Department of Diagnostics and Public Health, Clinical Pharmacology Unit, University of Verona, Verona, Italy.
Department of Medicine, University of Verona, Verona, Italy.
J Am Geriatr Soc. 2024 Oct;72(10):3219-3238. doi: 10.1111/jgs.19035. Epub 2024 Jun 1.
Polypharmacy is a primary risk factor for the prescription of potentially inappropriate medications (PIMs), drug-drug interactions (DDIs), and ultimately, adverse drug reactions (ADRs). Medication review and deprescribing represent effective strategies to simplify therapeutic regimens, minimize risks, and reduce PIM prescriptions. This systematic review and meta-analysis of experimental and observational studies aimed to evaluate the impact of different medication review and deprescribing interventions in hospitalized older patients.
Experimental and observational prospective cohort studies evaluating the clinical effects of medication review and deprescribing strategies in older hospitalized patients were searched in the bibliographic databases, PubMed, Embase, and Scopus, from inception until January 8, 2024. A narrative synthesis of the results was provided, along with a meta-analysis of dichotomous data (i.e., re-hospitalizations and mortality).
Overall, 21 randomized controlled trials, 7 non-randomized interventional studies, and 2 prospective cohort studies were included in the systematic review. Of these, 14 (46.7%) assessed medication appropriateness as the primary outcome, while the remaining evaluated clinical outcomes (e.g., length of hospital stay, hospital readmissions, emergency department visits, and incidence of ADRs) and/or quality of life. The meta-analysis revealed a slight but statistically significant 8% reduction in hospital readmissions (HR: 0.92; 95% CI: 0.85-0.99) following medication review and deprescribing, but no significant impact on mortality (HR: 0.98; 95% CI: 0.96-1.00). Of the 30 included studies, 21 were considered at high risk of bias, mostly due to potential deviations from intended interventions and randomization processes. The remaining nine studies had "some concerns" (eight studies) or were considered at "low" risk of bias (one study).
Medication review and deprescribing are associated with potential benefits in reducing hospital readmission rates among hospitalized older patients, particularly through the reduction of PIM prescriptions. The integration of thorough medication review and deprescribing protocols in hospital settings may improve post-discharge outcomes and reduce overall healthcare costs.
多种药物治疗是导致开具潜在不适当药物（PIMs）、药物-药物相互作用（DDIs）以及最终药物不良反应（ADRs）的主要风险因素。药物审查和减药是简化治疗方案、降低风险和减少 PIM 处方的有效策略。本系统评价和荟萃分析旨在评估不同药物审查和减药干预措施对住院老年患者的影响。
从建库起至 2024 年 1 月 8 日，在文献数据库 PubMed、Embase 和 Scopus 中检索评估药物审查和减药策略对老年住院患者临床效果的实验和观察性前瞻性队列研究。提供结果的叙述性综合分析，并对二分类数据（即再住院和死亡率）进行荟萃分析。
共有 21 项随机对照试验、7 项非随机干预研究和 2 项前瞻性队列研究纳入系统评价。其中，14 项（46.7%）将药物适宜性作为主要结局进行评估，其余研究评估了临床结局（如住院时间、住院再入院、急诊就诊和 ADR 发生率）和/或生活质量。荟萃分析显示，药物审查和减药后，住院再入院率略有但具有统计学意义的降低 8%（HR：0.92；95%CI：0.85-0.99），但对死亡率无显著影响（HR：0.98；95%CI：0.96-1.00）。在 30 项纳入的研究中，21 项被认为存在高偏倚风险，主要是由于潜在的偏离预期干预措施和随机化过程。其余 9 项研究存在“一些关注”（8 项研究）或被认为具有“低”偏倚风险（1 项研究）。
药物审查和减药与降低住院老年患者的再入院率有关，尤其是通过减少 PIM 处方。在医院环境中整合全面的药物审查和减药方案可能会改善出院后的结局并降低总体医疗成本。
