City Pharmacies Zagreb, Zagreb, Croatia.
Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia.
Br J Clin Pharmacol. 2022 Feb;88(2):452-463. doi: 10.1111/bcp.14947. Epub 2021 Jul 2.
Community-based pharmacists are an important stakeholder in providing continuing care for chronic multi-morbid patients, and their role is steadily expanding. The aim of this study is to examine the literature exploring community-based pharmacist-initiated and/or -led deprescribing and to evaluate the impact on the success of deprescribing and clinical outcomes.
Library and clinical trials databases were searched from inception to March 2020. Studies were included if they explored deprescribing in adults, by community-based pharmacists and were available in English. Two reviewers extracted data independently using a pre-agreed data extraction template. Meta-analysis was not performed due to heterogeneity of study designs, types of intervention and outcomes.
A total of 24 studies were included in the review. Results were grouped based on intervention method into four categories: educational interventions; interventions involving medication review, consultation or therapy management; pre-defined pharmacist-led deprescribing interventions; and pharmacist-led collaborative interventions. All types of interventions resulted in greater discontinuation of medications in comparison to usual care. Educational interventions reported financial benefits as well. Medication review by community-based pharmacist can lead to successful deprescribing of high-risk medication, but do not affect the risk or rate of falls, rate of hospitalisations, mortality or quality of life. Pharmacist-led medication review, in patients with mental illness, resulting in deprescribing improves anticholinergic side effects, memory and quality of life. Pre-defined pharmacist-led deprescribing did not reduce healthcare resource consumptions but can contribute to financial savings. Short follow-up periods prevent evaluation of long-term sustainability of deprescribing interventions.
This systematic review suggests community-based pharmacists can lead deprescribing interventions and that they are valuable partners in deprescribing collaborations, providing necessary monitoring throughout tapering and post-follow-up to ensure the success of an intervention.
社区药剂师是为慢性多病患者提供持续护理的重要利益相关者，其作用正在稳步扩大。本研究旨在考察探索社区药剂师发起和/或主导的药物减量的文献，并评估其对药物减量成功和临床结果的影响。
从建库到 2020 年 3 月，检索了图书馆和临床试验数据库。如果研究探讨了由社区药剂师在成年人中进行的药物减量，且可用英文获取，则将其纳入研究。两名评审员使用预先商定的数据提取模板独立提取数据。由于研究设计、干预类型和结果的异质性，未进行荟萃分析。
综述共纳入 24 项研究。根据干预方法将结果分为四类：教育干预；涉及药物审查、咨询或治疗管理的干预；预定义的药剂师主导的药物减量干预；以及药剂师主导的合作干预。与常规护理相比，所有类型的干预都导致更多药物的停用。教育干预也报告了经济收益。社区药剂师进行的药物审查可以成功减少高危药物的使用，但不会影响跌倒风险或发生率、住院率、死亡率或生活质量。在患有精神疾病的患者中，由药剂师主导的药物审查导致药物减量，可以改善抗胆碱能副作用、记忆力和生活质量。预定义的药剂师主导的药物减量不会减少医疗资源的消耗，但可以节省开支。随访时间短会妨碍对药物减量干预的长期可持续性进行评估。
本系统评价表明，社区药剂师可以主导药物减量干预，并且作为药物减量合作的有价值的伙伴，可以在逐渐减少药物剂量和后续监测期间提供必要的监测，以确保干预的成功。
