End-of-life Care Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.
Centre for Research and Innovation in Care, Nurse and Pharmaceutical Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Br J Clin Pharmacol. 2024 Jan;90(1):12-106. doi: 10.1111/bcp.15906. Epub 2023 Oct 24.
The aim of this umbrella review was to identify tools and guidelines to aid the deprescribing process of potentially inappropriate medications (PIMs), evaluate development and validation methods, and describe evidence levels for medication inclusion.
Searches were conducted on MEDLINE (Ovid), Embase.com, Cochrane CDSR, CINAHL (EBSCO), Web of Science Core Collection and guideline databases from the date of inception to 7 July 2022. Following the initial search, an additional search was conducted to identify an updated versions of tools on 17 July 2023. We analysed the contents of tools and guidelines.
From 23 systematic reviews and guidelines, we identified 95 tools (72 explicit, 12 mixed and 11 implicit) and nine guidelines. Most tools (83.2%) were developed to use for older persons, including 14 for those with limited life expectancy. Seven tools were for children <18 years (7.37%). Most explicit/mixed tools (78.57%) and all guidelines were validated. We found 484 PIMs and 202 medications with different appropriateness independent of disease for older persons with normal and limited life expectancy, respectively. Only two tools and eight guidelines reported the evidence level, and a quarter of medications had high-quality evidence.
Tools are available for a diversity of populations. There were discrepancies, with the same medication being classified as inappropriate in some tools and appropriate in others, possibly due to low-quality evidence. In particular, tools for patients with limited life expectancy were developed based on very limited evidence, and research to generate this evidence is urgently needed. Our medication lists, along with the level of evidence, could facilitate efforts to strengthen the evidence.
本综述旨在确定有助于潜在不适当药物（PIMs）停药过程的工具和指南，评估其开发和验证方法，并描述纳入药物的证据水平。
从建库至 2022 年 7 月 7 日，在 MEDLINE（Ovid）、Embase.com、Cochrane CDSR、CINAHL（EBSCO）、Web of Science 核心合集和指南数据库中进行了检索。在初始检索后，于 2023 年 7 月 17 日进行了额外检索，以确定工具的更新版本。我们分析了工具和指南的内容。
从 23 项系统评价和指南中，我们确定了 95 种工具（72 种明确、12 种混合和 11 种隐含）和 9 种指南。大多数工具（83.2%）是为老年人开发的，其中包括 14 种用于预期寿命有限的老年人的工具。有 7 种工具用于 <18 岁的儿童（7.37%）。大多数明确/混合工具（78.57%）和所有指南都经过了验证。我们为预期寿命正常和有限的老年人分别确定了 484 种 PIMs 和 202 种具有不同适宜性的药物，而不考虑疾病。只有两种工具和八种指南报告了证据水平，四分之一的药物具有高质量的证据。
有多种人群适用的工具。尽管存在差异，即同一种药物在某些工具中被归类为不适当，而在其他工具中被归类为适当，但这可能是由于证据质量低所致。特别是，针对预期寿命有限的患者的工具是基于非常有限的证据开发的，迫切需要开展生成这种证据的研究。我们的药物清单以及证据水平可以促进加强证据的努力。
