PDF(Pubmed)
Abstract：
BACKGROUND: Polypharmacy is common among individuals with multimorbidity, often leading to inappropriate medication use and is associated with an increased risk of frailty, hospitalisation and mortality. Structured medication reviews (SMRs) have emerged as a promising method for optimising medication use. However, research examining their efficacy is limited. This review aims to evaluate the impact of SMRs on improving outcomes for adults with multimorbidity and polypharmacy in primary care settings. Additionally, this review seeks to identify prevailing patterns and trends in the mode of delivery of SMRs.
METHODS: A systematic review will be conducted using Ovid MEDLINE, Ovid EMBASE, Web of Science and CINAHL (1997-present). Primary outcomes will include medication-related measures such as dose, frequency and dosage form. Secondary outcomes under investigation will include physical, mental, functional and health service outcomes, as reported. Two independent reviewers will conduct the screening and data extraction, resolving disagreements through discussion. Once eligible studies are identified, the extracted data will be summarised in tabular format. The risk of bias in the articles will be assessed using either the Cochrane Risk of Bias 2 tool or the Newcastle-Ottawa scale, depending on the design of the studies retrieved. Subgroup analysis will be performed using demographic variables and modes of delivery where the data supports. If appropriate, a meta-analysis of the data extracted will be conducted to determine the impact of the SMRs on reported outcomes. If a meta-analysis is not possible due to heterogeneity, a narrative synthesis approach will be adopted.
BACKGROUND: This proposed review is exempt from ethical approval as it aims to collate and summarise peer-reviewed, published evidence. This protocol and the subsequent review will be disseminated in peer-reviewed journals, conferences and patient-led lay summaries.
UNASSIGNED: CRD42023454965.
METHODS: A systematic review will be conducted using Ovid MEDLINE, Ovid EMBASE, Web of Science and CINAHL (1997-present). Primary outcomes will include medication-related measures such as dose, frequency and dosage form. Secondary outcomes under investigation will include physical, mental, functional and health service outcomes, as reported. Two independent reviewers will conduct the screening and data extraction, resolving disagreements through discussion. Once eligible studies are identified, the extracted data will be summarised in tabular format. The risk of bias in the articles will be assessed using either the Cochrane Risk of Bias 2 tool or the Newcastle-Ottawa scale, depending on the design of the studies retrieved. Subgroup analysis will be performed using demographic variables and modes of delivery where the data supports. If appropriate, a meta-analysis of the data extracted will be conducted to determine the impact of the SMRs on reported outcomes. If a meta-analysis is not possible due to heterogeneity, a narrative synthesis approach will be adopted.
BACKGROUND: This proposed review is exempt from ethical approval as it aims to collate and summarise peer-reviewed, published evidence. This protocol and the subsequent review will be disseminated in peer-reviewed journals, conferences and patient-led lay summaries.
UNASSIGNED: CRD42023454965.
摘要：
背景：多重用药在多病患者中很常见，通常导致不适当的药物使用，并与虚弱的风险增加有关，住院和死亡率。结构化药物审查（SMR）已成为优化药物使用的有希望的方法。然而,研究它们的功效是有限的。这篇综述旨在评估SMR对改善初级保健环境中多发病率和多药房成人预后的影响。此外,这项审查旨在确定SMR交付模式的主要模式和趋势。
方法：将使用OvidMEDLINE进行系统评价，OvidEmbase,WebofScience和CINAHL(1997年至今)。主要结果将包括与药物相关的措施，如剂量，频率和剂型。调查的次要结果将包括身体，心理，功能和卫生服务成果，据报道。两名独立评审员将进行筛选和数据提取，通过讨论解决分歧。一旦确定了合格的研究，提取的数据将以表格格式汇总。将使用Cochrane偏差风险2工具或纽卡斯尔-渥太华量表评估文章中的偏差风险，根据检索到的研究的设计。亚组分析将使用人口统计变量和数据支持的交付模式进行。如果合适,将对提取的数据进行荟萃分析,以确定SMR对报告结局的影响.如果由于异质性而无法进行荟萃分析，将采用叙事综合方法。
背景：这项拟议的审查不受道德批准，因为它旨在整理和总结同行评审，公布的证据。该协议和随后的审查将在同行评审的期刊上传播，会议和患者主导的横向总结。
■CRD42023454965。
方法：将使用OvidMEDLINE进行系统评价，OvidEmbase,WebofScience和CINAHL(1997年至今)。主要结果将包括与药物相关的措施，如剂量，频率和剂型。调查的次要结果将包括身体，心理，功能和卫生服务成果，据报道。两名独立评审员将进行筛选和数据提取，通过讨论解决分歧。一旦确定了合格的研究，提取的数据将以表格格式汇总。将使用Cochrane偏差风险2工具或纽卡斯尔-渥太华量表评估文章中的偏差风险，根据检索到的研究的设计。亚组分析将使用人口统计变量和数据支持的交付模式进行。如果合适,将对提取的数据进行荟萃分析,以确定SMR对报告结局的影响.如果由于异质性而无法进行荟萃分析，将采用叙事综合方法。
背景：这项拟议的审查不受道德批准，因为它旨在整理和总结同行评审，公布的证据。该协议和随后的审查将在同行评审的期刊上传播，会议和患者主导的横向总结。
■CRD42023454965。
