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药物治疗管理服务的临床、经济和人文结局:一项系统评价与荟萃分析。

Clinical, economic and humanistic outcomes of medication therapy management services: A systematic review and meta-analysis.

作者信息

Deng Zhi-Jie, Gui Lin, Chen Jing, Peng Shun-Shun, Ding Yu-Feng, Wei An-Hua

机构信息

Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Front Pharmacol. 2023 Apr 5;14:1143444. doi: 10.3389/fphar.2023.1143444. eCollection 2023.

Abstract

Medication therapy management (MTM) services is a method that can effectively improve patients' conditions, but the efficacy of economic and humanistic outcomes remain unclear. This systematic review and meta-analysis aim to use economic, clinical and humanistic outcomes to evaluate the multi-benefits of MTM services. A systematic review and meta-analysis was conducted by retrieving PubMed, EMBASE, the Cochrane Library and ClinicalTrial.gov from the inception to April 2022. There were two reviewers screening the records, extracting the data, and assessing the quality of studies independently. A total of 81 studies with 60,753 participants were included. MTM services were more effective in clinical outcomes with decreasing the rate of readmission (OR: 0.78; 95% CI: 0.73 to 0.83; I = 56%), emergency department visit (OR: 0.88; 95% CI: 0.81 to 0.96; I = 32%), adverse drug events (All-cause: OR: 0.68; 95% CI: 0.56 to 0.84; I = 61%; SAE: OR: 0.51; 95% CI: 0.33 to 0.79; I = 35%) and drug-related problems (MD: -1.37; 95% CI: -2.24 to -0.5; I = 95%), reducing the length of stay in hospital (MD: -0.74; 95% CI: -1.37 to -0.13; I = 70%), while the economic and humanistic outcomes were less effective. Our systematic review and meta-analysis demonstrated that MTM services had great ability to improve patients' clinical conditions while the efficacy of economic and humanistic outcomes, with some of the outcomes showing high degree of heterogeneity and possible publication bias, required more future studies to provide stronger evidence. : [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=349050], identifier [CRD42022349050].

摘要

药物治疗管理(MTM)服务是一种能够有效改善患者病情的方法,但其在经济和人文结局方面的疗效仍不明确。本系统评价和荟萃分析旨在利用经济、临床和人文结局来评估MTM服务的多重益处。通过检索PubMed、EMBASE、Cochrane图书馆和ClinicalTrial.gov,从建库至2022年4月进行了一项系统评价和荟萃分析。由两名 reviewers 独立筛选记录、提取数据并评估研究质量。共纳入81项研究,涉及60753名参与者。MTM服务在临床结局方面更有效,可降低再入院率(OR:0.78;95%CI:0.73至0.83;I² = 56%)、急诊就诊率(OR:0.88;95%CI:0.81至0.96;I² = 32%)、药物不良事件(全因:OR:0.68;95%CI:0.56至0.84;I² = 61%;严重不良事件:OR:0.51;95%CI:0.33至0.79;I² = 35%)和药物相关问题(MD:-1.37;95%CI:-2.24至-0.5;I² = 95%),缩短住院时间(MD:-0.74;95%CI:-1.37至-0.13;I² = 70%),而在经济和人文结局方面效果较差。我们的系统评价和荟萃分析表明,MTM服务在改善患者临床病情方面有很大能力,而经济和人文结局的疗效,其中一些结局显示出高度异质性和可能的发表偏倚,需要更多未来研究提供更有力的证据。: [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=349050],标识符 [CRD42022349050]

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/765c/10113465/d8e8a2c67007/fphar-14-1143444-g001.jpg

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