Waldron Catherine, Hughes John, Wallace Emma, Cahir Caitriona, Bennett K
Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, D02 DH60, Ireland.
Department of General Practice, University College Cork, Cork, Ireland.
HRB Open Res. 2023 Dec 28;5:53. doi: 10.12688/hrbopenres.13580.2. eCollection 2022.
Older adults in Ireland are at increased risk of adverse drug events (ADE) due, in part, to increasing rates of polypharmacy. Interventions to reduce ADE in community dwelling older adults (CDOA) have had limited success, therefore, new approaches are required.A realist review uses a different lens to examine why and how interventions were supposed to work rather than if, they worked. A rapid realist review (RRR) is a more focused and accelerated version.The aim of this RRR is to identify and examine the contexts and mechanisms that play a role in the outcomes relevant to reducing ADE in CDOA in the GP setting that could inform the development of interventions in Ireland.
Six candidate theories (CT) were developed, based on knowledge of the field and recent literature, in relation to how interventions are expected to work. These formed the search strategy. Eighty full texts from 633 abstracts were reviewed, of which 27 were included. Snowballing added a further five articles, relevant policy documents increased the total number to 45. Data were extracted relevant to the theories under iteratively developed sub-themes using NVivo software.
Of the six theories, three theories, relating to GP engagement in interventions, relevance of health policy documents for older adults, and shared decision-making, provided data to guide future interventions to reduce ADEs for CDOA in an Irish setting. There was insufficient data for two theories, a third was rejected as existing barriers in the Irish setting made it impractical to use.
To improve the success of Irish GP based interventions to reduce ADEs for CDOA, interventions must be relevant and easily applied in practice, supported by national policy and be adequately resourced. Future research is required to test our theories within a newly developed intervention.
爱尔兰的老年人发生药物不良事件（ADE）的风险增加，部分原因是多重用药率不断上升。减少社区居住老年人（CDOA）药物不良事件的干预措施成效有限，因此需要新的方法。实证性综述采用不同的视角来审视干预措施为何以及如何发挥作用，而非其是否有效。快速实证性综述（RRR）是一种更具针对性且加速版的综述。本快速实证性综述的目的是识别和研究在全科医生（GP）环境中与减少CDOA药物不良事件相关的结果中起作用的背景和机制，为爱尔兰干预措施的制定提供参考。
基于该领域的知识和近期文献，针对干预措施预期如何发挥作用，制定了六个候选理论（CT）。这些理论构成了搜索策略。对633篇摘要中的80篇全文进行了审查，其中27篇被纳入。通过滚雪球法又增加了五篇文章，相关政策文件使总数增至45篇。使用NVivo软件，针对迭代发展的子主题，提取与各理论相关的数据。
在这六个理论中，有三个理论，即全科医生参与干预、健康政策文件对老年人的相关性以及共同决策，提供了数据以指导未来在爱尔兰环境中减少CDOA药物不良事件的干预措施。有两个理论的数据不足，第三个理论因爱尔兰环境中存在的障碍使其无法实际应用而被否决。
为提高爱尔兰基于全科医生的干预措施减少CDOA药物不良事件的成功率，干预措施必须与实际相关且易于应用，得到国家政策的支持并有充足的资源。需要开展进一步研究，在新开发的干预措施中检验我们的理论。
