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首页> 美国卫生研究院文献>European Journal of Hospital Pharmacy >Overview of current and future research and clinical directions for drug discontinuation: psychological traditional and professional obstacles to deprescribing
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Overview of current and future research and clinical directions for drug discontinuation: psychological traditional and professional obstacles to deprescribing

机译：药物停用的当前和未来研究及临床方向概述：停用处方的心理传统和专业障碍

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The vicious circle of age-related diseases, many experts and guidelines/drugs fuels the 21st century iatrogenic epidemic of inappropriate medication use and polypharmacy. There are no evidence-based medicine (EBM) ‘guidelines’ for treating older people, and knowledge gaps regarding dosage requirements. For all drugs, the positive benefit/risk ratio is decreasing/inverted in correlation to very old age, comorbidity, dementia, frailty and limited life-expectancy (VOCODFLEX). Main obstacles to routine deprescribing are emotional/psychological myths; patient–doctor interactions are expected to be transformed into prescription; doctors are perceived as expert prescribers who wisely choose the right medication/s to treat all diseases. Although most ‘guidelines’ were not proven in older people, particularly VOCODFLEX, doctors are afraid of lawsuits and of the patient/family reaction if they do not follow all experts' recommendations. Doctors are frustrated facing uncertainty regarding the effectiveness of strategies to reduce polypharmacy and the lack of EBM indicating when to de-prescribe. When explicit criteria and ‘drugs to avoid’ are used alone, we may disregard undiagnosed harms imposed by the remaining drug groups and interactions. The best approaches are implicit tools that take into consideration EBM data, clinical circumstances and medical judgement. The Garfinkel Good Palliative-Geriatric Practice method recommends deprescribing of as many drugs as possible simultaneously, giving high priority to patient/family preferences. It was proven highly effective and safe in nursing departments and in community-dwelling elders, having significant economic benefits as well.
机译：与年龄有关的疾病的恶性循环，许多专家和指南/药品助长了21世纪医源性流行病的不适当用药和综合药房的流行。没有治疗老年人的循证医学“指南”，也没有关于剂量需求的知识差距。对于所有药物，正向受益/风险比率都随着年龄的增长，合并症，痴呆，虚弱和预期寿命有限（VOCODFLEX）而降低/反转。日常不宜使用的主要障碍是情感/心理神话；医患互动有望转化为处方；医生被视为专家处方，他们明智地选择正确的药物来治疗所有疾病。尽管大多数“指南”并未在老年人中得到证实，尤其是VOCODFLEX，但医生如果不遵循所有专家的建议，就会担心诉讼以及患者/家庭的反应。医生们对于减少多元药房的策略的有效性以及EBM的缺乏表示不确定何时取消处方感到不确定。当单独使用明确的标准和“避免使用的药物”时，我们可能会忽略其余药物组和相互作用所造成的无法诊断的危害。最好的方法是隐性工具，这些工具应考虑到EBM数据，临床情况和医学判断。 Garfinkel优良姑息老年医学实践方法建议同时停用尽可能多的药物，从而优先考虑患者/家庭的喜好。它在护理部门和社区老年人中被证明是高度有效和安全的，同时也具有显着的经济效益。

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