Persaud Nav, Rizvi Amal, Workentin Aine, Skidmore Becky, McDonald Emily G
MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital Unity Health Toronto Toronto Ontario Canada.
Department of Family and Community Medicine University of Toronto Toronto Ontario Canada.
Health Sci Rep. 2025 Jul 31;8(8):e70981. doi: 10.1002/hsr2.70981. eCollection 2025 Aug.
Interventions to address potentially inappropriate prescribing (PIP), where risks outweigh benefits, are effective but often not implemented due to barriers (e.g., patient, provider, systems). Concerns about questioning healthcare providers or symptom resurgence when discontinuing medications may make PIP interventions less acceptable. This systematic review aims to determine the acceptability of PIP interventions among older adult outpatients.
We searched MEDLINE, Embase, and other databases for controlled studies of PIP interventions including older adults (≥ 65 years) residing in community or care home settings. The review included interventions aimed at reducing PIP, whether clinical or external providers. We assessed risk of bias and performed a meta-analysis.
Nine studies ( = 4,843) were included: six randomized controlled trials, two prospective cohort studies, and one pre-post study. Studies spanned the US, England, Ireland, Lebanon, the Netherlands, Spain, and Switzerland. Seven out of nine (78%) studies were assessed as having a low risk of bias; two out of nine (22%) at moderate risk. Meta-analysis showed no significant difference in patient satisfaction between PIP interventions and standard care, though satisfaction was slightly higher with PIP interventions (SMD 0.45; 95% CI -0.14 to 1.04, I² = 96%, = 4,414). Meta-analysis showed more patients discussed discontinuing medications with their prescriber after a PIP intervention (RR 4.32; 95% CI 0.0 to 56,270, I² = 43%, = 429).
PIP interventions are as acceptable to patients as usual care, despite some burden for patients and prescribers. Patients are more willing to engage in deprescribing conversations when a deprescribing intervention is present.
针对潜在不适当处方（PIP，即风险大于益处的情况）的干预措施是有效的，但由于存在障碍（如患者、医疗服务提供者、系统方面的障碍），这些措施往往未得到实施。对质疑医疗服务提供者或停药后症状复发的担忧可能会使PIP干预措施的可接受性降低。本系统评价旨在确定PIP干预措施在老年门诊患者中的可接受性。
我们检索了MEDLINE、Embase和其他数据库，以查找有关PIP干预措施的对照研究，研究对象包括居住在社区或养老院的老年人（≥65岁）。该评价纳入了旨在减少PIP的干预措施，无论是临床还是外部医疗服务提供者实施的干预措施。我们评估了偏倚风险并进行了荟萃分析。
共纳入9项研究（n = 4843）：6项随机对照试验、2项前瞻性队列研究和1项前后对照研究。研究涵盖美国、英国、爱尔兰、黎巴嫩、荷兰、西班牙和瑞士。9项研究中有7项（78%）被评估为偏倚风险低；9项中有2项（22%）为中度风险。荟萃分析显示，PIP干预措施与标准护理之间患者满意度无显著差异，不过PIP干预措施的满意度略高（标准化均数差0.45；95%置信区间-0.14至1.04，I² = 96%，n = 4414）。荟萃分析显示，PIP干预措施实施后，更多患者与开药医生讨论了停药事宜（风险比4.32；95%置信区间0.0至56270，I² = 43%，n = 429）。
尽管对患者和开药医生而言存在一定负担，但PIP干预措施对患者而言与常规护理一样可接受。当存在减药干预措施时，患者更愿意参与减药对话。
