医生-护士-药师协作干预老年患者治疗效果研究的系统评价∗

摘要

Objective To evaluate the intervention effectiveness of collaboration among physicians, nurses and pharmacists for elderly people. Methods Randomized controlled trails ( RCT) of collaboration among physicians,nurses and pharmacists for elderly people were gathered from MEDLINE,EMbase,CENTRAL,CNKI,VIP and Wanfang. The retrieved studies were screened according to the inclusion and exclusion criteria, evaluated the quality of included studies, and then performed meta-analyses with The Cochrane Collaboration ' s Revman 5. 3. 0 software. Results Four randomized controlled trials of collaboration among physicians,nurses and pharmacists for elderly people were included. The results of meta-analyses showed that the hospitalization rate, emergency admission rate, mortality and potentially inappropriate medication use were not significantly better in the collaboration group than in the standard of care group [RR=1.02,95%CI (0.93,1.11),P=0.69;RR=0.97,95%CI (0.89,1.05),P=0.42;RR=1.03,95%CI (0.87,1.21),P=0.75;and RR=1.09,95%CI (0.84,1.41),P=0.51,respectively]. There were no statistically significant differences between the collaboration group and the standard of care group. Conclusion Collaboration among physicians, nurses and pharmacists is not therapeutically effective for elderly people. But its long-term efficacy still needs to be confirmed by performing more high quality,large sample RCTs with long term follow-up.%目的：系统评价医生-护士-药师协作干预老年患者的治疗效果。方法计算机检索英文数据库：MEDLINE、EMbase、CENTRAL和中文数据库：中国知网、维普数据库和万方数据库，查找医生-护士-药师协作干预老年患者的随机对照试验，检索时限截至2015年3月。由2位研究者根据纳入与排除标准独立筛选文献、提取资料并评价质量后，采用RevMan5.3.0版软件进行Meta分析。结果最终纳入RCT4个。结果显示：协作组与常规组住院率差异无统计学意义[RR＝1.02，95％CI(0.93，1.11)，P＝0.69]，急诊率差异无统计学意义[RR＝0.97，95％CI(0.89，1.05)，P＝0.42]，病死率差异无统计学意义[RR＝1.03，95％CI(0.87，1.21)，P＝0.75]。对于改善潜在不合理用药比例，两组差异无统计学意义[RR＝1.09，95％CI(0.84，1.41)，P＝0.51]。结论医生-护士-药师协作工作对于老年患者的结局指标比常规组没有较大益处，这可能与纳入文献数量有限有关。临床还需要继续探索更有效的医生-护士-药师协作诊疗工作。