McGrory Fionnuala, Elnaem Mohamed Hassan
School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine BT52 1SA, UK.
Pharmacy (Basel). 2025 Aug 19;13(4):109. doi: 10.3390/pharmacy13040109.
Polypharmacy in older adults increases risks of adverse drug reactions (ADRs), hospitalisations, and mortality. Pharmacist-led interventions using validated tools (e.g., STOPP/START, MAI, STOPPFrail) aim to optimise prescribing, yet their impact on clinical and economic outcomes in UK/Ireland health systems remains underexplored. This systematic review aimed to critically assess the impact of pharmacist-led deprescribing interventions on PIP, clinical outcomes, and costs in older adults (≥65 years) across the UK and Ireland. Following PRISMA 2020 guidelines, four databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched for studies (2010-2024). Eligible studies included randomised trials, observational designs, and intervention studies in hospitals, care homes, community pharmacies, and intermediate care settings. Fourteen studies met the inclusion criteria. The risk of bias was assessed using CASP checklists. Narrative syntheses and heat maps summarised the findings. Twelve of fourteen studies reported positive outcomes: reductions in potentially inappropriate medications, ADRs, medication burdens, and falls/fall risks. Medication appropriateness improved significantly in 35% of studies using the MAI. STOPPFrail reduced PIMs in care homes, while the MAI enhanced complex hospital reviews. Community interventions improved adherence and reduced the use of fall risk drugs. No studies demonstrated a reduction in hospitalisations, mortality, or the length of stays. Economic analyses showed mixed cost-effectiveness. Key barriers included low uptake of pharmacist recommendations and short follow-up periods. Pharmacist-led interventions have significantly improved the prescribing quality and reduced medication-related risks, but they fail to impact hospitalisations or mortality due to implementation gaps. Context-specific tools and policy reforms-including expanded pharmacist roles and electronic decision support-are critical for sustainability. Future research should focus on long-term outcomes, cost-effectiveness, and multidisciplinary integration.
老年人的多重用药会增加药物不良反应（ADR）、住院和死亡的风险。由药剂师主导、使用经过验证的工具（如STOPP/START、MAI、STOPPFrail）进行的干预旨在优化处方，但在英国/爱尔兰卫生系统中，其对临床和经济结果的影响仍未得到充分探索。本系统评价旨在严格评估药剂师主导的减药干预对英国和爱尔兰65岁及以上老年人的潜在不适当用药（PIP）、临床结果和成本的影响。按照PRISMA 2020指南，检索了四个数据库（PubMed、Scopus、科学网、Cochrane图书馆）中的研究（2010 - 2024年）。符合条件的研究包括随机试验、观察性设计以及在医院、养老院、社区药房和中间护理机构进行的干预研究。14项研究符合纳入标准。使用CASP清单评估偏倚风险。叙述性综合分析和热图总结了研究结果。14项研究中有12项报告了积极结果：潜在不适当用药、药物不良反应、用药负担以及跌倒/跌倒风险有所降低。在使用MAI的研究中，35%的研究用药适宜性显著提高。STOPPFrail减少了养老院中的潜在不适当用药，而MAI加强了复杂的医院用药审查。社区干预提高了依从性，并减少了跌倒风险药物的使用。没有研究表明住院、死亡率或住院时间有所减少。经济分析显示成本效益参差不齐。主要障碍包括药剂师建议的采纳率低和随访期短。药剂师主导的干预显著提高了处方质量并降低了用药相关风险，但由于实施差距，未能对住院或死亡率产生影响。针对具体情况的工具和政策改革——包括扩大药剂师的作用和电子决策支持——对于可持续性至关重要。未来的研究应关注长期结果、成本效益和多学科整合。
