Alshatti Dalal, Cox Anthony R, Hirsch Christine, Cheng Vicky, Aston Jeff
Clinical Pharmacy, School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, 3rd floor, Edgbaston, Birmingham, B15 2TT, United Kingdom.
Clinical Pharmacy and Drug Safety, School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, 3rd floor, Edgbaston, Birmingham, B15 2TT, United Kingdom.
Int J Pharm Pract. 2025 Feb 7;33(1):34-44. doi: 10.1093/ijpp/riae070.
Deprescribing, a process of dose reduction or withdrawal of inappropriate medication that no longer has benefit, is a proposed intervention in the care of older adults living with frailty.
OBJECTIVE/AIM: To evaluate the safety, effectiveness, and clinical impact of deprescribing services in frail patients.
A systematic literature search was performed in November 2023 using Scopus, CINAHL PLUS (EBSCO), MEDLINE (OVID and EMBASE), and Cochrane Library. The Mixed Methods Appraisal tool was used for appraising the methodological quality of the included papers. Studies were selected after title, abstract, and full-text screening, with independent review. Thematic analysis was used for analysing data from the selected articles.
Five hundred ninety unique titles were identified, with nine (six trials, one interview, one survey, and one designed-delay study) meeting inclusion and exclusion criteria. Four main descriptive themes have been identified: challenges of deprescribing in frailty, facilitators of deprescribing in frailty, deprescribing processes in current practice in frail patients, and deprescribing outcomes. Additionally, two analytical themes have been identified: safety and quality.
A number of issues have been highlighted that impact the implementation of deprescribing services in frail patients. Currently, there is limited evidence showing strong benefits of such deprescribing services, such as reducing the number of potentially inappropriate medications and medication costs.
减药是指减少或停用不再有益的不适当药物的过程，是针对体弱老年患者护理提出的一种干预措施。
评估减药服务对体弱患者的安全性、有效性和临床影响。
2023年11月使用Scopus、CINAHL PLUS（EBSCO）、MEDLINE（OVID和EMBASE）以及Cochrane图书馆进行了系统的文献检索。采用混合方法评估工具对纳入论文的方法学质量进行评估。经过标题、摘要和全文筛选后，选择研究并进行独立评审。采用主题分析法对所选文章的数据进行分析。
共识别出590个独特标题，其中9篇（6项试验、1次访谈、1项调查和1项设计延迟研究）符合纳入和排除标准。确定了四个主要描述性主题：体弱患者减药的挑战、体弱患者减药的促进因素、体弱患者当前实践中的减药过程以及减药结果。此外，还确定了两个分析性主题：安全性和质量。
已突出了一些影响体弱患者减药服务实施的问题。目前，证据有限，显示此类减药服务有显著益处，如减少潜在不适当药物的数量和药物成本。
