Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 580, Conj. das Químicas, Bloco 13, Cidade Universitária Butantã, São Paulo, Brazil.
Municipal Health Department, Multiprofessional Residency Program in Family and Community Health, João Pessoa, PB, Brazil.
Int J Clin Pharm. 2023 Oct;45(5):1037-1049. doi: 10.1007/s11096-023-01637-2. Epub 2023 Sep 15.
Consolidated and reliable evidence regarding the effectiveness of pharmacist interventions for deprescribing benzodiazepines in older outpatients is lacking.
This study evaluated and summarized the impact of pharmacist interventions on benzodiazepine deprescribing among older outpatients.
A literature search was conducted until August 2022 in PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials databases. The review included randomized controlled trials that assessed the impact of pharmacist interventions on deprescribing benzodiazepine in older outpatients. Two independent investigators conducted the study selection, data extraction, and risk of bias assessment. Meta-analyses were conducted using random-effect models in the RStudio software.
A total of 893 records were identified. Five studies, including 3,879 patients, met the inclusion criteria and were included in the systematic review. All five studies used health education as an intervention strategy, and three also conducted medication reviews. There was no evidence of the pharmacist's authority to modify prescriptions during benzodiazepine deprescribing. One study was classified as having a low risk of bias, whereas the other had some concerns or a high risk of bias. Three studies were included in the meta-analysis and a significant impact of pharmacist interventions on benzodiazepines deprescribing rates in older outpatients was observed (RR = 2.75 [95%CI 1.29; 5.89]; p = 0.04; I = 69%; low certainty of evidence).
Pharmacists may contribute to deprescribing benzodiazepines in older outpatients. Further studies are needed to increase the reliability of these findings. PROSPERO registration number: CRD42022358563.
缺乏关于药师干预在老年门诊患者中减少苯二氮䓬类药物使用方面有效性的综合可靠证据。
本研究评估并总结了药师干预对老年门诊患者减少苯二氮䓬类药物使用的影响。
检索截至 2022 年 8 月 PubMed、PsycINFO 和 Cochrane 中央对照试验注册库中的文献。综述纳入了评估药师干预对老年门诊患者减少苯二氮䓬类药物使用影响的随机对照试验。两名独立研究者进行了研究选择、数据提取和偏倚风险评估。使用 RStudio 软件中的随机效应模型进行荟萃分析。
共确定了 893 条记录。纳入了 5 项研究，共 3879 名患者，符合纳入标准并纳入系统评价。所有 5 项研究均采用健康教育作为干预策略，其中 3 项还进行了药物审查。在减少苯二氮䓬类药物使用过程中，药师没有修改处方的权力。有 1 项研究被归类为低偏倚风险，而其他研究存在一些关注或高偏倚风险。3 项研究纳入荟萃分析，结果显示药师干预对老年门诊患者减少苯二氮䓬类药物使用的效果显著（RR=2.75[95%CI 1.29;5.89]；p=0.04；I=69%；证据质量低）。
药师可能有助于减少老年门诊患者的苯二氮䓬类药物使用。需要进一步研究以提高这些发现的可靠性。PROSPERO 注册号：CRD42022358563。
