背景:由社区药剂师(CPs)领导的药物评价的有效性通常没有定论。有人假设研究不够标准化,因此,很难得出结论。
目的:检查CP主导的药物审查研究建立方式的差异。这是通过调查(1)患者选择标准来实现的,(2)药物审查干预措施的组成部分,(3)结果的类型,和(4)使用的测量仪器。
方法:在PubMed和Cochrane图书馆对CP主导的药物综述的随机对照试验进行了系统的文献检索。关于病人选择的信息,干预组件,并提取了结果测量值,并对频率进行了分析。在可能的情况下,结果被映射到药物审查研究的核心结果集(COS).最后,进行了网络分析,以探讨个体因素对结局效应的影响.
结果:总计,包括30篇文章(26项研究)。大多数文章都有药物类别特异性或疾病特异性患者选择标准(n=19)。一半的文章包括年龄≥60岁的患者(n=15),40%(n=12/30)的患者服用4种或更多的药物。在30篇文章中的24篇文章中,药物审查包括额外的干预措施,例如分发教育材料和培训或后续访问。提取了大约40种不同的结果。在具体结果中,测量仪器各不相同,COS很少出现。
结论:显示患者选择的差异,干预交付,和结局评估突出表明,在CP主导的药物综述研究中需要更多的标准化.虽然应该更准确地描述干预措施的实施,以捕捉干预措施之间的潜在差异,结果评估应通过应用COS进行结果选择标准化,以及关于选定的核心成果测量工具,以便能够比较结果。
BACKGROUND: Findings on the effectiveness of medication reviews led by community pharmacists (CPs) are often inconclusive. It has been hypothesized that studies are not sufficiently standardized, and thus, it is difficult to draw conclusions.
OBJECTIVE: To examine differences in the way CP-led medication
review studies are set up. This was accomplished by investigating (1) patient selection criteria, (2) components of the medication
review interventions, (3) types of outcomes, and (4) measurement instruments used.
METHODS: A systematic literature search of randomized controlled trials of CP-led medication reviews was carried out in PubMed and Cochrane Library. Information on patient selection, intervention components, and outcome measurements was extracted, and frequencies were analyzed. Where possible, outcomes were mapped to the Core Outcome Set (COS) for medication
review studies. Finally, a network analysis was conducted to explore the influence of individual factors on outcome effects.
RESULTS: In total, 30 articles (26 studies) were included. Most articles had a drug class-specific or disease-specific patient selection criterion (n = 19). Half of the articles included patients aged ≥60 years (n = 15), and in 40% (n = 12/30) patients taking 4 drugs or more. In 24 of 30 articles, a medication
review was comprised with additional interventions, such as distribution of educational material and training or follow-up visits. About 40 different outcomes were extracted. Within specific outcomes, the measurement instruments varied, and COS was rarely represented.
CONCLUSIONS: The revealed differences in patient selection, intervention delivery, and outcome assessment highlight the need for more standardization in research on CP-led medication reviews. While intervention delivery should be more precisely described to capture potential differences between interventions, outcome assessment should be standardized in terms of outcome selection by application of the COS, and with regard to the selected core outcome measurement instruments to enable comparison of the results.