德国维滕-赫尔德克大学Anja Rieckert团队探讨了使用电子决策支持工具减少老年慢性病患者服用多种药物的效果。该研究于2020年6月18日发表在《英国医学杂志》上。

为了评估计算机决策支持工具在老年人服用多药综合评价中的效果，研究组进行了一项实用、多中心、整群随机对照试验，2015年1月至10月，在奥地利、德国、意大利和英国的359项全科实践中，招募了3904名75岁以上、定期服用8种以上药物的老年患者。

新开发的电子决策支持工具包括全面的药物审查，以帮助全科医生判断潜在的不适当和非循证药物。研究组将参与者随机分组，其中181项实践和1953名参与者接受电子决策支持（干预组），178项实践和1951名参与者接受常规治疗（对照组）。

24个月时，干预组中有871人（44.6％）发生计划外住院或死亡的综合结局，对照组中有944人（48.4％），在意向治疗分析中，综合结局的优势比为0.88；但在一项仅限于按照方案参加实践的参与者分析中，优势比为0.82，有利于干预组。24个月时，干预组的处方药数量与对照组相比显著减少。

总之，在意向治疗分析中，使用计算机决策支持工具对服用多种药物的老年人进行全面药物审查，并不能减少24个月内计划外住院或死亡的综合结局，但在不损害患者预后的情况下实现了减药。

附：英文原文

Title: Use of an electronic decision support tool to reduce polypharmacy in elderly people with chronic diseases: cluster randomised controlled trial

Author: Anja Rieckert, David Reeves, Attila Altiner, Eva Drewelow, Aneez Esmail, Maria Flamm, Mark Hann, Tim Johansson, Renate Klaassen-Mielke, Ilkka Kunnamo, Christin Lffler, Giuliano Piccoliori, Christina Sommerauer, Ulrike S Trampisch, Anna Vgele, Adrine Woodham, Andreas Snnichsen

Issue&Volume: 2020/06/18

Abstract: Objective To evaluate the effects of a computerised decision support tool for comprehensive drug review in elderly people with polypharmacy.

Design Pragmatic, multicentre, cluster randomised controlled trial.

Setting 359 general practices in Austria, Germany, Italy, and the United Kingdom.

Participants 3904 adults aged 75 years and older using eight or more drugs on a regular basis, recruited by their general practitioner.

Intervention A newly developed electronic decision support tool comprising a comprehensive drug review to support general practitioners in deprescribing potentially inappropriate and non-evidence based drugs. Doctors were randomly allocated to either the electronic decision support tool or to provide treatment as usual.

Main outcome measures The primary outcome was the composite of unplanned hospital admission or death by 24 months. The key secondary outcome was reduction in the number of drugs.

Results 3904 adults were enrolled between January and October 2015. 181 practices and 1953 participants were assigned to electronic decision support (intervention group) and 178 practices and 1951 participants to treatment as usual (control group). The primary outcome (composite of unplanned hospital admission or death by 24 months) occurred in 871 (44.6%) participants in the intervention group and 944 (48.4%) in the control group. In an intention-to-treat analysis the odds ratio of the composite outcome was 0.88 (95% confidence interval 0.73 to 1.07; P=0.19, 997 of 1953 v 1055 of 1951). In an analysis restricted to participants attending practice according to protocol, a difference was found favouring the intervention (odds ratio 0.82, 95% confidence interval 0.68 to 0.98; 774 of 1682 v 873 of 1712, P=0.03). By 24 months the number of prescribed drugs had decreased in the intervention group compared with control group (uncontrolled mean change 0.42 v 0.06: adjusted mean difference 0.45, 95% confidence interval 0.63 to 0.26; P<0.001).

Conclusions In intention-to-treat analysis, a computerised decision support tool for comprehensive drug review of elderly people with polypharmacy showed no conclusive effects on the composite of unplanned hospital admission or death by 24 months. Nonetheless, a reduction in drugs was achieved without detriment to patient outcomes.

DOI: 10.1136/bmj.m1822

Source: https://www.bmj.com/content/369/bmj.m1822