Gorman Ashleigh, Rankin Audrey, Hughes Carmel, O'Dwyer Máire, Ryan Cristín
School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland.
School of Pharmacy, Queen's University Belfast, United Kingdom.
Explor Res Clin Soc Pharm. 2022 Aug 9;7:100166. doi: 10.1016/j.rcsop.2022.100166. eCollection 2022 Sep.
Polypharmacy (the use of multiple medications) is common in older patients and achieving a balance between appropriate and inappropriate polypharmacy is a challenge routinely faced by prescribers. It is recommended to incorporate the use of theory when developing complex interventions, but it is not known if theoretically derived interventions aimed at improving appropriate polypharmacy are effective.
This systematic review aimed to establish the overall effectiveness of theoretically derived interventions on improving appropriate polypharmacy and to investigate the degree to which theory informed intervention design.
Seven electronic databases were searched from inception to August 2021 including hand-searching of reference lists. Interventions developed using a theory, involving the use of a validated tool to assess prescribing, delivered in primary care to participants with a mean age of ≥65 years and prescribed ≥four medications, were included. Data was extracted independently by two reviewers. The Theory Coding Scheme (TCS) was applied to evaluate the use of theory; Risk of Bias (RoB) was assessed using the Cochrane RoB 2.0 tool.
Two studies, one feasibility study and one randomised controlled trial (RCT) were included, and therefore overall effectiveness of the theoretically derived intervention could not be assessed. Theory used in development included the Theoretical Domains Framework and Reason's system-based risk management theory. The RCT was rated to have a high RoB. Based on the TCS, neither study used theory completely.
The effectiveness of theoretically derived interventions to improve appropriate polypharmacy in primary care could not be determined due to the small number of studies and their heterogeneity. Further incorporation of theory into intervention development is required to understand the effectiveness of this approach.Prospero registration: CRD42020157175.
多重用药（使用多种药物）在老年患者中很常见，而在合理与不合理的多重用药之间取得平衡是开处方者经常面临的挑战。建议在制定复杂干预措施时纳入理论的运用，但尚不清楚旨在改善合理多重用药的理论推导干预措施是否有效。
本系统评价旨在确定理论推导干预措施对改善合理多重用药的总体有效性，并调查理论对干预措施设计的影响程度。
检索了7个电子数据库，从建库至2021年8月，包括手工检索参考文献列表。纳入使用理论开发的干预措施，这些措施涉及使用经过验证的工具来评估处方情况，在初级保健中提供给平均年龄≥65岁且开具≥4种药物的参与者。数据由两名评审员独立提取。应用理论编码方案（TCS）来评估理论的运用；使用Cochrane偏倚风险（RoB）2.0工具评估偏倚风险。
纳入了两项研究，一项可行性研究和一项随机对照试验（RCT），因此无法评估理论推导干预措施的总体有效性。开发过程中使用的理论包括理论领域框架和基于瑞森系统的风险管理理论。该RCT被评为具有较高的偏倚风险。根据TCS，两项研究均未完全运用理论。
由于研究数量少且存在异质性，无法确定理论推导干预措施在初级保健中改善合理多重用药的有效性。需要进一步将理论纳入干预措施的开发中，以了解这种方法的有效性。国际前瞻性系统评价注册库注册号：CRD42020157175。
