Abstract：
BACKGROUND: Polypharmacy is a primary risk factor for the prescription of potentially inappropriate medications (PIMs), drug-drug interactions (DDIs), and ultimately, adverse drug reactions (ADRs). Medication review and deprescribing represent effective strategies to simplify therapeutic regimens, minimize risks, and reduce PIM prescriptions. This systematic review and meta-analysis of experimental and observational studies aimed to evaluate the impact of different medication review and deprescribing interventions in hospitalized older patients.
METHODS: Experimental and observational prospective cohort studies evaluating the clinical effects of medication review and deprescribing strategies in older hospitalized patients were searched in the bibliographic databases, PubMed, Embase, and Scopus, from inception until January 8, 2024. A narrative synthesis of the results was provided, along with a meta-analysis of dichotomous data (i.e., re-hospitalizations and mortality).
RESULTS: Overall, 21 randomized controlled trials, 7 non-randomized interventional studies, and 2 prospective cohort studies were included in the systematic review. Of these, 14 (46.7%) assessed medication appropriateness as the primary outcome, while the remaining evaluated clinical outcomes (e.g., length of hospital stay, hospital readmissions, emergency department visits, and incidence of ADRs) and/or quality of life. The meta-analysis revealed a slight but statistically significant 8% reduction in hospital readmissions (HR: 0.92; 95% CI: 0.85-0.99) following medication review and deprescribing, but no significant impact on mortality (HR: 0.98; 95% CI: 0.96-1.00). Of the 30 included studies, 21 were considered at high risk of bias, mostly due to potential deviations from intended interventions and randomization processes. The remaining nine studies had \"some concerns\" (eight studies) or were considered at \"low\" risk of bias (one study).
CONCLUSIONS: Medication review and deprescribing are associated with potential benefits in reducing hospital readmission rates among hospitalized older patients, particularly through the reduction of PIM prescriptions. The integration of thorough medication review and deprescribing protocols in hospital settings may improve post-discharge outcomes and reduce overall healthcare costs.
METHODS: Experimental and observational prospective cohort studies evaluating the clinical effects of medication review and deprescribing strategies in older hospitalized patients were searched in the bibliographic databases, PubMed, Embase, and Scopus, from inception until January 8, 2024. A narrative synthesis of the results was provided, along with a meta-analysis of dichotomous data (i.e., re-hospitalizations and mortality).
RESULTS: Overall, 21 randomized controlled trials, 7 non-randomized interventional studies, and 2 prospective cohort studies were included in the systematic review. Of these, 14 (46.7%) assessed medication appropriateness as the primary outcome, while the remaining evaluated clinical outcomes (e.g., length of hospital stay, hospital readmissions, emergency department visits, and incidence of ADRs) and/or quality of life. The meta-analysis revealed a slight but statistically significant 8% reduction in hospital readmissions (HR: 0.92; 95% CI: 0.85-0.99) following medication review and deprescribing, but no significant impact on mortality (HR: 0.98; 95% CI: 0.96-1.00). Of the 30 included studies, 21 were considered at high risk of bias, mostly due to potential deviations from intended interventions and randomization processes. The remaining nine studies had \"some concerns\" (eight studies) or were considered at \"low\" risk of bias (one study).
CONCLUSIONS: Medication review and deprescribing are associated with potential benefits in reducing hospital readmission rates among hospitalized older patients, particularly through the reduction of PIM prescriptions. The integration of thorough medication review and deprescribing protocols in hospital settings may improve post-discharge outcomes and reduce overall healthcare costs.
摘要：
背景：多重用药是潜在不适当药物（PIMs）处方的主要风险因素，药物-药物相互作用（DDI），最终,药物不良反应（ADR）。药物审查和开处方是简化治疗方案的有效策略，将风险降至最低,减少PIM处方。这项对实验和观察性研究的系统评价和荟萃分析旨在评估不同药物评价和取消处方干预措施对住院老年患者的影响。
方法：在书目数据库中搜索了评估老年住院患者药物审查和去处方策略临床效果的实验和观察性前瞻性队列研究，PubMed,Embase,还有Scopus,从开始到2024年1月8日。提供了结果的叙述性综合，以及对二分数据的荟萃分析(即，再次住院和死亡率)。
结果：总体而言，21项随机对照试验,7项非随机干预研究，系统评价包括2项前瞻性队列研究.其中,14（46.7％）将药物适当性评估为主要结果，而其余评估的临床结果(例如，住院时间,医院再入院,急诊部门的访问，和ADR的发生率）和/或生活质量。荟萃分析显示，在药物审查和取消处方后，再入院率略有降低，但有统计学意义的8%(HR:0.92;95%CI:0.85-0.99)。但对死亡率无显著影响(HR:0.98;95%CI:0.96-1.00)。在30项纳入的研究中，21人被认为存在偏见的高风险，主要是由于与预期干预和随机化过程的潜在偏差。其余9项研究存在“一些担忧”（8项研究）或被认为存在“低”偏倚风险（1项研究）。
结论：药物审查和取消处方与降低住院老年患者再入院率的潜在益处相关，特别是通过减少PIM处方。在医院环境中整合全面的药物审查和开处方协议可以改善出院后的结果并降低整体医疗成本。
方法：在书目数据库中搜索了评估老年住院患者药物审查和去处方策略临床效果的实验和观察性前瞻性队列研究，PubMed,Embase,还有Scopus,从开始到2024年1月8日。提供了结果的叙述性综合，以及对二分数据的荟萃分析(即，再次住院和死亡率)。
结果：总体而言，21项随机对照试验,7项非随机干预研究，系统评价包括2项前瞻性队列研究.其中,14（46.7％）将药物适当性评估为主要结果，而其余评估的临床结果(例如，住院时间,医院再入院,急诊部门的访问，和ADR的发生率）和/或生活质量。荟萃分析显示，在药物审查和取消处方后，再入院率略有降低，但有统计学意义的8%(HR:0.92;95%CI:0.85-0.99)。但对死亡率无显著影响(HR:0.98;95%CI:0.96-1.00)。在30项纳入的研究中，21人被认为存在偏见的高风险，主要是由于与预期干预和随机化过程的潜在偏差。其余9项研究存在“一些担忧”（8项研究）或被认为存在“低”偏倚风险（1项研究）。
结论：药物审查和取消处方与降低住院老年患者再入院率的潜在益处相关，特别是通过减少PIM处方。在医院环境中整合全面的药物审查和开处方协议可以改善出院后的结果并降低整体医疗成本。
