处方精简实施的阻碍因素和促进因素：基于更新版实施性研究综合框架的范围综述

doi:10.12114/j.issn.1007-9572.2025.0032

中国全科医学 ›› 2026, Vol. 29 ›› Issue (07): 936-944.DOI: 10.12114/j.issn.1007-9572.2025.0032

处方精简实施的阻碍因素和促进因素：基于更新版实施性研究综合框架的范围综述

严明¹, 夏瑀², 周鹏翔³, 周馨媚⁴, 方力争¹, 赵洋⁵^,⁶^,^*(), 徐志杰⁴^,^*()

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
2．518036　广东省深圳市，北京大学深圳医院全科医学科
3．100191　北京市，北京大学第三医院药学部
4．310009　浙江省杭州市，浙江大学医学院附属第二医院全科医学科
5．2050澳大利亚悉尼，新南威尔士大学乔治全球健康研究院
6．169857　新加坡，新加坡国立大学，杜克-新国立医学院

收稿日期:2025-03-20 修回日期:2025-05-22 出版日期:2026-03-05 发布日期:2026-02-13
通讯作者: 赵洋, 徐志杰
作者贡献：
严明负责文章的构思与设计、可行性分析、论文撰写；严明、夏瑀、周鹏翔、周馨媚负责文献资料收集和整理；周鹏翔对文章提出修改意见；徐志杰、赵洋对文章整体负责，监督管理。
基金资助:
国家自然科学基金资助项目(72304008); 浙江省医药卫生科技计划(2023KY748，2024KY1026)

Barriers and Facilitators to the Implementation of Deprescribing: a Scoping Review Based on the Updated Consolidated Framework for Implementation Research

YAN Ming¹, XIA Yu², ZHOU Pengxiang³, ZHOU Xinmei⁴, FANG Lizheng¹, ZHAO Yang⁵^,⁶^,^*(), XU Zhijie⁴^,^*()

1. Department of General Practice, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
2. Department of General Practice, Peking University Shenzhen Hospital, Shenzhen 518036, China
3. Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
4. Department of General Practice, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310019, China
5. The George Institute for Global Health, University of New South Wales, Sydney 2050, Australia
6. Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore

Received:2025-03-20 Revised:2025-05-22 Published:2026-03-05 Online:2026-02-13
Contact: ZHAO Yang, XU Zhijie

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摘要/Abstract

摘要： 背景处方精简是一种识别和停用潜在不适当药物的循证实践，已被证实在减少药物不良反应和减轻治疗负担等方面具有重要价值。现有研究揭示了在临床实践中实施处方精简面临的阻碍和促进因素，但缺乏实施科学视角下综合、全面的归纳分析。目的本研究采用范围综述的方法，分析实施处方精简的阻碍因素和促进因素，为构建实施策略提供依据。方法系统检索中国知网、万方数据知识服务平台、PubMed和Web of Science 4个文献数据库，检索时限为2000年1月—2024年9月，筛选处方精简实施影响因素的相关研究。由2名研究者独立采用预设的数据提取表格收集研究特征和实施因素等信息，并基于2022年更新版实施性研究综合框架（CFIR）分析实施处方精简的阻碍因素和促进因素。结果共纳入46项研究。促进因素包括：患者与医生对处方精简的积极态度，医疗团队的协作配合，良好的医患沟通，患者对处方精简的认知等。阻碍因素则包括：患者对处方精简的抵触态度，医疗机构之间缺乏有效协作，医患沟通时使用过多专业术语，患者对药物知识的缺乏等。结论处方精简的成功实施涉及多层次因素的综合影响，未来研究应基于特定场景下的促进因素和阻碍因素，精准匹配实施策略，从而为推动处方精简工作提出兼具针对性与可行性的方案。

关键词: 更新版实施性研究综合框架, 处方精简, 阻碍因素, 促进因素, 范围综述

Abstract:

Background

Deprescribing is an intervention strategy aimed at identifying and discontinuing potentially inappropriate medications, which holds significant value in reducing medication-related risks and improving patient outcomes. However, there is a lack of comprehensive and integrated inductive analysis from the perspective of implementation science.

Objective

This study aims to review the barriers to and facilitators of deprescribing implementation based on the updated 2022 Consolidated Framework for Implementation Research (CFIR) to provide evidence-based recommendations for optimizing implementation strategies.

Methods

A systematic search was conducted in four electronic databases—China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, and Web of Science—for relevant literature published from January 2000 to September 2024, to identify studies exploring the influencing factors on the implementation of deprescribing. Two researchers independently used a predefined data extraction form to collect information on study characteristics, intervention content, and implementation determinants. The barriers and facilitators were analyzed thematically and synthesized using the updated CFIR.

Results

A total of 46 studies were included in the analysis. The facilitators identified included positive attitudes of patients and physicians toward deprescribing, collaboration within healthcare teams, effective doctor-patient communication, and patients' understanding of deprescribing. The barriers included resistance from patients, lack of effective collaboration between healthcare institutions, excessive use of technical jargon in doctor-patient communication, and patients' lack of knowledge about medications.

Conclusion

The successful implementation of deprescribing is influenced by a combination of multifaceted factors. Future research should precisely match implementation strategies based on the facilitating and hindering factors in specific scenarios, to propose targeted and feasible solutions for promoting the process of deprescribing.

Key words: Updated Consolidated Framework for Implementation Research, Deprescribing, Barriers, Facilitators, Scoping review

中图分类号:

R 197.1

严明,夏瑀,周鹏翔,等. 处方精简实施的阻碍因素和促进因素：基于更新版实施性研究综合框架的范围综述[J]. 中国全科医学, 2026, 29(07): 936-944. DOI: 10.12114/j.issn.1007-9572.2025.0032.
YAN Ming,XIA Yu,ZHOU Pengxiang, et al. Barriers and Facilitators to the Implementation of Deprescribing: a Scoping Review Based on the Updated Consolidated Framework for Implementation Research[J]. Chinese General Practice, 2026, 29(07): 936-944. DOI: 10.12114/j.issn.1007-9572.2025.0032.

图/表 3

参考文献 62

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检索步骤	检索式
#1	（"Deprescriptions"[MeSH]） OR（"Polypharmacy"[MeSH]） OR（"Inappropriate Prescribing"[MeSH]） OR（"Drug Utilization"[MeSH]） OR（"Medication Therapy Management"[MeSH]） OR（"Drug Utilization Review"[MeSH]） OR（"Pharmaceutical Services"[MeSH]）
#2	（Deprescribing OR Deprescription* OR Drug discontinuation OR Medication discontinuation OR Drug withdrawal OR Prescription optimization OR Medication optimization OR Polypharmacy OR Inappropriate prescribing OR Inappropriate medication* OR Potentially inappropriate medication* OR Potentially inappropriate prescribing OR Drug-related problem* OR Medication-related problem* OR Overprescribing）
#3	#1 OR #2
#4	（"Qualitative Research"[MeSH]） OR（"Focus Groups"[MeSH]） OR（"Interviews as Topic"[MeSH]） OR（"Randomized Controlled Trial" [Publication Type]） OR（"Clinical Trial"[Publication Type]） OR（"Mixed Method Analysis"[MeSH]）
#5	（Qualitative OR Interview* OR Focus group* OR Controlled trial* OR Clinical trial* OR RCT OR Mixed method* OR Multi-method* OR Multiple method* OR Systematic review OR Meta-analysis）
#6	#4 OR #5
#7	#3 AND #6

检索步骤	检索式
#1	（"Deprescriptions"[MeSH]） OR（"Polypharmacy"[MeSH]） OR（"Inappropriate Prescribing"[MeSH]） OR（"Drug Utilization"[MeSH]） OR（"Medication Therapy Management"[MeSH]） OR（"Drug Utilization Review"[MeSH]） OR（"Pharmaceutical Services"[MeSH]）
#2	（Deprescribing OR Deprescription* OR Drug discontinuation OR Medication discontinuation OR Drug withdrawal OR Prescription optimization OR Medication optimization OR Polypharmacy OR Inappropriate prescribing OR Inappropriate medication* OR Potentially inappropriate medication* OR Potentially inappropriate prescribing OR Drug-related problem* OR Medication-related problem* OR Overprescribing）
#3	#1 OR #2
#4	（"Qualitative Research"[MeSH]） OR（"Focus Groups"[MeSH]） OR（"Interviews as Topic"[MeSH]） OR（"Randomized Controlled Trial" [Publication Type]） OR（"Clinical Trial"[Publication Type]） OR（"Mixed Method Analysis"[MeSH]）
#5	（Qualitative OR Interview* OR Focus group* OR Controlled trial* OR Clinical trial* OR RCT OR Mixed method* OR Multi-method* OR Multiple method* OR Systematic review OR Meta-analysis）
#6	#4 OR #5
#7	#3 AND #6

CFIR框架维度	构念	促进因素	阻碍因素
创新	A创新来源	处方精简证据来源于Meta分析^{[12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]}	不适用
	B创新证据基础	处方精简可减少患者用药数、潜在不适当用药以及不良药物反应发生率^{[12,13,14,15,16,17,18,19,20,21,22]}	处方精简改善临床结局方面（如跌倒、住院或健康相关生活质量等），证据尚不足以充分支持其有效性^{[15,16,17,18,23,24,25,26,27]}
	C创新相对优势	处方精简有助于提高患者生活质量、依从性以及便利性，降低治疗成本，减少用药数量，从而减少可能的副作用^{[4,28,29,30,31,32,43]}	不适用
	D创新适应性	不适用	不适用
	F创新复杂性	不适用	处方精简涉及评估、计划、实施和监测多个阶段，需要多学科团队配合^[4,28]患者年龄、药物的数量或复杂性、家族史、监管影响均能影响处方精简的实施^[33,34]
	G创新设计	不适用	不适用
	H创新成本	处方精简可减少药物数量而降低治疗成本^[4]	不适用
外部环境因素	A重要事件	不适用	不适用
	B当地态度	患者认为药物数量多，担心药物不良反应，存在减少用药的意愿^{[28,32,33,35,36,37,39,40,41,45]}。临床医生认同处方精简的价值^{[28,29,30,31,32]}	医生认为处方精简存在风险，倾向于补充或维持治疗^{[31,38,45,47]}患者存在抵制变更治疗方案的态度，担心停药后发生不利事件^{[28,29,32,33,34,35,37,40,42,44,45,46]}
	C当地条件	不适用	医疗系统复杂，包括行政管理负担、信息技术系统不完善^[48]
	D协作关系和联系	不适用	不同医疗机构之间缺乏沟通协作，跨专业合作和联盟的缺乏^[35,49]
	E政策和法律	国家或政府推动处方精简相关政策的制定和实施^{[30,36,51,55]}	不适用
	F金融资助	政府针对处方精简工作提供财政奖励^[30]	政府对处方精简工作缺乏适当的财政激励^[30,48]
	G外部压力	处方点评制度与药物审查可减少多种药物使用、优化药物选择和配方^{[30,36,51,55]}	外部第三方开展药物审查工作引发了繁重的文书任务^[30]
内部环境因素	A结构特征	电子信息技术使患者的药物信息和处方记录实时更新和共享^[30,32]	杂乱的用药记录和缺乏协同互联的电子病历系统^{[30,32,45,47,57]}
	B协作	医生、护士、药师等开展关于处方精简的跨专业的合作^[30,45,55]	医生、护士、药师等缺乏沟通协作^{[28,35,36,38,49,51]}
	C沟通	加强医患沟通或采用共同决策，可增强医患信任关系，使患者意识到处方精简的益处^{[29,31,32,35,37,46,47]}	医患沟通障碍，专业化术语过多，患者难以理解^[35,47]
	D文化	医生以及患者、家属及朋友在处方精简态度达成一致共识^[29,37]	患者对药物了解程度低，高估了药物作用和重要性^[30,36]
	E变革的迫切性	不适用	不适用
	F兼容性	不适用	不适用
	G相对优先权	不适用	不适用
	H激励制度	给予适当的财务激励，可提高医师参与处方精简的积极性^[47]	薪酬不足被认为是进行处方精简的阻碍^{[30,47,51,55]}
	I目标一致	医生与药师之间有一致的处方精简目标^[38]	医生与药师目标不一致，医生无视或拒绝药师建议^[38]
	G可用资源	不适用	缺乏足够的工作人员和信息技术支持^[30,48,54]
	K知识和信息的可及性	提供明确的处方精简指南和易于查找的在线指南数据库^[28,45]	缺乏处方精简以及多重用药管理指南，难以获取患者详细的医疗记录^{[31,38,46,47,49]}
个人特征	A需要	患者用药负担重、药物成本高、服药不便，有处方精简的需要^{[33,39,50,52,53,56]}	患者并未意识到药物副作用，缺乏处方精简相关知识^{[29,46,50,56]}
	B能力	拥有长期工作经验的医生，推进处方精简更为积极^[30,49,52]	医生、护士缺乏处方精简经验、专业知识及培训^{[28,30,44,47,48,49,51]}
	C机会	患者意识到药物不良反应后进行处方精简^[29,40,41]	医院缺乏人力资源，医生缺乏充分沟通的时间，医疗环境拥挤^{[28,29,30,35,40,41,44,47,48,49,51,56,57]}
	D动机	患者充分知晓处方精简的好处和危害后，将会更积极参与处方精简^{[37,39,49,51]}	医生缺乏处方精简意识，不主动评估处方精简需求^[33]
实施过程	A团队合作	定期组织处方精简的治疗计划会议，增强团队合作交流^[49]	药师与全科医生、护理人员和居民未建立良好的关系^[37,54]
	B需求评估	不适用	医生在全面评估患者需求方面面临挑战，不了解患者偏好，而患者难以确认治疗优先级的问题^[28,34]
	C环境评估	不适用	不适用
	D规划	不适用	不适用
	E调整策略	处方精简流程上应提供标准化方法，并在减少药物后提供可替代的非药物措施，或试验性停药，发放个性化药物管理手册，提供随访监测^{[29,31,35,41,44,51,54]}	停药后未提供密切的监测^[35,41]
	F动员	对患者提供药物精简的健康教育和用药咨询，提高对多重用药风险的认知^{[29,31,35,41,44,51,54]}	不适用
	G执行	通过逐渐减少药物，使患者有掌控感，增加患者减药信心^[35,50,53]	不适用
	H反思与评价	不适用	不适用
	I适应	不适用	不适用

CFIR框架维度	构念	促进因素	阻碍因素
创新	A创新来源	处方精简证据来源于Meta分析^{[12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]}	不适用
	B创新证据基础	处方精简可减少患者用药数、潜在不适当用药以及不良药物反应发生率^{[12,13,14,15,16,17,18,19,20,21,22]}	处方精简改善临床结局方面（如跌倒、住院或健康相关生活质量等），证据尚不足以充分支持其有效性^{[15,16,17,18,23,24,25,26,27]}
	C创新相对优势	处方精简有助于提高患者生活质量、依从性以及便利性，降低治疗成本，减少用药数量，从而减少可能的副作用^{[4,28,29,30,31,32,43]}	不适用
	D创新适应性	不适用	不适用
	F创新复杂性	不适用	处方精简涉及评估、计划、实施和监测多个阶段，需要多学科团队配合^[4,28]患者年龄、药物的数量或复杂性、家族史、监管影响均能影响处方精简的实施^[33,34]
	G创新设计	不适用	不适用
	H创新成本	处方精简可减少药物数量而降低治疗成本^[4]	不适用
外部环境因素	A重要事件	不适用	不适用
	B当地态度	患者认为药物数量多，担心药物不良反应，存在减少用药的意愿^{[28,32,33,35,36,37,39,40,41,45]}。临床医生认同处方精简的价值^{[28,29,30,31,32]}	医生认为处方精简存在风险，倾向于补充或维持治疗^{[31,38,45,47]}患者存在抵制变更治疗方案的态度，担心停药后发生不利事件^{[28,29,32,33,34,35,37,40,42,44,45,46]}
	C当地条件	不适用	医疗系统复杂，包括行政管理负担、信息技术系统不完善^[48]
	D协作关系和联系	不适用	不同医疗机构之间缺乏沟通协作，跨专业合作和联盟的缺乏^[35,49]
	E政策和法律	国家或政府推动处方精简相关政策的制定和实施^{[30,36,51,55]}	不适用
	F金融资助	政府针对处方精简工作提供财政奖励^[30]	政府对处方精简工作缺乏适当的财政激励^[30,48]
	G外部压力	处方点评制度与药物审查可减少多种药物使用、优化药物选择和配方^{[30,36,51,55]}	外部第三方开展药物审查工作引发了繁重的文书任务^[30]
内部环境因素	A结构特征	电子信息技术使患者的药物信息和处方记录实时更新和共享^[30,32]	杂乱的用药记录和缺乏协同互联的电子病历系统^{[30,32,45,47,57]}
	B协作	医生、护士、药师等开展关于处方精简的跨专业的合作^[30,45,55]	医生、护士、药师等缺乏沟通协作^{[28,35,36,38,49,51]}
	C沟通	加强医患沟通或采用共同决策，可增强医患信任关系，使患者意识到处方精简的益处^{[29,31,32,35,37,46,47]}	医患沟通障碍，专业化术语过多，患者难以理解^[35,47]
	D文化	医生以及患者、家属及朋友在处方精简态度达成一致共识^[29,37]	患者对药物了解程度低，高估了药物作用和重要性^[30,36]
	E变革的迫切性	不适用	不适用
	F兼容性	不适用	不适用
	G相对优先权	不适用	不适用
	H激励制度	给予适当的财务激励，可提高医师参与处方精简的积极性^[47]	薪酬不足被认为是进行处方精简的阻碍^{[30,47,51,55]}
	I目标一致	医生与药师之间有一致的处方精简目标^[38]	医生与药师目标不一致，医生无视或拒绝药师建议^[38]
	G可用资源	不适用	缺乏足够的工作人员和信息技术支持^[30,48,54]
	K知识和信息的可及性	提供明确的处方精简指南和易于查找的在线指南数据库^[28,45]	缺乏处方精简以及多重用药管理指南，难以获取患者详细的医疗记录^{[31,38,46,47,49]}
个人特征	A需要	患者用药负担重、药物成本高、服药不便，有处方精简的需要^{[33,39,50,52,53,56]}	患者并未意识到药物副作用，缺乏处方精简相关知识^{[29,46,50,56]}
	B能力	拥有长期工作经验的医生，推进处方精简更为积极^[30,49,52]	医生、护士缺乏处方精简经验、专业知识及培训^{[28,30,44,47,48,49,51]}
	C机会	患者意识到药物不良反应后进行处方精简^[29,40,41]	医院缺乏人力资源，医生缺乏充分沟通的时间，医疗环境拥挤^{[28,29,30,35,40,41,44,47,48,49,51,56,57]}
	D动机	患者充分知晓处方精简的好处和危害后，将会更积极参与处方精简^{[37,39,49,51]}	医生缺乏处方精简意识，不主动评估处方精简需求^[33]
实施过程	A团队合作	定期组织处方精简的治疗计划会议，增强团队合作交流^[49]	药师与全科医生、护理人员和居民未建立良好的关系^[37,54]
	B需求评估	不适用	医生在全面评估患者需求方面面临挑战，不了解患者偏好，而患者难以确认治疗优先级的问题^[28,34]
	C环境评估	不适用	不适用
	D规划	不适用	不适用
	E调整策略	处方精简流程上应提供标准化方法，并在减少药物后提供可替代的非药物措施，或试验性停药，发放个性化药物管理手册，提供随访监测^{[29,31,35,41,44,51,54]}	停药后未提供密切的监测^[35,41]
	F动员	对患者提供药物精简的健康教育和用药咨询，提高对多重用药风险的认知^{[29,31,35,41,44,51,54]}	不适用
	G执行	通过逐渐减少药物，使患者有掌控感，增加患者减药信心^[35,50,53]	不适用
	H反思与评价	不适用	不适用
	I适应	不适用	不适用

处方精简实施的阻碍因素和促进因素：基于更新版实施性研究综合框架的范围综述

Barriers and Facilitators to the Implementation of Deprescribing: a Scoping Review Based on the Updated Consolidated Framework for Implementation Research

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