社区老年人处方精简的研究进展与启示

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。

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

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.