Doherty Ann, Moriarty Frank, Boland Fiona, Clyne Barbara, Fahey Tom, Kennelly Seán, Wallace Emma
Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland.
School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland.
HRB Open Res. 2021 Sep 21;4:72. doi: 10.12688/hrbopenres.13345.2. eCollection 2021.
Internationally, health systems face the challenge of managing a growing ageing population living with multimorbidity and polypharmacy. Potentially inappropriate prescribing is common among patients with polypharmacy, increasing the risk for adverse drug reactions (ADRs). Several prescribing indicator sets exist to improve prescribing and reduce potentially inappropriate prescribing, but do not address prescribing cascades. Prescribing cascades occur when a medication is prescribed to treat an ADR to another prescribed medication, whether intentionally or unintentionally, and constitute an important area to consider when characterising problematic polypharmacy. This is a protocol for a systematic review examining prescribing cascades in community-dwelling adults. The review will be reported adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of Medline (Ovid), EMBASE, PsycINFO, CINAHL and the Cochrane Library will be conducted from inception to March 2021, using a predetermined strategy. Grey literature will be searched using Open Grey, MedNar, Dart Europe, and the Turning Research Into Practice (TRIP) databases. No restrictions will be placed on language or publication year. Inclusion criteria are: population - community-dwelling adults (≥18 years); risk - prescription medication with the potential to cause side effects; outcomes - initiation of a new medicine to 'treat' or reduce the risk of experiencing an ADR. Prospective and retrospective cohort studies, case control and case series studies will be included. Two reviewers will independently screen titles and abstracts; studies meeting inclusion criteria will undergo independent full-text screening by two reviewers. A narrative synthesis will be conducted. Study quality will be independently assessed using the relevant Joanna Briggs Institute Critical Appraisal Checklist. This systematic review will identify examples of prescribing cascades for community-dwelling adults and contribute to developing an evidence base regarding such cascades. PROSPERO [ CRD42021243163, 31/03/2021].
在国际上，卫生系统面临着管理日益增长的患有多种疾病和多种药物治疗的老年人口的挑战。在接受多种药物治疗的患者中，潜在不适当处方很常见，这增加了药物不良反应（ADR）的风险。有几种处方指标集可用于改善处方并减少潜在不适当处方，但未涉及处方级联反应。当为治疗另一种已开具药物的ADR而开具药物时，无论有意还是无意，都会发生处方级联反应，这是在描述有问题的多种药物治疗时需要考虑的一个重要领域。这是一项系统评价的方案，旨在研究社区居住成年人中的处方级联反应。该评价将按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行报告。将从创刊至2021年3月，使用预定策略对Medline（Ovid）、EMBASE、PsycINFO、CINAHL和Cochrane图书馆进行系统检索。将使用Open Grey、MedNar、Dart Europe和将研究转化为实践（TRIP）数据库检索灰色文献。语言或出版年份不设限制。纳入标准为：人群——社区居住成年人（≥18岁）；风险——有潜在副作用的处方药；结局——开始使用新药“治疗”或降低发生ADR的风险。前瞻性和回顾性队列研究、病例对照和病例系列研究将被纳入。两名评审员将独立筛选标题和摘要；符合纳入标准的研究将由两名评审员进行独立的全文筛选。将进行叙述性综合分析。将使用相关的乔安娜·布里格斯研究所批判性评价清单独立评估研究质量。这项系统评价将确定社区居住成年人处方级联反应的实例，并有助于建立有关此类级联反应的证据基础。国际前瞻性系统评价注册库[CRD42021243163，2021年3月31日]
