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有哪些数量、质量和类型的系统评价证据可用于为他汀类药物和抗高血压药物的最佳处方提供信息?系统评价伞状综述及证据和差距图。

What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map.

机构信息

Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK

Exeter Policy Research Programme Evidence Review Facility, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, EX1 2LU, Exeter, UK.

出版信息

BMJ Open. 2024 Feb 24;14(2):e072502. doi: 10.1136/bmjopen-2023-072502.

Abstract

OBJECTIVES

We aimed to map the systematic review evidence available to inform the optimal prescribing of statins and antihypertensive medication.

DESIGN

Systematic umbrella review and evidence and gap map (EGM).

DATA SOURCES

Eight bibliographic databases (Cochrane Database of Systematic Reviews, CINAHL, EMBASE, Health Management Information Consortium, MEDLINE ALL, PsycINFO, Conference Proceedings Citation Index-Science and Science Citation Index) were searched from 2010 to 11 August 2020. Update searches conducted in MEDLINE ALL 2 August 2022. We searched relevant websites and conducted backwards citation chasing.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We sought systematic reviews of quantitative or qualitative research where adults 16 years+ were currently receiving, or being considered for, a prescription of statin or antihypertensive medication. Eligibility criteria were applied to the title and abstract and full text of each article independently by two reviewers.

DATA EXTRACTION AND SYNTHESIS

Quality appraisal was completed by one reviewer and checked by a second. Review characteristics were tabulated and incorporated into an EGM based on a patient care pathway. Patients with lived experience provided feedback on our research questions and EGM.

RESULTS

Eighty reviews were included within the EGM. The highest quantity of evidence focused on evaluating interventions to promote patient adherence to antihypertensive medication. Key gaps included a lack of reviews synthesising evidence on experiences of specific interventions to promote patient adherence or improve prescribing practice. The evidence was predominantly of low quality, limiting confidence in the findings from individual reviews.

CONCLUSIONS

This EGM provides an interactive, accessible format for policy developers, service commissioners and clinicians to view the systematic review evidence available relevant to optimising the prescribing of statin and antihypertensive medication. To address the paucity of high-quality research, future reviews should be conducted and reported according to existing guidelines and address the evidence gaps identified above.

摘要

目的

我们旨在绘制系统评价证据图,以提供有关他汀类药物和抗高血压药物最佳处方的信息。

设计

系统评价伞状综述和证据与差距图(EGM)。

数据来源

从 2010 年至 2020 年 8 月 11 日,在 8 个文献数据库(Cochrane 系统评价数据库、CINAHL、EMBASE、健康管理信息联盟、MEDLINE ALL、PsycINFO、会议论文引文索引-科学和科学引文索引)中进行了搜索。2022 年 8 月 2 日在 MEDLINE ALL 中进行了更新搜索。我们还搜索了相关网站并进行了回溯引文追踪。

纳入研究的选择标准

我们寻求对定量或定性研究的系统评价,其中 16 岁以上的成年人正在接受或正在考虑开具他汀类药物或抗高血压药物的处方。两名审查员分别对每篇文章的标题、摘要和全文进行了资格筛选。

数据提取和综合

一名审查员完成了质量评估,另一名审查员进行了检查。对综述特征进行了制表,并根据患者护理路径纳入 EGM 中。有实际经验的患者对我们的研究问题和 EGM 提供了反馈。

结果

EGM 中纳入了 80 篇综述。证据量最多的是评估促进患者遵守抗高血压药物治疗的干预措施。关键差距包括缺乏综合特定干预措施以促进患者依从性或改善处方实践的证据。证据主要质量较低,限制了对个别综述结果的信心。

结论

该 EGM 为政策制定者、服务管理者和临床医生提供了一种互动、易于访问的格式,以查看与优化他汀类药物和抗高血压药物处方相关的系统评价证据。为了解决高质量研究匮乏的问题,未来的研究应根据现有指南进行并报告,并解决上述证据差距。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/694d/10895245/b7c65aaf360c/bmjopen-2023-072502f01.jpg

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