence suggested that PBPs, in collaboration with other practice team members, had mixed effects on outcomes focused on optimizing medicines management for older people. Most included studies were of poor quality and data to estimate the risk of bias were often missing.
Future high-quality studies are needed to test the effects of PBP interventions on a well-defined range of medicines management-related outcomes.
很少有研究评估全科医生主导的药剂师（PBPs）的作用，特别是在优化患有多种疾病和多种药物治疗的老年人的药物管理方面。
探讨 PBPs 单独或与其他初级卫生保健专业人员合作提供的服务类型和效果，这些服务旨在优化患有多种疾病和多种药物治疗的老年人的药物管理。
检索了 8 个电子数据库和 3 个试验注册处，以获取截至 2020 年 4 月发表的英文研究。纳入标准为在初级保健/全科医疗中由 PBPs 提供的服务的随机对照试验、非随机对照试验和对照前后研究，服务对象为年龄≥65 岁、患有多种疾病和多种药物治疗且关注多个结局的患者。使用 Cochrane 随机试验偏倚风险工具（RoB 1）和非随机干预研究偏倚风险（ROBINS-I）评估工具对质量进行评估。由于研究存在异质性，因此进行了叙述性综合分析。
有 7 项研究符合纳入标准。所有纳入的研究都采用了由 PBPs 主导的药物审查，同时提出了建议，并由全科医生同意和实施。在一项研究中还描述了其他针对患者和实践的干预措施。有限的可用证据表明，PBPs 与其他实践团队成员合作，对以优化老年人药物管理为重点的结局产生了混合影响。大多数纳入的研究质量较差，并且经常缺少估计偏倚风险的数据。
需要未来开展高质量的研究，以测试 PBPs 干预对一系列明确的药物管理相关结局的影响。
