School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, 7005, Australia.
Br J Clin Pharmacol. 2021 Oct;87(10):3672-3689. doi: 10.1111/bcp.14824. Epub 2021 Apr 20.
We aimed to investigate the efficacy and effectiveness of pharmacist-led interventions to reduce adverse drug events (ADEs) in older people living in residential aged care facilities (RACFs).
We systematically searched MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials and PsycINFO from their inceptions to July 2020. We investigated experimental study designs that employed a control group, or quasi-experimental studies conducted in RACFs.
We screened 3826 records and included 23 studies. We found seven single-component and 16 multicomponent pharmacist-led interventions to reduce ADEs in older people living in RACFs. The most frequent single-component pharmacist-led intervention was medication review. Medication review and education provision to healthcare professionals were the most common components in many pharmacist-led multicomponent interventions. Thirteen studies (56%) showed no effect, whereas ten studies (43%) reported significant reductions in ADEs following pharmacist-led interventions either as a sole intervention or as a part of a multi-component intervention. Many interventions focused on reducing the incidence of falls (39%).
This systematic review suggests that pharmacist-led interventions have the potential to reduce the incidence of ADEs in older people living in RACFs. Medication review and educational programmes, particularly academic detailing, either as a single component or as part of multicomponent interventions were the most common approaches to reducing drug-related harm in older people living in RACFs. The lack of a positive association between interventions and ADE in many studies suggests that targeted and tailored pharmacist-led interventions are required to reduce ADEs in older people in RACFs.
我们旨在调查药剂师主导的干预措施在减少居住在养老院（RACF）中的老年人不良药物事件（ADE）方面的疗效和效果。
我们系统地通过 PubMed、Embase、Cochrane 对照试验中心注册库和 PsycINFO 从其开始到 2020 年 7 月搜索了 MEDLINE。我们调查了采用对照组的实验性研究设计，或在 RACF 中进行的准实验研究。
我们筛选了 3826 条记录，纳入了 23 项研究。我们发现了 7 项单一成分和 16 项多成分药剂师主导的干预措施，以减少居住在 RACF 中的老年人的 ADE。最常见的单一成分药剂师主导的干预措施是药物审查。向医疗保健专业人员提供药物审查和教育是许多药剂师主导的多成分干预措施中最常见的组成部分。13 项研究（56%）没有效果，而 10 项研究（43%）报告称，在药剂师主导的干预措施后，无论是作为单一干预措施还是作为多成分干预措施的一部分，ADE 都显著减少。许多干预措施侧重于减少跌倒的发生率（39%）。
本系统评价表明，药剂师主导的干预措施有可能减少居住在养老院中的老年人的 ADE 发生率。药物审查和教育计划，特别是学术细节，无论是作为单一成分还是作为多成分干预措施的一部分，都是减少养老院中老年人药物相关伤害的最常见方法。许多研究中干预措施与 ADE 之间缺乏积极关联表明，需要针对居住在养老院中的老年人进行有针对性和量身定制的药剂师主导的干预措施，以减少 ADE。
