Linsky Amy M, Motala Aneesa, Booth Marika, Lawson Emily, Shekelle Paul G
Center for Health Optimization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts.
New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System Boston, Massachusetts.
JAMA Netw Open. 2025 May 1;8(5):e259375. doi: 10.1001/jamanetworkopen.2025.9375.
Deprescribing has the potential to improve patient safety and quality of care by reducing polypharmacy and potentially inappropriate medications (PIMs), which in turn may reduce adverse drug events. Questions remain about the effectiveness of deprescribing interventions in outpatient settings.
To determine the association of deprescribing interventions with reducing medication count and PIMs in community-dwelling older adults.
Included studies were English-language human studies in PubMed and the Cochrane Library published from January 2019 to July 26, 2024, and results were supplemented with reference-mining and expert consultation.
Studies were eligible if they were solely or primarily about deprescribing, focused on community-dwelling adults, were multisite, used a randomized trial design, and reported on the primary or secondary outcome.
Two authors extracted study design, intervention characteristics, population characteristics, and follow-up. Outcomes were extracted by the statistician and checked by a second author. Meta-analyses were conducted using random effects with the Hartung-Knapp-Sidik-Jonkman method. The study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria.
The primary outcome was the number of PIMs or total medications, and the secondary outcome was proportion of persons prescribed at least 1 PIM.
Two authors independently screened 1586 titles from PubMed and Cochrane and 33 from other sources; 321 abstracts and 133 full-text studies were further reviewed, and disagreements were reconciled through discussion, resulting in 17 studies in 18 publications. A total of 8 studies of interventions targeting multiple medications were identified for primary outcome analysis; the random-effects pooled analysis found a mean difference of -0.14 (95% CI, -0.27 to -0.01) medications prescribed. A total of 6 studies of interventions targeting multiple medications were identified for secondary outcome analysis; the random effects pooled analysis found no significant reduction in the proportion of persons prescribed at least 1 PIM (odds ratio, 0.92 [95% CI, 0.74 to 1.14]).
This systematic review and meta-analysis found moderate-certainty evidence that deprescribing interventions were associated with reduced PIM and medication counts in community-dwelling older adults. While the individual-level association was very small, on an aggregated population level, the outcomes may be large, given the high prevalence of polypharmacy and PIMs in community-dwelling older adults.
减药有可能通过减少多重用药和潜在不适当用药（PIM）来提高患者安全性和护理质量，进而可能减少药物不良事件。关于门诊环境中减药干预措施的有效性仍存在疑问。
确定减药干预措施与减少社区居住老年人的用药数量和PIM之间的关联。
纳入的研究为2019年1月至2024年7月26日在PubMed和Cochrane图书馆发表的英文人体研究，结果通过参考文献挖掘和专家咨询进行补充。
如果研究仅或主要关于减药，关注社区居住成年人，为多中心研究，采用随机试验设计，并报告主要或次要结局，则符合入选标准。
两位作者提取研究设计、干预特征、人群特征和随访情况。结局由统计学家提取，并由另一位作者进行核对。采用Hartung-Knapp-Sidik-Jonkman方法进行随机效应荟萃分析。本研究按照系统评价和荟萃分析的首选报告项目（PRISMA）标准进行报告。
主要结局为PIM数量或总用药量，次要结局为开具至少1种PIM的人员比例。
两位作者独立筛选了来自PubMed和Cochrane的1586篇标题以及来自其他来源的33篇标题；进一步审查了321篇摘要和133篇全文研究，并通过讨论解决了分歧，最终纳入18篇出版物中的17项研究。共确定了8项针对多种药物的干预措施研究用于主要结局分析；随机效应汇总分析发现，开具的药物平均差异为-0.14（95%CI，-0.27至-0.01）。共确定了6项针对多种药物的干预措施研究用于次要结局分析；随机效应汇总分析发现，开具至少1种PIM的人员比例没有显著降低（优势比，0.92[95%CI，0.74至1.14]）。
本系统评价和荟萃分析发现，有中等确定性证据表明，减药干预措施与社区居住老年人的PIM和用药数量减少有关。虽然个体层面的关联非常小，但在总体人群层面，鉴于社区居住老年人多重用药和PIM的高患病率，这些结局可能是显著的。
