居家用药评估服务的系统评价

Home Medicines Review (HMR): A Systematic Review

关键词:  药师  居家用药评估  系统评价  随机对照试验

Key words:  pharmacist  home medicines review  systematic review  randomized controlled trials

摘要:

目的 系统评价国内外居家用药评估(Home medicines review，HMR)服务的实施现状。方法 计算机检索以下数据库：Cochrane Library、PubMed、Embase、CNKI、CBM、VIP和万方数据库，检索时间截止2014年9月。纳入HMR相关的中英文研究，对所纳入的RCT文献，采用RevMan 5.1软件进行Meta分析，其余文献采用描述性分析。结果 共纳入27项研究，其中包括10项RCTs，17项其他研究。Meta分析显示，HMR组较对照组的药物相关问题减少20.8%~70.4%；HMR组的再入院率高于对照组(38.34% vs 33.63%)，但差异无统计学意义(P=0.64)；死亡率未明显降低，差异无统计学意义。HMR组较对照组的满意度高，2组HMR接受度及生活质量评分差异均无统计学意义。HMR的实施困难包括医师、药师、患者及模式自身问题。结论 实施HMR面临多方面困难，HMR是否能显著改善患者各项结局指标还有待更多大样本、高质量研究来证实。

Abstract:

OBJECTIVE To systematically evaluate the situation of home medicines review(HMR) at home and abroad. METHODS The databases including the Cochrane Library, PubMed, Embase, CNKI, CBM, VIP and WanFang database were searched(up to September 2014) to collect studies about HMR. The publication language was limited to English and Chinese. RCT literatures were given a meta-analysis by using RevMan 5.1 software, and other were reviewed by descriptive analysis. RESULTS A total of 27 literatures were included(10 RCTs and 17 other studies). Meta-analysis showed that: drug related problems in HMR group were 20.8%-70.4% less than control group; hospital readmissions in HMR group were higher than control group(38.34% vs 33.63%), with no statistically significant difference(P=0.64), and mortality in HMR group was not significantly descreased. The patients in HMR group were satisfied with the service, and there was also no statistically significant difference on acception and the quality of life between two groups. CONCLUSION Whether HMR can significantly improve the outcomes of patients remains to be confirmed by more high-quality and large-samples studies.