PDF(Pubmed)
Abstract：
BACKGROUND: Polypharmacy and multimorbidity pose escalating challenges. Despite numerous attempts, interventions have yet to show consistent improvements in health outcomes. A key factor may be varied approaches to targeting patients for intervention.
OBJECTIVE: To explore how patients are targeted for intervention by examining the literature with respect to: understanding how polypharmacy is defined; identifying problematic polypharmacy in practice; and addressing problematic polypharmacy through interventions.
METHODS: We performed a scoping review as defined by the Joanna Briggs Institute.
METHODS: The focus was on primary care settings.
METHODS: Medline, Embase, Cumulative Index to Nursing and Allied Health Literature and Cochrane along with ClinicalTrials.gov, Science.gov and WorldCat.org were searched from January 2004 to February 2024.
METHODS: We included all articles that had a focus on problematic polypharmacy in multimorbidity and primary care, incorporating multiple types of evidence, such as reviews, quantitative trials, qualitative studies and policy documents. Articles focussing on a single index disease or not written in English were excluded.
UNASSIGNED: We performed a narrative synthesis, comparing themes and findings across the collective evidence to draw contextualised insights and conclusions.
RESULTS: In total, 157 articles were included. Case-finding methods often rely on basic medication counts (often five or more) without considering medical history or whether individual medications are clinically appropriate. Other approaches highlight specific drug indicators and interactions as potentially inappropriate prescribing, failing to capture a proportion of patients not fitting criteria. Different potentially inappropriate prescribing criteria also show significant inconsistencies in determining the appropriateness of medications, often neglecting to consider multimorbidity and underprescribing. This may hinder the identification of the precise population requiring intervention.
CONCLUSIONS: Improved strategies are needed to target patients with polypharmacy, which should consider patient perspectives, individual factors and clinical appropriateness. The development of a cross-cutting measure of problematic polypharmacy that consistently incorporates adjustment for multimorbidity may be a valuable next step to address frequent confounding.
OBJECTIVE: To explore how patients are targeted for intervention by examining the literature with respect to: understanding how polypharmacy is defined; identifying problematic polypharmacy in practice; and addressing problematic polypharmacy through interventions.
METHODS: We performed a scoping review as defined by the Joanna Briggs Institute.
METHODS: The focus was on primary care settings.
METHODS: Medline, Embase, Cumulative Index to Nursing and Allied Health Literature and Cochrane along with ClinicalTrials.gov, Science.gov and WorldCat.org were searched from January 2004 to February 2024.
METHODS: We included all articles that had a focus on problematic polypharmacy in multimorbidity and primary care, incorporating multiple types of evidence, such as reviews, quantitative trials, qualitative studies and policy documents. Articles focussing on a single index disease or not written in English were excluded.
UNASSIGNED: We performed a narrative synthesis, comparing themes and findings across the collective evidence to draw contextualised insights and conclusions.
RESULTS: In total, 157 articles were included. Case-finding methods often rely on basic medication counts (often five or more) without considering medical history or whether individual medications are clinically appropriate. Other approaches highlight specific drug indicators and interactions as potentially inappropriate prescribing, failing to capture a proportion of patients not fitting criteria. Different potentially inappropriate prescribing criteria also show significant inconsistencies in determining the appropriateness of medications, often neglecting to consider multimorbidity and underprescribing. This may hinder the identification of the precise population requiring intervention.
CONCLUSIONS: Improved strategies are needed to target patients with polypharmacy, which should consider patient perspectives, individual factors and clinical appropriateness. The development of a cross-cutting measure of problematic polypharmacy that consistently incorporates adjustment for multimorbidity may be a valuable next step to address frequent confounding.
摘要：
背景：多重用药和多重用药带来了不断升级的挑战。尽管多次尝试,干预措施尚未显示出健康结果的持续改善。一个关键因素可能是针对患者进行干预的各种方法。
目的：通过研究以下方面的文献，探索如何针对患者进行干预：了解如何定义多重用药；在实践中发现有问题的多重用药；并通过干预解决有问题的多重用药。
方法：我们进行了由JoannaBriggs研究所定义的范围审查。
方法：重点是初级保健设置。
方法：Medline，Embase,护理和相关健康文献和Cochrane的累积指数以及ClinicalTrials.gov，从2004年1月至2024年2月搜索了Science.gov和WorldCat.org。
方法：我们收录了所有关注多发病率和初级保健中存在问题的多重用药的文章，结合多种类型的证据，如评论,定量试验,定性研究和政策文件。排除了关注单指标疾病或不以英语书写的文章。
■我们进行了叙事合成，比较整个集体证据的主题和发现，以得出上下文的见解和结论。
结果：总计，共纳入157篇文章。病例发现方法通常依赖于基本的药物计数（通常为5个或更多），而不考虑病史或个别药物是否适合临床。其他方法强调特定的药物指标和相互作用，可能是不适当的处方，未能捕捉到不符合标准的患者比例。不同的潜在不适当的处方标准在确定药物的适当性方面也显示出显著的不一致,经常忽略考虑多发病和处方不足。这可能会阻碍对需要干预的精确人群的识别。
结论：需要改进的策略来针对多重用药的患者，应该考虑病人的观点，个体因素和临床适当性。开发一种有问题的多重用药的交叉措施，该措施始终包含对多发病率的调整，这可能是解决频繁混淆的有价值的下一步。
目的：通过研究以下方面的文献，探索如何针对患者进行干预：了解如何定义多重用药；在实践中发现有问题的多重用药；并通过干预解决有问题的多重用药。
方法：我们进行了由JoannaBriggs研究所定义的范围审查。
方法：重点是初级保健设置。
方法：Medline，Embase,护理和相关健康文献和Cochrane的累积指数以及ClinicalTrials.gov，从2004年1月至2024年2月搜索了Science.gov和WorldCat.org。
方法：我们收录了所有关注多发病率和初级保健中存在问题的多重用药的文章，结合多种类型的证据，如评论,定量试验,定性研究和政策文件。排除了关注单指标疾病或不以英语书写的文章。
■我们进行了叙事合成，比较整个集体证据的主题和发现，以得出上下文的见解和结论。
结果：总计，共纳入157篇文章。病例发现方法通常依赖于基本的药物计数（通常为5个或更多），而不考虑病史或个别药物是否适合临床。其他方法强调特定的药物指标和相互作用，可能是不适当的处方，未能捕捉到不符合标准的患者比例。不同的潜在不适当的处方标准在确定药物的适当性方面也显示出显著的不一致,经常忽略考虑多发病和处方不足。这可能会阻碍对需要干预的精确人群的识别。
结论：需要改进的策略来针对多重用药的患者，应该考虑病人的观点，个体因素和临床适当性。开发一种有问题的多重用药的交叉措施，该措施始终包含对多发病率的调整，这可能是解决频繁混淆的有价值的下一步。
