PDF(Pubmed)
Abstract：
OBJECTIVE: The growing deprescribing field is challenged by a lack of consensus around evidence and knowledge gaps. The objective of this overview of systematic reviews was to summarize the review evidence for deprescribing interventions in older adults.
METHODS: 11 databases were searched from 1st January 2005 to 16th March 2023 to identify systematic reviews. We summarized and synthesized the results in two steps. Step 1 summarized results reported by the included reviews (including meta-analyses). Step 2 involved a narrative synthesis of review results by outcome. Outcomes included medication-related outcomes (e.g., medication reduction, medication appropriateness) or twelve other outcomes (e.g., mortality, adverse events). We summarized outcomes according to subgroups (patient characteristics, intervention type and setting) when direct comparisons were available within the reviews. The quality of included reviews was assessed using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2).
RESULTS: We retrieved 3,228 unique citations and assessed 135 full-text articles for eligibility. Forty-eight reviews (encompassing 17 meta-analyses) were included. Thirty-one of the 48 reviews had a general deprescribing focus, 16 focused on specific medication classes or therapeutic categories and one included both. Twelve of 17 reviews meta-analyzed medication-related outcomes (33 outcomes: 25 favored the intervention, 7 found no difference, 1 favored the comparison). The narrative synthesis indicated that most interventions resulted in some evidence of medication reduction while for other outcomes we found primarily no evidence of an effect. Results were mixed for adverse events and few reviews reported adverse drug withdrawal events. Limited information was available for people with dementia, frailty and multimorbidity. All but one review scored low or critically low on quality assessment.
CONCLUSIONS: Deprescribing interventions likely resulted in medication reduction but evidence on other outcomes, in particular relating to adverse events, or in vulnerable subgroups or settings was limited. Future research should focus on designing studies powered to examine harms, patient-reported outcomes, and effects on vulnerable subgroups.
BACKGROUND: PROSPERO CRD42020178860.
METHODS: 11 databases were searched from 1st January 2005 to 16th March 2023 to identify systematic reviews. We summarized and synthesized the results in two steps. Step 1 summarized results reported by the included reviews (including meta-analyses). Step 2 involved a narrative synthesis of review results by outcome. Outcomes included medication-related outcomes (e.g., medication reduction, medication appropriateness) or twelve other outcomes (e.g., mortality, adverse events). We summarized outcomes according to subgroups (patient characteristics, intervention type and setting) when direct comparisons were available within the reviews. The quality of included reviews was assessed using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2).
RESULTS: We retrieved 3,228 unique citations and assessed 135 full-text articles for eligibility. Forty-eight reviews (encompassing 17 meta-analyses) were included. Thirty-one of the 48 reviews had a general deprescribing focus, 16 focused on specific medication classes or therapeutic categories and one included both. Twelve of 17 reviews meta-analyzed medication-related outcomes (33 outcomes: 25 favored the intervention, 7 found no difference, 1 favored the comparison). The narrative synthesis indicated that most interventions resulted in some evidence of medication reduction while for other outcomes we found primarily no evidence of an effect. Results were mixed for adverse events and few reviews reported adverse drug withdrawal events. Limited information was available for people with dementia, frailty and multimorbidity. All but one review scored low or critically low on quality assessment.
CONCLUSIONS: Deprescribing interventions likely resulted in medication reduction but evidence on other outcomes, in particular relating to adverse events, or in vulnerable subgroups or settings was limited. Future research should focus on designing studies powered to examine harms, patient-reported outcomes, and effects on vulnerable subgroups.
BACKGROUND: PROSPERO CRD42020178860.
摘要：
目的：由于缺乏关于证据和知识差距的共识，不断增长的去处方领域面临挑战。本系统综述的目的是总结老年人取消处方干预措施的综述证据。
方法：从2005年1月1日至2023年3月16日检索了11个数据库，以确定系统评价。我们分两步对结果进行了总结和综合。第1步总结了纳入的评论（包括荟萃分析）报告的结果。步骤2涉及按结果对评论结果进行叙述性综合。结果包括药物相关结果(例如，减少药物治疗,药物适当性)或12种其他结果(例如，死亡率,不良事件)。我们根据亚组(患者特征，干预类型和设置)，当评论中有直接比较时。使用MeaSurement工具评估系统评论2（AMSTAR2）评估纳入评论的质量。
结果：我们检索了3,228篇独特的引文，并评估了135篇全文文章的资格。包括48条评论（包括17项荟萃分析）。48项审查中有31项的重点是普遍取消处方，16个集中在特定的药物类别或治疗类别，一个包括两者。17篇综述中有12篇对药物相关结果进行了荟萃分析(33篇结果：25篇支持干预措施，7没有发现差异，1赞成比较）。叙事综合表明，大多数干预措施导致药物减少的一些证据，而对于其他结果，我们主要没有发现效果的证据。不良事件的结果好坏参半，很少有评论报告不良停药事件。痴呆症患者的信息有限，虚弱和多症。除一篇评论外，所有评论在质量评估方面的得分都很低或极低。
结论：取消处方干预可能导致药物减少，但其他结局的证据，特别是与不良事件有关，或在脆弱的亚组或环境中受到限制。未来的研究应该集中在设计能够检查危害的研究上，患者报告的结果，以及对弱势群体的影响。
背景：PROSPEROCRD42020178860.
方法：从2005年1月1日至2023年3月16日检索了11个数据库，以确定系统评价。我们分两步对结果进行了总结和综合。第1步总结了纳入的评论（包括荟萃分析）报告的结果。步骤2涉及按结果对评论结果进行叙述性综合。结果包括药物相关结果(例如，减少药物治疗,药物适当性)或12种其他结果(例如，死亡率,不良事件)。我们根据亚组(患者特征，干预类型和设置)，当评论中有直接比较时。使用MeaSurement工具评估系统评论2（AMSTAR2）评估纳入评论的质量。
结果：我们检索了3,228篇独特的引文，并评估了135篇全文文章的资格。包括48条评论（包括17项荟萃分析）。48项审查中有31项的重点是普遍取消处方，16个集中在特定的药物类别或治疗类别，一个包括两者。17篇综述中有12篇对药物相关结果进行了荟萃分析(33篇结果：25篇支持干预措施，7没有发现差异，1赞成比较）。叙事综合表明，大多数干预措施导致药物减少的一些证据，而对于其他结果，我们主要没有发现效果的证据。不良事件的结果好坏参半，很少有评论报告不良停药事件。痴呆症患者的信息有限，虚弱和多症。除一篇评论外，所有评论在质量评估方面的得分都很低或极低。
结论：取消处方干预可能导致药物减少，但其他结局的证据，特别是与不良事件有关，或在脆弱的亚组或环境中受到限制。未来的研究应该集中在设计能够检查危害的研究上，患者报告的结果，以及对弱势群体的影响。
背景：PROSPEROCRD42020178860.
