社区老年人处方精简的研究进展与启示

doi:10.12114/j.issn.1007-9572.2022.0160

中国全科医学 ›› 2022, Vol. 25 ›› Issue (13): 1557-1563.DOI: 10.12114/j.issn.1007-9572.2022.0160

• 老年人合理用药专题研究 • 上一篇下一篇

社区老年人处方精简的研究进展与启示

徐园园¹, 徐志杰², 倪雅婷¹, 梁旭健¹, 胡雪婷¹, 方哲明¹, 祝悦¹, 方力争¹^,^*()

1．310016　浙江省杭州市，浙江大学医学院附属邵逸夫医院全科医学科
2．310009　浙江省杭州市，浙江大学医学院附属第二医院全科医学科

收稿日期:2021-11-25 修回日期:2022-03-05 出版日期:2022-03-31 发布日期:2022-04-22
通讯作者: 方力争
徐园园，徐志杰，倪雅婷，等.社区老年人处方精简的研究进展与启示[J].中国全科医学，2022，25（13）：1557-1563.[www.chinagp.net]
作者贡献：徐园园、徐志杰负责文章的构思与设计、可行性分析；徐园园负责文献/资料收集、文献/资料整理、论文撰写；方力争对文章整体负责，监督管理。

Deprescribing for Older Adults in the Community: Recent Developments and Implications for China

Yuanyuan XU¹, Zhijie XU², Yating NI¹, Xujian LIANG¹, Xueting HU¹, Zheming FANG¹, Yue ZHU¹, Lizheng FANG¹^,^*()

1. Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
2. Department of General Practice, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China

Received:2021-11-25 Revised:2022-03-05 Published:2022-03-31 Online:2022-04-22
Contact: Lizheng FANG
About author:
XU Y Y, XU Z J, NI Y T, et al. Deprescribing for older adults in the community: recent developments and implications for China[J]. Chinese General Practice, 2022, 25 (13) : 1557-1563.

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摘要/Abstract

摘要： 用药安全是老年人医疗保健面临的一个主要挑战。多重用药可使老年人发生潜在不恰当用药（PIM）的可能性增加，常会引起药物间相互作用并导致药物不良事件发生，甚至会使老年人住院率、医疗费用及死亡率增加。处方精简是一种基于"以患者为中心、医患共同决策"理念的处方优化行为，旨在改善患者预后，降低与药物相关的不良事件发生率。社区是慢性病防控的"第一道防线"，社区老年患者多病共存、多重用药问题突出。社区全科医生在保证患者的用药安全方面起着至关重要的作用，并且其对患者过去和当前的健康状况、患病情况和治疗方案有着详细的了解这一优势，也有利于确保处方精简的顺利实施。然而，目前对我国社区老年人实施处方精简的相关报道较少。本研究通过阐述处方精简的定义、处方精简在社区环境下的实施过程与步骤及其干预效果，进而深入探讨处方精简对社区慢性病管理的影响与意义，以期为我国社区处方精简政策的制定及相关研究的深入开展提供参考。

关键词: 处方精简, 老年人, 初级卫生保健, 多重用药, 综述

Abstract:

It is a great challenge to ensure medication safety in healthcare for older adults, since polypharmacy in this group may increase the risk of potentially inappropriate medications, leading to adverse drug reactions, drug-drug interactions, hospitalizations, increased medical costs, and even deaths. Deprescribing improves patient prognosis and reduces adverse drug events through patient participation, and shared decision-making. The prevalence of multimorbidity and polypharmacy in older adults is notably in community care, the frontline for the management of use of multiple drugs. As primary care physicians have a deep understanding of patients' past and current diagnoses and treatments, they play a vital role in reviewing and managing patients' medications. However, there are few reports on deprescribing in primary care in China. We described the definition of deprescribing, and reviewed its recent advances, with a focus on the implementation process of deprescribing in the community, and the impact of deprescribing on chronic disease management by primary care physicians. This review may provide a reference for further study and policy making regarding deprescribing in the community in China.

Key words: Deprescribing, Elderly, Primary health care, Polypharmacy, Review

徐园园,徐志杰,倪雅婷,等. 社区老年人处方精简的研究进展与启示[J]. 中国全科医学, 2022, 25(13): 1557-1563. DOI: 10.12114/j.issn.1007-9572.2022.0160.
Yuanyuan XU,Zhijie XU,Yating NI, et al. Deprescribing for Older Adults in the Community: Recent Developments and Implications for China[J]. Chinese General Practice, 2022, 25(13): 1557-1563. DOI: 10.12114/j.issn.1007-9572.2022.0160.

图/表 2

参考文献 45

[1]	中国老年保健医学研究会老年内分泌与代谢病分会，中国毒理学会临床毒理专业委员会. 老年人多重用药安全管理专家共识[J]. 中国全科医学，2018，26(9):3533-3544. DOI：10.12114/j.issn.1007-9572.2018.00.225.
[2]	TOMMELEIN E, MEHUYS E, PETROVIC M，et al. Potentially inappropriate prescribing in community-dwelling older people across Europe：a systematic literature review[J]. Eur J Clin Pharmacol，2015，71(12):1415-1427. DOI：10.1007/s00228-015-1954-4.
[3]	OPONDO D, ESLAMI S, VISSCHER S，et al. Inappropriateness of medication prescriptions to elderly patients in the primary care setting：a systematic review[J]. PLoS One，2012，7(8):e43617. DOI：10.1371/journal.pone.0043617.
[4]	National Center for Health Statistics（US）. Health，United States，2016：with chartbook on long-term trends in health[EB/OL].(2017-05-01)[2021-10-15].
[5]	刘葳，于德华，金花，等. 社区老年多病共存患者多重用药情况评价研究[J].中国全科医学，2020，23(13):1592-1598. DOI：10.12114/j.issn.1007-9572.2020.00.026.
[6]	刘淼，李嘉琦，吕宪玉，等. 80岁老年人多重用药现况及影响因素分析[J]. 中国公共卫生，2017，33(3):412-414. DOI：10.11847/zgggws2017-33-03-18.
[7]	WALLACE E, MCDOWELL R, BENNETT K，et al. Impact of potentially inappropriate prescribing on adverse drug events，health related quality of life and emergency hospital attendance in older people attending general practice：a prospective cohort study[J]. J Gerontol A Biol Sci Med Sci，2017，72(2):271-277. DOI：10.1093/gerona/glw140.
[8]	REEVE E, GNJIDIC D, LONG J，et al. A systematic review of the emerging definition of "deprescribing" with network analysis：implications for future research and clinical practice[J]. Br J Clin Pharmacol，2015，80(6):1254-1268. DOI：10.1111/bcp.12732.
[9]	WOODWARD M. Deprescribing：achieving better health outcomes for older people through reducing medications[J]. Pharm Pract Res，2003，33(4):323-328. DOI：10.1002/jppr2003334323.
[10]	LE COUTEUR D, BANKS E, GNJIDIC D，et al. Deprescribing[J]. Aust Prescr. 2011，34(12):182-185. DOI：10.18773/austprescr.2011.095.
[11]	SCOTT I A, HILMER S N, REEVE E，et al. Reducing inappropriate polypharmacy：the process of deprescribing[J]. JAMA Intern Med，2015，175(5):827-834. DOI：10.1001/jamainternmed.2015.0324.
[12]	COE A, KAYLOR-HUGHES C, FLETCHER S，et al. Deprescribing intervention activities mapped to guiding principles for use in general practice：a scoping review[J]. BMJ Open，2021，11(9):e052547. DOI：10.1136/bmjopen-2021-052547.
[13]	ZECHMANN S, SENN O, VALERI F，et al. Effect of a patient-centred deprescribing procedure in older multimorbid patients in Swiss primary care：a cluster-randomised clinical trial[J]. BMC Geriatr，2020，20(1):471. DOI：10.1186/s12877-020-01870-8.
[14]	VAN DER MEER H G, WOUTERS H, PONT LG，et al. Reducing the anticholinergic and sedative load in older patients on polypharmacy by pharmacist-led medication review：a randomised controlled trial[J]. BMJ Open，2018，8(7):e019042. DOI：10.1136/bmjopen-2017-019042.
[15]	BLOOMFIELD H E, GREER N, LINSKY A M，et al. Deprescribing for community-dwelling older adults：a systematic review and Meta-analysis[J]. J Gen Intern Med，2020，35(11):3323-3332. DOI：10.1007/s11606-020-06089-2.
[16]	TINETTI M E, SPEECHLEY M. Prevention of falls among the elderly[J]. N Engl J Med，1989，320(16):1055-1059. DOI：10.1056/NEJM198904203201606.
[17]	TINETTI M E, INOUYE S K, GILL T M，et al. Shared risk factors for falls，incontinence and functional dependence. Unifying the approach to geriatric syndromes [J]. JAMA，1995，273(17):1348-1353.
[18]	WEBER V, WHITE A, MCILVRIED R. An electronic medical record（EMR）：based intervention to reduce polypharmacy and falls in an ambulatory rural elderly population[J]. J Gen Intern Med，2008，23(4):399-404. DOI：10.1007/s11606-007-0482-z.
[19]	BOYÉ N D, VAN DER VELDE N, DE VRIES O J，et al. Effectiveness of medication withdrawal in older fallers：results from the Improving Medication Prescribing to reduce Risk Of FALLs（IMPROveFALL）trial [J]. Age Ageing，2017，46(1):142-146. DOI：10.1093/ageing/afw161.
[20]	ROGERS S, WILSON D, WAN S，et al. Medication-related admissions in older people：a cross-sectional，observational study[J]. Drugs Aging，2009，26(11):951-961. DOI：10.2165/11316750-000000000-00000.
[21]	RIECKERT A, REEVES D, ALTINER A，et al. Use of an electronic decision support tool to reduce polypharmacy in elderly people with chronic diseases：cluster randomised controlled trial[J]. BMJ，2020，369(6):m1822. DOI：10.1136/bmj.m1822.
[22]	SCHMIDT-MENDE K, ANDERSEN M, WETTERMARK B，et al. Educational intervention on medication reviews aiming to reduce acute healthcare consumption in elderly patients with potentially inappropriate medicines：a pragmatic open-label cluster-randomized controlled trial in primary care[J]. Pharmacoepidemiol Drug Saf，2017，26(11):1347-1356. DOI：10.1002/pds.4263.
[23]	QIU C, WINBLAD B, FRATIGLIONI L. The age-dependent relation of blood pressure to cognitive function and dementia[J]. Lancet Neurol，2005，4(8):487-499. DOI：10.1016/S1474-4422(05)70141-1.
[24]	MOONEN J E, FOSTER-DINGLEY J C, DE RUIJTER W，et al. Effect of discontinuation of antihypertensive treatment in elderly people on cognitive functioning——the DANTE study Leiden：a randomized clinical trial[J]. JAMA Intern Med，2015，175(10):1622-1630. DOI：10.1001/jamainternmed.2015.4103.
[25]	ROMSKAUG R, SKOVLUND E, STRAAND J，et al. Effect of clinical geriatric assessments and collaborative medication reviews by geriatrician and family physician for improving health-related quality of life in home-dwelling older patients receiving polypharmacy：a cluster randomized clinical trial[J]. JAMA Intern Med，2020，180(2):181-189. DOI：10.1001/jamainternmed.2019.5096.
[26]	SCHÄFER I, KADUSZKIEWICZ H, MELLERT C，et al. Narrative medicine-based intervention in primary care to reduce polypharmacy：results from the cluster-randomised controlled trial MultiCare AGENDA [J]. BMJ Open，2018，8(1):e017653. DOI：10.1136/bmjopen-2017-017653.
[27]	CAHIR C, FAHEY T, TEELING M，et al. Potentially inappropriate prescribing and cost outcomes for older people：a national population study[J]. Br J Clin Pharmacol，2010，69(5):543-552. DOI：10.1111/j.1365-2125.2010.03628.x.
[28]	GILLESPIE P, CLYNE B, RAYMAKERS A，et al. Reducing potentially inappropriate prescribing for older people in primary care：cost-effectiveness of the opti-script intervention[J]. Int J Technol Assess Health Care，2017，33(4):494-503. DOI：10.1017/S0266462317000782.
[29]	SANYAL C, TURNER J P, MARTIN P，et al. Cost-effectiveness of pharmacist-led deprescribing of NSAIDs in community-dwelling older adults[J]. J Am Geriatr Soc，2020，68(5):1090-1097. DOI：10.1111/jgs.16388.
[30]	ELLIOTT R A, PUTMAN K D, FRANKLIN M，et al. Cost effectiveness of a pharmacist-led information technology intervention for reducing rates of clinically important errors in medicines management in general practices（PINCER）[J]. Pharmaco-economics，2014，32(6):573-590. DOI：10.1007/s40273-014-0148-8.
[31]	EARL T R, KATAPODIS N D, SCHNEIDERMAN S R，et al. Using deprescribing practices and the screening tool of older persons' potentially inappropriate prescriptions criteria to reduce harm and preventable adverse drug events in older adults[J]. J Patient Saf，2020，16(s1):23-35. DOI：10.1097/PTS.0000000000000747.
[32]	CAUGHEY G E, TAIT K, VITRY A I，et al. Influence of medication risks and benefits on treatment preferences in older patients with multimorbidity[J]. Patient Prefer Adher，2017，11(1):131-140. DOI：10.2147/PPA.S118836.
[33]	PAGE A T, CLIFFORD R M, POTTER K，et al. The feasibility and effect of deprescribing in older adults on mortality and health：a systematic review and Meta-analysis[J]. Br J Clin Pharmacol，2016，82(3):583-623. DOI：10.1111/bcp.12975.
[34]	REEVE E, SHAKIB S, HENDRIX I，et al. Harms of deprescribing[J]. Med J Aust，2014，201(7):386-389. DOI：10.5694/mja13.00200.
[35]	THOMPSON W, REEVE E, MORIARTY F，et al. Deprescribing：future directions for research[J]. Res Soc Admin Pharm，2019，15(6):801-805. DOI：10.1016/j.sapharm.2018.08.013.
[36]	SIROIS C, OUELLET N, REEVE E. Community-dwelling older people's attitudes towards deprescribing in Canada[J]. Res Social Adm Pharm，2017，13(4):864-870. DOI：10.1016/j.sapharm.2016.08.006.
[37]	ANDERSON K, STOWASSER D, FREEMAN C，et al. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults：a systematic review and thematic synthesis[J]. BMJ Open，2014，4(12):e006544. DOI：10.1136/bmjopen-2014-006544.
[38]	KOULADJIAN L, GNJIDIC D, REEVE E，et al. Health care practitioners' perspectives on deprescribing anticholinergic and sedative medications in older adults[J]. Ann Pharmacother，2016，50(8):625-636. DOI：10.1177/1060028016652997.
[39]	卫生部合理用药专家委员会. 中国医师药师临床用药指南[M]. 2版. 重庆：重庆出版社，2014.
[40]	中国老年保健医学研究会老年合理用药分会. 中国老年人潜在不适当用药判断标准（2017版）[J]. 药物不良反应杂志，2018，20(1):2-8. DOI：10.376/cma.j.issn.1008-5734.2018.01.002.
[41]	吴慧利. 老年住院糖尿病患者潜在不恰当用药现状及停药态度问卷的适用性研究[D]. 郑州：郑州大学，2017.
[42]	吴密彬，胡雁，朱叶卉，等. 药物信念问卷在乳腺癌患者内分泌治疗中的应用评价[J]. 护理学杂志，2014，29(1):31-33. DOI：10.3870/hlxzz.2014.01.031.
[43]	GILLAIZEAU F, CHAN E, TRINQUART L，et al. Computerized advice on drug dosage to improve prescribing practice[J]. Cochrane Database Syst Rev，2013，11:CD002894. DOI：10.1002/14651858.CD002894.
[44]	MEULENDIJK M C, SPRUIT M R, DRENTH-VAN MAANEN A C，et al. Computerized decision support improves medication review effectiveness：an experiment evaluating the STRIP Assistant's usability[J]. Drugs Aging，2015，32(6):495-503. DOI：10.1007/s40266-015-0270-0.
[45]	FARRELL B, POTTIE K, ROJAS-FERNANDEZ C H，et al. Methodology for developing deprescribing guidelines：using evidence and GRADE to guide recommendations for deprescribing[J]. PLoS One，2016，11(8):e0161248. DOI：10.1371/journal.pone.0161248.

社区老年人处方精简的研究进展与启示

Deprescribing for Older Adults in the Community: Recent Developments and Implications for China

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