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亚洲老年医疗环境中药师干预措施:关于住院、死亡率和生活质量的系统评价和荟萃分析。

Pharmacist interventions in Asian healthcare environments for older people: a systematic review and meta-analysis on hospitalization, mortality, and quality of life.

机构信息

College of Pharmacy and Graduate School of Pharmaceutical Sciences, Research Institute of Pharmaceutical Science, Ewha Womans University, 52 Ewhayeodae-Gil, Seodaemun-Gu, Seoul, 03760, Republic of Korea.

出版信息

BMC Geriatr. 2024 Jun 12;24(1):513. doi: 10.1186/s12877-024-05089-9.

Abstract

BACKGROUND

Pharmaceutical interventions play a key role in the care of older people experiencing polypharmacy. Despite the rapid increase in the aging population in Asia, there is a lack of evidence regarding the effectiveness of pharmacist interventions on older adult's healthcare. This systematic review and meta-analysis assessed the effects of pharmacist interventions in Asian health care environments on hospitalization, mortality, and quality of life (QoL) among older people in Asia.

METHODS

A comprehensive search was conducted across 5 databases, encompassing studies published from inception through June 2023. Only studies involving pharmacist interventions for people aged 65 years or older, residing in Asian countries, were considered. Studies without evidence of pharmacist involvement or conducted outside of Asia were excluded. Data extraction was performed by two reviewers, one reviewer (I.K.) performed the initial extraction, and another reviewer (G.R.) verified the extracted data. Forest plots were generated using a random effects model to obtain risk ratios or pooled standardized mean differences (SMDs).

RESULTS

A total of 170 articles underwent thorough review, and ultimately, ten studies meeting the inclusion criteria were included in the meta-analyses. These studies encompassed diverse healthcare settings such as outpatient, inpatient, and nursing homes, with sample sizes ranging from 32 to 306 older people. Pharmacist interventions were found to significantly reduce hospitalization rates (n = 5, risk ratio = 0.57, 95% CI = 0.41-0.81) and mortality rates (n = 4, risk ratio = 0.57, 95% CI = 0.37-0.88) among older people. The analysis revealed less significant improvement in QoL in these patients than in those receiving usual care (n = 6, SMD = 0.36, P = 0.057).

CONCLUSIONS

These findings highlight the crucial role of pharmacists within healthcare teams in Asian countries. Pharmacist interventions have an impact on reducing hospitalization and mortality rates among the elderly people, underscoring the importance of optimizing patient outcomes in Asia.

摘要

背景

药物干预在老年人多药治疗的护理中起着关键作用。尽管亚洲的老年人口迅速增加,但关于药师干预对亚洲老年人医疗保健的效果的证据仍然缺乏。本系统评价和荟萃分析评估了亚洲医疗保健环境中药师干预对亚洲老年人住院、死亡和生活质量(QoL)的影响。

方法

我们在 5 个数据库中进行了全面搜索,包括从成立到 2023 年 6 月发表的研究。仅考虑涉及年龄在 65 岁或以上、居住在亚洲国家的人群的药师干预研究。没有证据表明药师参与或在亚洲以外进行的研究被排除在外。由两名评审员进行数据提取,一名评审员(I.K.)进行初步提取,另一名评审员(G.R.)验证提取的数据。使用随机效应模型生成森林图以获得风险比或合并标准化均数差(SMD)。

结果

共有 170 篇文章经过仔细审查,最终有 10 项符合纳入标准的研究纳入荟萃分析。这些研究涵盖了各种医疗保健环境,如门诊、住院和疗养院,样本量从 32 到 306 名老年人不等。研究发现,药师干预可显著降低住院率(n=5,风险比=0.57,95%可信区间=0.41-0.81)和死亡率(n=4,风险比=0.57,95%可信区间=0.37-0.88)。分析显示,与接受常规护理的患者相比,这些患者的 QoL 改善程度较低(n=6,SMD=0.36,P=0.057)。

结论

这些发现强调了药师在亚洲国家医疗保健团队中的重要作用。药师干预对降低老年人的住院率和死亡率有影响,突显了优化亚洲患者结局的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2fa7/11170896/87e32532ee2f/12877_2024_5089_Fig1_HTML.jpg

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