Abstract：
The aim of this umbrella review was to identify tools and guidelines to aid the deprescribing process of potentially inappropriate medications (PIMs), evaluate development and validation methods, and describe evidence levels for medication inclusion.
Searches were conducted on MEDLINE (Ovid), Embase.com, Cochrane CDSR, CINAHL (EBSCO), Web of Science Core Collection and guideline databases from the date of inception to 7 July 2022. Following the initial search, an additional search was conducted to identify an updated versions of tools on 17 July 2023. We analysed the contents of tools and guidelines.
From 23 systematic reviews and guidelines, we identified 95 tools (72 explicit, 12 mixed and 11 implicit) and nine guidelines. Most tools (83.2%) were developed to use for older persons, including 14 for those with limited life expectancy. Seven tools were for children <18 years (7.37%). Most explicit/mixed tools (78.57%) and all guidelines were validated. We found 484 PIMs and 202 medications with different appropriateness independent of disease for older persons with normal and limited life expectancy, respectively. Only two tools and eight guidelines reported the evidence level, and a quarter of medications had high-quality evidence.
Tools are available for a diversity of populations. There were discrepancies, with the same medication being classified as inappropriate in some tools and appropriate in others, possibly due to low-quality evidence. In particular, tools for patients with limited life expectancy were developed based on very limited evidence, and research to generate this evidence is urgently needed. Our medication lists, along with the level of evidence, could facilitate efforts to strengthen the evidence.
Searches were conducted on MEDLINE (Ovid), Embase.com, Cochrane CDSR, CINAHL (EBSCO), Web of Science Core Collection and guideline databases from the date of inception to 7 July 2022. Following the initial search, an additional search was conducted to identify an updated versions of tools on 17 July 2023. We analysed the contents of tools and guidelines.
From 23 systematic reviews and guidelines, we identified 95 tools (72 explicit, 12 mixed and 11 implicit) and nine guidelines. Most tools (83.2%) were developed to use for older persons, including 14 for those with limited life expectancy. Seven tools were for children <18 years (7.37%). Most explicit/mixed tools (78.57%) and all guidelines were validated. We found 484 PIMs and 202 medications with different appropriateness independent of disease for older persons with normal and limited life expectancy, respectively. Only two tools and eight guidelines reported the evidence level, and a quarter of medications had high-quality evidence.
Tools are available for a diversity of populations. There were discrepancies, with the same medication being classified as inappropriate in some tools and appropriate in others, possibly due to low-quality evidence. In particular, tools for patients with limited life expectancy were developed based on very limited evidence, and research to generate this evidence is urgently needed. Our medication lists, along with the level of evidence, could facilitate efforts to strengthen the evidence.
摘要：
目的：本综述的目的是确定工具和指南，以帮助潜在不适当药物（PIM）的开药过程，评估开发和验证方法，并描述药物纳入的证据水平。
方法：在MEDLINE（Ovid）上进行了搜索，Embase.com,CochraneCDSR,CINAHL(EBSCO)，WebofScience核心合集,和指南数据库从开始之日起至2022年7月7日，并于2023年7月17日检查更新的工具。我们分析了工具和指南的内容。
结果：来自23项系统评价和指南，我们确定了95个工具(72个明确的，12混合，11条隐含)和9条准则。大多数工具(83.2%)是为老年人开发的，包括14个寿命有限的人。七种工具适用于18岁以下的儿童（7.37％）。最明确/混合的工具（78.57％）和所有指南都得到了验证。我们发现484个PIM和202个药物具有不同的适当性，独立于疾病的老年人与正常和有限的预期寿命，分别。只有两个工具和八个指南报告了证据水平，四分之一的药物有高质量的证据.
结论：工具可用于多种种群。相同的药物在某些工具中被归类为不适当，而在其他工具中被归类为适当的，存在差异。可能是由于证据质量低。特别是,基于非常有限的证据开发了针对预期寿命有限的患者的工具，非常需要研究来产生这种证据。我们的药物清单,随着证据的水平，可以促进加强证据的努力。
方法：在MEDLINE（Ovid）上进行了搜索，Embase.com,CochraneCDSR,CINAHL(EBSCO)，WebofScience核心合集,和指南数据库从开始之日起至2022年7月7日，并于2023年7月17日检查更新的工具。我们分析了工具和指南的内容。
结果：来自23项系统评价和指南，我们确定了95个工具(72个明确的，12混合，11条隐含)和9条准则。大多数工具(83.2%)是为老年人开发的，包括14个寿命有限的人。七种工具适用于18岁以下的儿童（7.37％）。最明确/混合的工具（78.57％）和所有指南都得到了验证。我们发现484个PIM和202个药物具有不同的适当性，独立于疾病的老年人与正常和有限的预期寿命，分别。只有两个工具和八个指南报告了证据水平，四分之一的药物有高质量的证据.
结论：工具可用于多种种群。相同的药物在某些工具中被归类为不适当，而在其他工具中被归类为适当的，存在差异。可能是由于证据质量低。特别是,基于非常有限的证据开发了针对预期寿命有限的患者的工具，非常需要研究来产生这种证据。我们的药物清单,随着证据的水平，可以促进加强证据的努力。
