药师干预下老年人多重用药合理性的系统评价  

Systematic evaluation of the rationality of polypharmacy in the elderly under the intervention of pharmacists

作　　者：郑灵招 林小青 温悦[2] 吕佩瑜[2] 欧阳华 ZHENG Lingzhao;LIN Xiaoqing;WEN Yue;LYU Peiyu;OUYANG Hua(School of Pharmacy,Fujian Medical University,Fuzhou 350000,China;Department of Pharmacy,Zhongshan Hospital Affiliated to Xiamen University,Xiamen 361004,China)

机构地区：[1]福建医科大学药学院,福州350000 [2]厦门大学附属中山医院药学部,厦门361004

出　　处：《中国临床药学杂志》2020年第5期360-366,共7页Chinese Journal of Clinical Pharmacy

摘　　要：目的系统评价药师干预对老年人多重用药的处方合理性与相关临床结局指标的影响。方法计算机检索PubMed、Embase、Medline、Web of science、Cochrane、中国知网、维普数据库和万方数据库,检索时间从建库至2019年5月31日。根据纳排标准对检索到的文献进行筛选,按照Cochrane手册评价纳入研究的偏倚风险,使用Review Manager 5.3软件对数据进行Meta分析,对无法合并的数据进行描述统计。结果本研究纳入9项随机对照研究(RCTs),涉及3 374例老年患者。Meta分析显示,药师干预能够提高老年人多重用药的处方适宜性(MD=-1.32[-1.63,-0.99],P<0.001)和用药依从性(OR=2.15[1.02,4.53],P=0.04),减少平均用药数量(MD=-0.97[-1.33,-0.61],P<0.001),但不能降低全因死亡率(OR=1.15[0.76,1.75],P=0.51)和再入院率(OR=0.79[0.59,1.07],P=0.13),对健康生活质量、药物不良反应等终点指标效果并不明确。结论药师对多重用药老年人的干预形式多样,可减少患者药物数量,提高用药合理性和依从性,但仍对许多临床结局指标影响尚未明确,需要更多高质量研究来评估。AIM To systematically evaluate of the effects of pharmacist intervention on prescription rationa-lity and related clinical outcome indicators of polypharmacy in the aged. METHODS Multiple electronic data-bases were searched including PubMed, Embase, Medline, Web of science, Cochrane, CNKI, VIP and Wanfang databases. All databases had been searched from the establishment of the databases to May 31, 2019. The retrieved documents were screened based on inclusion criteria and the evidence quality was assessed using the Cochrane risk of bias tool. Then Meta-analysis was conducted using Review Manager 5.3 software, and the data which could not be merged were descriped and counted. RESULTS This study included 9 randomized controlled trials(RCTs) which involving 3 374 elderly patients. Meta analysis showed that pharmacist intervention could improve prescription appropriateness(MD=-1.32[-1.63,-0.99],P<0.001) and medication adherence(OR=2.15[1.02,4.53], P=0.04)in the aged with polypharmacy, and reduce the number of prescriptions(MD=-0.97[-1.33,-0.61],P<0.001).But it could not reduce all-cause mortality rate(OR=1.15[0.76,1.75],P=0.51)and readmission rate(OR=0.79 [0.59,1.07], P=0.13). Its effects on endpoints for quality of life and adverse drug reactions were unclear. CONCLUSION Pharmacist intervention for the aged with polypharmacy is diverse, it can reduce the number of medication used by patients, improve rationality and compliance of medication. However, the impact on many other clinical outcome indicators is still unclear, and more high-quality studies are needed to evaluate.

关 键 词：老年人 多重用药 药师 合理用药 系统评价 

分 类 号：R95[医药卫生—药学]