Abstract：
This umbrella review examined systematic reviews of deprescribing studies by characteristics of intervention, population, medicine, and setting. Clinical and humanistic outcomes, barriers and facilitators, and tools for deprescribing are presented. The Medline database was used. The search was limited to systematic reviews and meta-analyses published in English up to April 2022. Reviews reporting deprescribing were included, while those where depre-scribing was not planned and supervised by a healthcare professional were excluded. A total of 94 systematic reviews (23 meta--analyses) were included. Most explored clinical or humanistic outcomes (70/94, 74 %); less explored attitudes, facilitators, or barriers to deprescribing (17/94, 18 %); few focused on tools (8/94, 8.5 %). Reviews assessing clinical or humanistic outcomes were divided into two groups: reviews with deprescribing intervention trials (39/70, 56 %; 16 reviewing specific deprescribing interventions and 23 broad medication optimisation interventions), and reviews with medication cessation trials (31/70, 44 %). Deprescribing was feasible and resulted in a reduction of inappropriate medications in reviews with deprescribing intervention trials. Complex broad medication optimisation interventions were shown to reduce hospitalisation, falls, and mortality rates. In reviews of medication cessation trials, a higher frequency of adverse drug withdrawal events underscores the importance of prioritizing patient safety and exercising caution when stopping medicines, particularly in patients with clear and appropriate indications.
摘要：
这项总括性综述根据干预措施的特点，研究了非处方性研究的系统综述，人口,医学,和设置。临床和人文结果，障碍和促进者，并提出了解除处方的工具。使用Medline数据库。搜索仅限于截至2022年4月以英文发布的系统评价和荟萃分析。包括报告开处方的评论，而那些没有由医疗保健专业人员计划和监督的人被排除在外。共纳入94项系统评价(23项Meta分析)。大多数探索的临床或人文结果(70/94，74%)；较少探索的态度，主持人，或取消处方的障碍（17/94，18%）；很少关注工具（8/94，8.5%）。评估临床或人文结果的评论分为两组：取消处方干预试验的评论（39/70，56％；16个审查特定的取消处方干预措施和23个广泛的药物优化干预措施）。以及药物停止试验的回顾（31/70，44%）。取消处方是可行的，并导致在取消处方干预试验的评论中减少了不适当的药物。复杂的广泛的药物优化干预被证明可以减少住院，falls,和死亡率。在对停药试验的回顾中，不良停药事件的频率较高，突显了优先考虑患者安全和停药时谨慎行事的重要性。特别是在有明确和适当适应症的患者中。
