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目的:探索与评价药师基于老年科病房的临床药学实践的特征、内容及效果。方法:计算机检索PubMed、EMbase、Cochrane图书馆临床对照试验资料库、CHINAL、Clinical Trials、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库,检索时间均从建库至2014年10月31日。由2位评价员根据纳入与排除标准独立进行文献筛选、资料提取和质量评价并交叉核对后,进行系统评价,必要时采用STATA12.0进行Meta分析。结果:共纳入15篇文献,其中2篇为随机对照研究,7篇为队列研究,6篇为病例系列研究,共涉及2 796名患者。研究结果表明,药师在老年科进行临床实践实施地点、团队合作、实践时间、使用工具、实践目的均较为多样化,实践内容以医嘱审核(9/15)、药物重整(5/15)为主。在药师实践的效果方面,药师提出了药物重整、药物相关问题等多方面建议,药师建议被接受比例的范围为45.0%~90.0%;进行单臂的Meta分析后,整体而言,药师建议被接受的比例为63.7%[95%CI,(0.523,0.751)]。尽管药师的药学实践对死亡率、再入院率等终点指标效果并不明确,但能够提高患者的用药合理性,降低患者的用药复杂程度,提高患者的依从性,降低患者的额外就诊率[OR0.44,95%CI(0.22,0.88),P=0.021]。结论:药师在老年科的临床药学实践形式和内容多样化,临床实践可对临床产生积极的作用,仍需设计良好的研究进一步明确药师对于终点结局的效果。
Objective: To explore and evaluate the characteristics, contents and effects of pharmacists based on clinical pharmacy practice in geriatric wards. METHODS: The databases of PubMed, EMbase and Cochrane Central Register of Controlled Trials (CNKI), CHINAL, Clinical Trials, CNKI, China Biomedical Literature Database (CBM) and Wanfang Database were searched by computer. October 31,. Two reviewers independently screened, extracted, and evaluated the quality of materials according to inclusion and exclusion criteria and cross-checked them for systematic evaluation. Metatarsalysis was performed if necessary using STATA12.0. RESULTS: A total of 15 articles were included, of which 2 were randomized controlled studies, 7 were cohort studies and 6 were case series studies involving 2 796 patients. The results showed that pharmacists in the geriatric practice clinical practice place, teamwork, practice time, the use of tools, the purpose of the practice are more diversified, the practice content to doctor’s advice (9/15), drug reorganization the Lord. In the practice of pharmacists, the pharmacists put forward many suggestions such as drug reforming and drug-related problems, and the proportion of pharmacists suggested to be accepted ranged from 45.0% to 90.0%. After one-arm meta-analysis, pharmacists suggested The accepted rate was 63.7% [95% CI, (0.523,0.751)]. Although the pharmacological practice of pharmacists is not clear about the end point indicators such as mortality and readmission rates, it can improve patients ’medication rationality, reduce patients’ medication complexity, improve patient compliance and reduce patient extra visits [OR0 .44, 95% CI (0.22, 0.88), P = 0.021]. Conclusion: Pharmacists in the geriatric clinical pharmacy practice form and content of diversification, clinical practice can have a positive clinical effect, still need to design a good study to further clarify the pharmacists for the end result.