Abstract：
OBJECTIVE: The Drug Burden Index (DBI) calculates a person\'s exposure to anticholinergic and sedative medications. We aimed to review randomized controlled trials (RCTs) of deprescribing interventions that reported the DBI as an outcome, their characteristics, effectiveness in reducing the DBI, and impact on other outcomes.
METHODS: Systematic review with meta-analysis.
METHODS: RCTs of deprescribing interventions where the DBI was measured as a primary or secondary outcome in humans within any setting were included.
METHODS: Electronic databases, citation indexes, and gray literature were searched from April 1, 2007, to September 1, 2023. Quality was assessed using the Cochrane risk-of-bias tool.
RESULTS: Of 1721 records identified, 9 met the inclusion criteria. Six interventions were delivered by pharmacists and 3 were delivered by pharmacists/nurses or pharmacists/geriatricians. All interventions required at least intermediate-level skills and involved multiple components and target groups. Studies were conducted in the community (n = 5), nursing homes (n = 2), and hospitals (n = 2). The mean or median age was ≥75 years and most participants were women in all studies. Most (n = 6) studies were underpowered. The follow-up period ranged from 3 to 12 months. Three studies reported a lower DBI in the intervention group compared with control: 1 pharmacist independent prescriber-delivered in nursing homes (adjusted rate ratio, 0.83; 95% CI, 0.74 to 0.92), 1 pharmacist/nurse practitioner-delivered in hospital (adjusted mean difference (MD), -0.28; 95% CI, -0.51 to -0.04), and 1 geriatrician/pharmacist-delivered in hospital (MD, -0.28; 95% CI, -0.52 to -0.04). Meta-analysis showed no difference in the change in DBI between control and intervention groups in the community including nursing homes (MD, -0.03; 95% CI, -0.08 to 0.01) or hospital setting (MD, -0.19; 95% CI, -0.45 to 0.06). Interventions had inconsistent effects on cognition and no effect on other reported outcomes.
CONCLUSIONS: RCTs of deprescribing interventions had no significant impact on reducing DBI or improving outcomes. Further suitably powered studies are required.
METHODS: Systematic review with meta-analysis.
METHODS: RCTs of deprescribing interventions where the DBI was measured as a primary or secondary outcome in humans within any setting were included.
METHODS: Electronic databases, citation indexes, and gray literature were searched from April 1, 2007, to September 1, 2023. Quality was assessed using the Cochrane risk-of-bias tool.
RESULTS: Of 1721 records identified, 9 met the inclusion criteria. Six interventions were delivered by pharmacists and 3 were delivered by pharmacists/nurses or pharmacists/geriatricians. All interventions required at least intermediate-level skills and involved multiple components and target groups. Studies were conducted in the community (n = 5), nursing homes (n = 2), and hospitals (n = 2). The mean or median age was ≥75 years and most participants were women in all studies. Most (n = 6) studies were underpowered. The follow-up period ranged from 3 to 12 months. Three studies reported a lower DBI in the intervention group compared with control: 1 pharmacist independent prescriber-delivered in nursing homes (adjusted rate ratio, 0.83; 95% CI, 0.74 to 0.92), 1 pharmacist/nurse practitioner-delivered in hospital (adjusted mean difference (MD), -0.28; 95% CI, -0.51 to -0.04), and 1 geriatrician/pharmacist-delivered in hospital (MD, -0.28; 95% CI, -0.52 to -0.04). Meta-analysis showed no difference in the change in DBI between control and intervention groups in the community including nursing homes (MD, -0.03; 95% CI, -0.08 to 0.01) or hospital setting (MD, -0.19; 95% CI, -0.45 to 0.06). Interventions had inconsistent effects on cognition and no effect on other reported outcomes.
CONCLUSIONS: RCTs of deprescribing interventions had no significant impact on reducing DBI or improving outcomes. Further suitably powered studies are required.
摘要：
目的：药物负担指数（DBI）计算一个人暴露于抗胆碱能药物和镇静药物。我们的目的是回顾报告DBI作为结果的非处方干预措施的随机对照试验（RCT）。他们的特点,降低DBI的有效性，以及对其他结果的影响。
方法：系统评价与荟萃分析。
方法：包括在任何情况下，将DBI作为人类的主要或次要结局进行测量的非处方干预措施的随机对照试验。
方法：电子数据库，引文索引，和灰色文献的检索时间为2007年1月4日至2023年1月9日。使用Cochrane偏倚风险工具评估质量。
结果：在确定的1721条记录中，9符合纳入标准。6种干预措施由药剂师提供，3种干预措施由药剂师/护士或药剂师/老年医师提供。所有干预措施至少需要中级技能，并涉及多个组成部分和目标群体。在社区中进行了研究(n=5)，疗养院（n=2），医院（n=2）。在所有研究中，平均或中位年龄≥75岁，大多数参与者都是女性。大多数（n=6）研究的动力不足。随访时间3～12个月。三项研究报告说，与对照组相比，干预组的DBI较低：1个独立于药剂师的处方者在疗养院（调整后的比率，0.83；95%CI，0.74-0.92），1名药剂师/执业护士-在医院分娩(调整后的平均差(MD)，-0.28；95%CI，-0.51至-0.04），和1名老年儿科医生/药剂师-在医院分娩(MD，-0.28；95%CI，-0.52至-0.04）。Meta分析显示，社区包括养老院在内的对照组和干预组之间的DBI变化没有差异（MD，-0.03；95%CI，-0.08至0.01）或医院设置（MD，-0.19；95%CI，-0.45至0.06）。干预对认知有不一致的影响，对其他报告的结果没有影响。
结论：取消处方干预措施的随机对照试验对减少DBI或改善结局没有显著影响。需要进一步的适当动力研究。
方法：系统评价与荟萃分析。
方法：包括在任何情况下，将DBI作为人类的主要或次要结局进行测量的非处方干预措施的随机对照试验。
方法：电子数据库，引文索引，和灰色文献的检索时间为2007年1月4日至2023年1月9日。使用Cochrane偏倚风险工具评估质量。
结果：在确定的1721条记录中，9符合纳入标准。6种干预措施由药剂师提供，3种干预措施由药剂师/护士或药剂师/老年医师提供。所有干预措施至少需要中级技能，并涉及多个组成部分和目标群体。在社区中进行了研究(n=5)，疗养院（n=2），医院（n=2）。在所有研究中，平均或中位年龄≥75岁，大多数参与者都是女性。大多数（n=6）研究的动力不足。随访时间3～12个月。三项研究报告说，与对照组相比，干预组的DBI较低：1个独立于药剂师的处方者在疗养院（调整后的比率，0.83；95%CI，0.74-0.92），1名药剂师/执业护士-在医院分娩(调整后的平均差(MD)，-0.28；95%CI，-0.51至-0.04），和1名老年儿科医生/药剂师-在医院分娩(MD，-0.28；95%CI，-0.52至-0.04）。Meta分析显示，社区包括养老院在内的对照组和干预组之间的DBI变化没有差异（MD，-0.03；95%CI，-0.08至0.01）或医院设置（MD，-0.19；95%CI，-0.45至0.06）。干预对认知有不一致的影响，对其他报告的结果没有影响。
结论：取消处方干预措施的随机对照试验对减少DBI或改善结局没有显著影响。需要进一步的适当动力研究。
