背景:缺乏关于药剂师干预对老年门诊患者停用苯二氮卓类药物的有效性的综合可靠证据。
目的:本研究评估并总结了药师干预对老年门诊患者苯二氮卓类药物的影响。
方法:直到2022年8月在PubMed进行了文献检索,PsycINFO,和Cochrane中央对照试验注册数据库。该综述包括随机对照试验,评估药剂师干预对老年门诊患者停用苯二氮卓类药物的影响。两名独立研究人员进行了研究选择,数据提取,和偏见风险评估。使用RStudio软件中的随机效应模型进行Meta分析。
结果:共确定了893条记录。五项研究,包括3879名病人,符合纳入标准,被纳入系统评价.所有五项研究都使用健康教育作为干预策略,三人还进行了药物审查。没有证据表明药剂师有权在苯二氮卓类药物停用期间修改处方。一项研究被归类为偏见风险低,而另一个则有一些担忧或偏见的高风险。荟萃分析中纳入了三项研究,观察到药师干预对老年门诊患者苯二氮卓类药物处方率的显著影响(RR=2.75[95CI1.29;5.89];p=0.04;I2=69%;证据确定性低)。
结论:药师可能有助于老年门诊患者停用苯二氮卓类药物。需要进一步的研究来提高这些发现的可靠性。PROSPERO注册号:CRD42022358563。
BACKGROUND: Consolidated and reliable evidence regarding the effectiveness of pharmacist interventions for deprescribing benzodiazepines in older outpatients is lacking.
OBJECTIVE: This study evaluated and summarized the impact of pharmacist interventions on
benzodiazepine deprescribing among older outpatients.
METHODS: A literature search was conducted until August 2022 in PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials databases. The
review included randomized controlled trials that assessed the impact of pharmacist interventions on deprescribing
benzodiazepine in older outpatients. Two independent investigators conducted the study selection, data extraction, and risk of bias assessment. Meta-analyses were conducted using random-effect models in the RStudio software.
RESULTS: A total of 893 records were identified. Five studies, including 3,879 patients, met the inclusion criteria and were included in the systematic
review. All five studies used health education as an intervention strategy, and three also conducted medication reviews. There was no evidence of the pharmacist\'s authority to modify prescriptions during
benzodiazepine deprescribing. One study was classified as having a low risk of bias, whereas the other had some concerns or a high risk of bias. Three studies were included in the meta-analysis and a significant impact of pharmacist interventions on benzodiazepines deprescribing rates in older outpatients was observed (RR = 2.75 [95%CI 1.29; 5.89]; p = 0.04; I2 = 69%; low certainty of evidence).
CONCLUSIONS: Pharmacists may contribute to deprescribing benzodiazepines in older outpatients. Further studies are needed to increase the reliability of these findings. PROSPERO registration number: CRD42022358563.