基于社区药房的老年人用药医疗保健干预的临床和人文结局：一项系统评价与荟萃分析

Clinical and Humanistic Outcomes of Community Pharmacy-Based Healthcare Interventions Regarding Medication Use in Older Adults: A Systematic Review and Meta-Analysis.

作者信息

Christopher Christina Malini, Kc Bhuvan, Blebil Ali, Alex Deepa, Ibrahim Mohamed Izham Mohamed, Ismail Norhasimah, Alrasheedy Alian A

机构信息

School of Pharmacy, Monash University Malaysia, Subang Jaya 47500, Malaysia.

Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia.

出版信息

Healthcare (Basel). 2021 Nov 18;9(11):1577. doi: 10.3390/healthcare9111577.

DOI:10.3390/healthcare9111577

PMID:34828622

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8625440/

Abstract

This review and meta-analysis aimed to determine the clinical and humanistic outcomes of community pharmacy-based interventions on medication-related problems of older adults at the primary care level. We identified randomized controlled trials (RCTs) examining the impact of various community pharmacy-based interventions from five electronic databases (namely, MEDLINE (Ovid), EMBASE (Ovid), CINAHL, APA PSYInfo, and Scopus) from January 2010 to December 2020. Consequently, we assessed these interventions' clinical and humanistic outcomes on older adults and compared them with non-intervention. We included 13 RCTs in the current review and completed a meta-analysis with six of them. The included studies had a total of 6173 older adults. Quantitative analysis showed that patient education was significantly associated with an increase in the discontinuation of sedative-hypnotics use (risk ratio 1.28; 95% CI (1.20, 1.36) I2 = 0%, < 0.00001). Moreover, the qualitative analysis showed that medication reviews and education with follow-ups could improve various clinical outcomes, including reducing adverse drug events, reducing uncontrolled health outcomes, and improving appropriate medication use among the elderly population. However, medication review could not significantly reduce the number of older adults who fall (risk ratio 1.25; 95% CI (0.78, 1.99) I2 = 0%, = 0.36) and require hospitalization (risk ratio 0.72; 95% CI (0.47, 1.12) I2 = 45%, = 0.15). This study showed that community pharmacy-based interventions could help discontinue inappropriate prescription medications among older adults and could improve several clinical and humanistic outcomes. However, more effective community pharmacy-based interventions should be implemented, and more research is needed to provide further evidence for clinical and humanistic outcomes of such interventions on older adults.

摘要

本综述和荟萃分析旨在确定基层医疗层面基于社区药房的干预措施对老年人用药相关问题的临床和人文结局。我们从五个电子数据库（即MEDLINE（Ovid）、EMBASE（Ovid）、CINAHL、APA PSYInfo和Scopus）中检索了2010年1月至2020年12月期间考察各种基于社区药房干预措施影响的随机对照试验（RCT）。因此，我们评估了这些干预措施对老年人的临床和人文结局，并将其与无干预情况进行比较。我们在当前综述中纳入了13项RCT，并对其中6项进行了荟萃分析。纳入研究的老年人共有6173名。定量分析表明，患者教育与镇静催眠药停用增加显著相关（风险比1.28；95%置信区间（1.20，1.36），I² = 0%，P < 0.00001）。此外，定性分析表明，药物审查及随访教育可改善各种临床结局，包括减少药物不良事件、减少未控制的健康结局以及改善老年人群的合理用药。然而，药物审查并不能显著减少跌倒的老年人数量（风险比1.25；95%置信区间（0.78，1.99），I² = 0%，P = 0.36）以及需要住院治疗的老年人数量（风险比0.72；95%置信区间（0.47，1.12），I² = 45%，P = 0.15）。本研究表明，基于社区药房的干预措施有助于老年人停用不适当的处方药，并可改善一些临床和人文结局。然而，应实施更有效的基于社区药房的干预措施，并且需要更多研究为这类干预措施对老年人的临床和人文结局提供进一步证据。