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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、Pub Med、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Rev Man 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。
Objective To systematically evaluate the implementation status of Home Medicine review (HMR) services at home and abroad. Methods The following databases were searched by computer: Cochrane Library, Pub Med, Embase, CNKI, CBM, VIP and Wanfang database. The search time is up to September 2014. Included in the HMR related Chinese and English studies, the inclusion of RCT literature, using Rev Man 5.1 software for meta-analysis, the rest of the literature using descriptive analysis. Results A total of 27 studies were included, including 10 RCTs and 17 other studies. Meta - analysis showed that drug - related problems in HMR group were reduced by 20.8% -70.4% compared with those in control group, while rehospitalization rate in HMR group was higher than that in control group (38.34% vs 33.63%), but the difference was not statistically significant (P = 0.64). Mortality was not significantly reduced, the difference was not statistically significant. The satisfaction of HMR group was higher than that of control group. There was no significant difference in HMR acceptance and quality of life between two groups. HMR implementation difficulties include physicians, pharmacists, patients and their own problems. Conclusion There are many difficulties in implementing HMR. Whether HMR can significantly improve the outcomes of patients has yet to be confirmed by large sample and high quality research.