Goetschi Aljoscha Noël, Verloo Henk, Schönenberger Nicole, Wernli Ursina, Meyer-Massetti Carla
Clinical Pharmacology and Toxicology, Department of General Internal Medicine, University Hospital Bern, Bern, Switzerland.
Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
J Eval Clin Pract. 2025 Aug;31(5):e70253. doi: 10.1111/jep.70253.
Chronic non-cancer pain (CNCP) affects 28%-88% of older adults. They also experience more medication-related problems and are more likely to receive insufficient pain therapy, impacting their quality of care. Quality indicators (QIs) can be used to assess and improve the quality of their care.
This integrative review aimed to consolidate the scientific evidence on existing QIs for the pharmacological care of older adult patients with CNCP.
We systematically searched Medline and Embase via Ovid, CINAHL via EBSCO, the SCOPUS databases and Google Scholar. We used backward citation searching to identify additional studies. We included studies reporting validated QIs and studies reporting quality-related factors associated with reduced medication safety caused by pain-related medication therapy. Two reviewers independently screened the titles, abstracts and full texts. One extracted and charted the data and assessed the risk of bias; the second validated this.
We screened 4068 articles identified through the systematic search of databases and 2774 articles identified via citation searching. Seventy-eight articles met our inclusion criteria and were retained for analysis. We extracted 11 validated QIs and developed a further 243 based on quality criteria reported in the literature. QIs covered different levels, from pharmacotherapy in general to particular substance groups and individual active substances. The risk of bias in the included studies was judged to be very high in the majority of studies.
This integrative review established a scientific basis for developing QIs for the pharmacological management of older adult patients with CNCP. The high risk of bias present in the included studies, highlights the need for expert validation and input from patients. These indicators could help improve the quality of care provided to older adult patients with CNCP and help focus specific interventions on vulnerable patients.
慢性非癌性疼痛（CNCP）影响28%-88%的老年人。他们还会经历更多与药物相关的问题，且更有可能接受不足的疼痛治疗，这会影响他们的护理质量。质量指标（QIs）可用于评估和改善他们的护理质量。
本整合性综述旨在巩固有关老年CNCP患者药物治疗现有质量指标的科学证据。
我们通过Ovid系统检索了Medline和Embase，通过EBSCO检索了CINAHL，检索了SCOPUS数据库和谷歌学术。我们使用反向引文检索来识别其他研究。我们纳入了报告经过验证的质量指标的研究，以及报告与疼痛相关药物治疗导致药物安全性降低相关的质量相关因素的研究。两名评审员独立筛选标题、摘要和全文。一人提取并整理数据并评估偏倚风险；另一人进行验证。
我们筛选了通过数据库系统检索识别出的4068篇文章和通过引文检索识别出的2774篇文章。78篇文章符合我们的纳入标准并被保留用于分析。我们提取了11个经过验证的质量指标，并根据文献中报告的质量标准进一步制定了243个。质量指标涵盖了不同层面，从一般药物治疗到特定物质组和个别活性物质。纳入研究中的大多数研究的偏倚风险被判定为非常高。
本整合性综述为制定老年CNCP患者药物管理的质量指标奠定了科学基础。纳入研究中存在的高偏倚风险凸显了专家验证和患者参与的必要性。这些指标有助于提高为老年CNCP患者提供护理的质量，并有助于将特定干预措施聚焦于脆弱患者。
