Gonçalves João Rafael, Magalhães Neuza, Machado Sara, Ramalhinho Isabel, Cavaco Afonso Miguel
iMed.ULisboa-Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, 1649-003 Lisboa, Portugal.
Faculty of Science and Technology, University of Algarve, Campus de Gambelas, 8005-139 Faro, Portugal.
Pharmacy (Basel). 2025 Jan 4;13(1):3. doi: 10.3390/pharmacy13010003.
Multimorbidity and polypharmacy are prevalent among Long-Term Care (LTC) users. Older people, who most use LTC services, are more prone to drug-related problems, which polypharmacy aggravates. Deprescribing is a key intervention to address polypharmacy and inappropriate medication. Evidence shows that pharmacists' expertise in medicines and their growing involvement in clinical-oriented activities have proven to play an essential role across many healthcare settings, including LTC. Thus, this study aimed to identify and assess LTC pharmacist-mediated deprescribing. A systematic review was undertaken following the PRISMA checklist, using three literature databases (PubMed, Scopus, and Web of Knowledge). A set of 18 keywords, divided into three domains (professional, type of care, and type of setting), were combined into search equations. The studies selected were assessed through the Quality Assessment Tool for Quantitative Studies. Fifteen studies met the inclusion criteria out of 288 initial hits. Pharmacist-mediated deprescribing was divided into specific (targeted to a medicine group) and non-specific. Half of the studies were graded as low quality (53%). In total, the studies enrolled 6928 patients and 45 pharmacists. The ATC groups A, C, M, and N, as well as medicines with anticholinergic properties, were the most addressed medicines groups. Acceptance rates of pharmacists' recommendations ranged between 30% and 100%. Generically, the number of medicines was reduced after the intervention. Mixed results were found for falls and quality of life outcomes. Cost savings associated with the interventions ranged from neutral to as high as 3800 €/patient/year. Barriers to deprescribing were mainly linked to patients' or family members' refusal to change. In conclusion, pharmacist-mediated deprescribing seems feasible in LTC. The studies' methodological heterogeneity hampers robust comparisons and conclusions. The medicine groups targeted by deprescribing can help tailor interventions to optimize the use of medicines in LTC. A detailed understanding of barriers and enablers to deprescribing would support developing and implementing these interventions.
多重疾病和多重用药在长期护理（LTC）使用者中很普遍。使用LTC服务最多的老年人更容易出现与药物相关的问题，而多重用药会加剧这些问题。减药是解决多重用药和不适当用药的关键干预措施。有证据表明，药剂师在药物方面的专业知识以及他们越来越多地参与以临床为导向的活动，已被证明在包括LTC在内的许多医疗环境中发挥着重要作用。因此，本研究旨在识别和评估由LTC药剂师介导的减药情况。按照PRISMA清单，使用三个文献数据库（PubMed、Scopus和Web of Knowledge）进行了系统综述。将一组18个关键词分为三个领域（专业、护理类型和环境类型），并组合成搜索方程。通过定量研究质量评估工具对所选研究进行评估。在288条初始命中记录中，有15项研究符合纳入标准。药剂师介导的减药分为特定（针对某类药物）和非特定两种。一半的研究质量等级为低质量（53%）。这些研究总共纳入了6928名患者和45名药剂师。解剖学治疗学化学（ATC）分类中的A、C、M和N组以及具有抗胆碱能特性的药物是研究最多的药物类别。药剂师建议的接受率在30%至100%之间。一般来说，干预后药物数量减少。在跌倒和生活质量结果方面发现了混合结果。与干预相关的成本节约范围从中性到高达3800欧元/患者/年。减药的障碍主要与患者或家庭成员拒绝改变有关。总之，药剂师介导的减药在LTC中似乎是可行的。研究的方法学异质性妨碍了有力的比较和结论。减药针对的药物类别有助于调整干预措施，以优化LTC中药物的使用。对减药障碍和促进因素的详细了解将有助于制定和实施这些干预措施。
