Wu Harry, Kouladjian O'Donnell Lisa, Fujita Kenji, Masnoon Nashwa, Hilmer Sarah N
Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia.
Department of Pharmacy, Royal North Shore Hospital, St Leonards, NSW, Australia.
Int J Gen Med. 2021 Jul 24;14:3793-3807. doi: 10.2147/IJGM.S253177. eCollection 2021.
Polypharmacy is a major challenge in healthcare for older people, and is associated with increased risks of adverse outcomes, such as delirium, falls, frailty, cognitive impairment and hospitalization. There is significant public and professional interest in the role of deprescribing in reducing medication-related harms in older people. We aim to provide a narrative review of 1) the safety and efficacy of deprescribing interventions, 2) the challenges and solutions of deprescribing research and implementation in clinical practice, and 3) the benefits of using Computerized Clinical Decision Support Systems (CCDSS) and Quality Indicators (QIs) in deprescribing research and practice. Deprescribing is an established management strategy to minimize polypharmacy and potentially inappropriate medications. There is limited clinical evidence for its efficacy on global and geriatric outcomes. Various challenges at patient, healthcare professional and healthcare system levels may impact on the success of deprescribing interventions in research and practice. Management strategies that target all levels of the healthcare system are required to overcome these challenges. Future studies may consider large multicenter prospective designs to establish the effects and sustainability of deprescribing interventions on clinical outcomes.
多重用药是老年人医疗保健中的一项重大挑战，且与不良后果风险增加相关，如谵妄、跌倒、身体虚弱、认知障碍和住院治疗。在减少老年人用药相关危害方面，减药的作用受到了公众和专业人士的极大关注。我们旨在进行一项叙述性综述，内容包括：1) 减药干预措施的安全性和有效性；2) 临床实践中减药研究与实施面临的挑战及解决方法；3) 在减药研究与实践中使用计算机化临床决策支持系统（CCDSS）和质量指标（QIs）的益处。减药是一种既定的管理策略，旨在尽量减少多重用药和潜在不适当用药情况。关于其对整体和老年患者结局有效性的临床证据有限。患者、医疗保健专业人员和医疗保健系统层面的各种挑战可能会影响减药干预措施在研究和实践中的成功实施。需要针对医疗保健系统各个层面的管理策略来克服这些挑战。未来的研究可考虑采用大型多中心前瞻性设计，以确定减药干预措施对临床结局的影响及可持续性。
