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1.
Air Med J ; 39(5): 340-342, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33012469

RESUMO

In late 2019, a novel coronavirus was identified as the cause of a cluster of atypical pneumonia cases in Wuhan, China. It subsequently spread throughout China and around the world, quickly becoming a public health emergency. In March 2020, the World Health Organization declared coronavirus disease 2019 a pandemic. This article explores the preparation and early experiences of a large Canadian critical care transport program during the coronavirus disease 2019 pandemic focused on 6 broad strategic objectives centered around staff welfare, regular and transparent communication, networking, evidenced-based approach to personal protective equipment, agile mission planning, and an expedited approach to clinical practice and policy updates and future state modeling.


Assuntos
Comunicação , Infecções por Coronavirus , Cuidados Críticos/organização & administração , Disseminação de Informação , Liderança , Pandemias , Transferência de Pacientes/organização & administração , Pneumonia Viral , Transporte de Pacientes/organização & administração , Medicina Aeroespacial , Resgate Aéreo , Ambulâncias , Betacoronavirus , Colúmbia Britânica , Prática Clínica Baseada em Evidências , Humanos , Equipamento de Proteção Individual/provisão & distribução , Resiliência Psicológica
2.
J Nurs Adm ; 50(9): 438-441, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32804703

RESUMO

This column discusses the establishment of a multidisciplinary model for care transition of COVID-19-positive patients from hospital to community. The pandemic has presented challenging issues for discharge transition. A tiered patient identification and clinical messaging referral system was developed. The use of the COVID-19 transition model provided support to patients and physicians during the 30-day discharge period and can serve as a model for emerging public health issues in the future.


Assuntos
Infecções por Coronavirus/enfermagem , Modelos de Enfermagem , Pandemias , Transferência de Pacientes/organização & administração , Pneumonia Viral/enfermagem , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
3.
Crit Care Med ; 48(11): e1147-e1157, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32858530

RESUMO

OBJECTIVES: To identify and appraise articles describing criteria used to prioritize or withhold a critical care admission. DATA SOURCES: PubMed, Embase, Medline, EBM Reviews, and CINAHL Complete databases. Gray literature searches and a manual review of references were also performed. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. STUDY SELECTION: We sought all articles and abstracts of original research as well as local, provincial, or national policies on the topic of ICU resource allocation. We excluded studies whose population of interest was neonatal, pediatric, trauma, or noncritically ill. Screening of 6,633 citations was conducted. DATA EXTRACTION: Triage and/or transport criteria were extracted, based on type of article, methodology, publication year, and country. An appraisal scale was developed to assess the quality of identified articles. We also developed a robustness score to further appraise the robustness of the evidence supporting each criterion. Finally, all criteria were extracted, evaluated, and grouped by theme. DATA SYNTHESIS: One-hundred twenty-nine articles were included. These were mainly original research (34%), guidelines (26%), and reviews (21%). Among them, we identified 200 unique triage and transport criteria. Most articles highlighted an exclusion (71%) rather than a prioritization mechanism (17%). Very few articles pertained to transport of critically ill patients (4%). Criteria were classified in one of four emerging themes: patient, condition, physician, and context. The majority of criteria used were nonspecific. No study prospectively evaluated the implementation of its cited criteria. CONCLUSIONS: This systematic review identified 200 criteria classified within four themes that may be included when devising triage programs including the coronavirus disease 2019 pandemic. We identified significant knowledge gaps where research would assist in improving existing triage criteria and guidelines, aiming to decrease arbitrary decisions and variability.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Estado Terminal/terapia , Unidades de Terapia Intensiva/organização & administração , Transferência de Pacientes/organização & administração , Pneumonia Viral/terapia , Triagem/organização & administração , Betacoronavirus , Serviços Médicos de Emergência/organização & administração , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Segurança do Paciente
9.
J Nurs Adm ; 50(3): 174-181, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32068626

RESUMO

OBJECTIVE: Rush University Medical Center nursing leadership undertook a process improvement project to revamp nursing handoff during unit transfer with the goal of improving patient throughput. The aim was to decrease assign-to-occupy time, the duration from bed assignment to bed occupancy. BACKGROUND: There was a lengthy lag time in admitting/transferring patients, leading to delays in patient throughput and potential threats to patient safety. In fiscal year 2016, assign-to-occupy time averaged 97 minutes. The goal was to decrease that time to 60 minutes or less. METHODS: Process improvement leaders held a rapid improvement event to determine viable solutions. A team then standardized handoff workflow; created an electronic tool, virtually eliminating verbal report; and implemented a new handoff process. RESULTS: Assign-to-occupy time at 1 year after go-live averaged 55 minutes, and it has been staying less than 60 minutes since the implementation. CONCLUSIONS: Key success strategies included engaging stakeholders during the rapid improvement event, imploring frontline nurses to create and promote the revised process to facilitate staff engagement, and leveraging electronic health records.


Assuntos
Eficiência Organizacional/normas , Registros Eletrônicos de Saúde/organização & administração , Transferência da Responsabilidade pelo Paciente/organização & administração , Transferência de Pacientes/organização & administração , Centros Médicos Acadêmicos/organização & administração , Humanos , Avaliação de Resultados em Cuidados de Saúde , Segurança do Paciente/normas , Melhoria de Qualidade , Fluxo de Trabalho
10.
Washington; Organización Panamericana de la Salud; feb. 28, 2020. 12 p.
Não convencional em Espanhol | LILACS | ID: biblio-1096493

RESUMO

Los servicios de emergencias médicas prehospitalarias (SEM) facilitan atención inicial de soporte vital básico y/o avanzado y traslado de heridos o enfermos desde el lugar donde ocurre la emergencia hasta el centro sanitario donde le van a prestar cuidados definitivos. Los SEM también pueden prestar traslado de pacientes desde una instalación de salud a otra de mayor nivel o complejidad, en lo que se conoce como traslado interhospitalario. Los servicios de ambulancia es el componente más conocido y puede ser prestado por diferentes proveedores que pueden ir desde departamentos de bomberos, organizaciones de voluntarios o servicios adscritos a universidades hasta hospitales que cuentan con su propio servicio de ambulancias para cubrir a sus usuarios. Los SEM prehospitalarios también incluyen otros componentes como los centros tipo 911 o los Centro Reguladores de Urgencia y Emergencias (CRUE) y los programas de primer respondiente. Todos ellos deben integrase de una forma coordinada con las redes integradas de servicios de salud para asegurar una continuidad de los cuidados de salud prestados a la persona herida o enferma. Durante emergencias de salud pública, los servicios de emergencia medicas prehospitalarias pueden verse superados por el número de llamadas o demanda de traslados médicos. Por ello es importante que las agencias y/o organizaciones que prestan atención prehospitalaria cuenten con las herramientas y mecanismos para asegurar no solo la actividad diaria sino también para adecuar su capacidad para la respuesta a escenarios específicos como el del COVID19 En este contexto, se insta a los SEM prehospitalarios a implementar las acciones de alistamiento para la respuesta y a trabajar de forma coordinada e integral con las autoridades de salud a cargo de la respuesta del COVID-19.


Assuntos
Humanos , Isolamento de Pacientes/métodos , Pneumonia Viral/prevenção & controle , Sistemas de Saúde/organização & administração , Transferência de Pacientes/organização & administração , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Betacoronavirus
11.
Enferm. glob ; 19(57): 615-625, ene. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193663

RESUMO

OBJETIVO: Evaluar, según la literatura, cuáles son los principales factores considerados facilitadores y/o agravantes en la realización del transporte de pacientes en estado crítico. MÉTODO: Este estudio se trata de una revisión sistemática realizada con el método PICO. RESULTADO: Los periódicos seleccionados comprendían un espacio temporal en los últimos diez años, donde 6 periódicos fueron elegibles, basado en los criterios establecidos. Los resultados relatan que los temas encontrados en esta revisión demuestran una alineación entre la práctica asistencial y la literatura, pero para que el transporte sea realizado sin eventos adversos, es necesario que haya unión entre la gestión y los profesionales involucrados. CONCLUSIÓN: Aunque los hallazgos demuestren una gran preocupación en relación a la calidad en la asistencia y en la preparación del equipo, los autores creen que más estudios deben ser fomentados una vez que el trabajo en equipo, a pesar de ser complejo, es la clave para la realización de los procedimientos con efectividad


OBJETIVO: Avaliar segundo a literatura quais são os principais fatores que são considerados facilitadores e/ou agravantes na realização do transporte de pacientes em estado crítico. MÉTODO: Este estudo trata-se de uma revisão sistemática realizada com método PICO. RESULTADO: Os periódicos selecionados compreendiam um espaço temporal nos últimos dez anos, onde 6 periódicos foram elegíveis, baseado nos critérios estabelecidos. Os resultados relatam que os temas encontrados nesta revisão demonstram um alinhamento entre a prática assistencial e a literatura, porém para que o transporte seja realizado sem eventos adversos, é necessário que haja união entre a gestão e os profissionais envolvidos. CONCLUSÃO: Embora os achados demonstrem uma grande preocupação em relação à qualidade na assistência e no preparo da equipe, os autores acreditam que mais estudos devem ser fomentados uma vez que o trabalho em equipe apesar de ser complexo, é a chave para a realização dos procedimentos com efetividade


OBJECTIVE: To evaluate, according to the literature, the main factors considered facilitators and/or aggravating in the transportation of patients in critical condition. METHOD: This study is a systematic review performed using the PICO method. RESULTS: The selected journals comprised a time space in the last 10 years, with six journals eligible, based on the established criteria. The results report that the themes found in this review demonstrate an alignment between care practice and literature, but, for a transportation without adverse events, there must be a union between the management and the professionals involved. CONCLUSION: Although the findings demonstrate a great concern regarding the quality of care and team preparation, the authors believe that more studies should be encouraged since teamwork, despite being complex, is the key to performing the procedures with effectiveness


Assuntos
Humanos , Transferência de Pacientes/organização & administração , Estado Terminal/enfermagem , Cuidados Críticos/métodos , Enfermagem de Cuidados Críticos/métodos , Qualidade da Assistência à Saúde/organização & administração , Segurança do Paciente/normas
13.
Crit Care Med ; 48(3): e227-e232, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31913986

RESUMO

OBJECTIVES: We sought to evaluate the impact of transitions of care among staff intensivists on the compliance with evidence-based processes of care. DESIGN: Cohort study using data from the Toronto Intensive Care Observational Registry. SETTING: Seven academic ICUs in Toronto, Ontario. PATIENTS: Critically ill mechanically ventilated adult patients. INTERVENTIONS: We explored the effects of the weekly transition of care among staff intensivists on compliance with three evidence-based processes of care (spontaneous breathing trials, lung-protective ventilation, and neuromuscular blocking agents). Two practices that are less guided by evidence (early discontinuation of antibiotics and extubation attempts) served as positive controls. We conducted the analysis using generalized estimating equations to account for clustering at the patient level. MEASUREMENTS AND MAIN RESULTS: The cohort consisted of 10,570 patients admitted between June 2014 and August 2018. Compliance varied for each practice (63.6%, 42.5%, and 21.1% for lung-protective ventilation, spontaneous breathing trials, and neuromuscular blockade, respectively). There was no effect of transitions of care on compliance with spontaneous breathing trials (odds ratio, 1.00; 95% CI, 0.95-1.07), lung-protective ventilation (odds ratio, 1.07, 95% CI, 0.90-1.26), or neuromuscular blockade use (odds ratio, 0.95; 95% CI, 0.75-1.20). However, early antibiotic discontinuation was more likely (odds ratio, 1.23; 95% CI, 1.06-1.42) and extubation attempts were less frequent (odds ratio, 0.77; 95% CI, 0.65-0.93) after a transition of care. CONCLUSIONS: We observed no significant impact of transitions of care between individual staff physicians on evidence-based processes of care for mechanically ventilated adult patients. However, transitions were associated with a lower likelihood of extubation and higher odds of earlier discontinuation of antibiotics.


Assuntos
Estado Terminal/terapia , Fidelidade a Diretrizes/estatística & dados numéricos , Unidades de Terapia Intensiva/organização & administração , Transferência de Pacientes/organização & administração , Guias de Prática Clínica como Assunto/normas , Centros Médicos Acadêmicos , Adulto , Idoso , Extubação/métodos , Extubação/normas , Antibacterianos/administração & dosagem , Feminino , Humanos , Unidades de Terapia Intensiva/normas , Masculino , Pessoa de Meia-Idade , Bloqueadores Neuromusculares/administração & dosagem , Transferência de Pacientes/normas , Indicadores de Qualidade em Assistência à Saúde , Respiração Artificial/métodos , Respiração Artificial/normas , Desmame do Respirador/métodos , Desmame do Respirador/normas
14.
Neurology ; 94(5): e453-e463, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-31831595

RESUMO

OBJECTIVE: To determine feasibility and safety of stroke care organization within our Neurovascular Network of Southwest Bavaria (NEVAS) in a rural area with distances of up to 100 kilometers, we compared patients who underwent mechanical thrombectomy (MT) in large vessel occlusion admitted directly to our center (direct to center [DTC]) to patients who were transferred for MT via NEVAS (drip and ship [DS]). METHODS: This is a retrospective analysis of prospectively collected data of all MT patients between January 2015 and May 2018. Successful recanalization was defined as a thrombolysis in cerebral infarction score of 2b-3. Symptomatic intracerebral hemorrhage (sICH) was defined according to European Cooperative Acute Stroke Study 3. Modified Rankin Scale (mRS) score of 0-2 at 3 months indicated good outcome. RESULTS: MT was performed in 410 patients: 221 DTC and 189 DS. Median NIH Stroke Scale (NIHSS) score was 16 and premorbid mRS score was 0. Thrombolysis was applied in 62.2% with the same time from symptom onset in both groups (94.5 vs 95 minutes). Successful recanalization (79.3% vs 77.8%) and NIHSS score reduction from admission to discharge (16-7 vs 17-6) were comparable. Time delay from onset to revascularization was 96 minutes in DS (212 vs 308 minutes, p = 0.001). At follow-up, DTC patients had a trend to better outcome (33.5% vs 24.3%, p = 0.056). Neither sICH (6.3% vs 5.9%, p = 0.840) nor mortality (31.2% vs 34.4%, p = 0.387) differed between the groups. CONCLUSION: DS patients benefit from MT without relevant safety concerns, but with a trend to unfavorable outcome compared to DTC patients. These results suggest that DS is suitable to provide MT in rural areas where DTC is not possible.


Assuntos
Assistência à Saúde/organização & administração , Transferência de Pacientes/organização & administração , Acidente Vascular Cerebral/terapia , Trombectomia , Terapia Trombolítica , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/epidemiologia , Procedimentos Endovasculares , Estudos de Viabilidade , Feminino , Alemanha/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , População Rural , Acidente Vascular Cerebral/fisiopatologia
16.
J Surg Res ; 246: 269-273, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31614324

RESUMO

BACKGROUND: A structured family meeting (FM) is recommended within 72 h of admission for trauma patients with high risk of mortality or disability. Multidisciplinary FMs (MDFMs) may further facilitate decision-making. We hypothesized that FM within three hospital days (HDs) or MDFM would be associated with increased use of comfort measures. MATERIALS AND METHODS: We reviewed all adult trauma deaths at an academic level 1 trauma center from December 2014 to December 2017. Death in the first 24 h or on nonsurgical services were excluded. Demographics, injury characteristics, FM characteristics, and outcomes such as length of stay (LOS) were recorded. Early FM was defined as occurring within three HDs; MDFM required attendance by two or more specialty teams. RESULTS: A total of 177 patients were included. Median LOS was 6 d (interquartile range 4-12). FMs were documented in 166 patients (94%), with 57% occurring early. MDFM occurred in 49 (28%), but usually occurred later (median HD 5 and interquartile range 2-8). Early FM was associated with reduced LOS (5 versus 11 d, P < 0.001), ventilator days (4 versus 9 d, P < 0.001), and deaths during a code (1.2% versus 13.2%, P < 0.001). MDFM was associated with higher use of comfort measures (88% versus 68%, P < 0.05). Of patients who transitioned to comfort care status (n = 130, 73.4%), code status change occurred earlier if an early FM occurred (5 versus 13 d, P < 0.001). CONCLUSIONS: MDFM is associated with increased comfort care measures, whereas early FM is associated with reduced LOS, ventilator days, death during a code, and earlier comfort care transition.


Assuntos
Tomada de Decisões , Família , Planejamento de Assistência ao Paciente , Assistência Terminal/organização & administração , Ferimentos e Lesões/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/organização & administração , Cuidados Paliativos/estatística & dados numéricos , Transferência de Pacientes/organização & administração , Transferência de Pacientes/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Centros de Traumatologia/organização & administração , Centros de Traumatologia/estatística & dados numéricos , Índices de Gravidade do Trauma , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade
17.
Healthc Q ; 22(3): 26-29, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31845854

RESUMO

This case describes a design contest strategy to procure a solution to coordination of care transitions across healthcare programs to strengthen patient outcomes. The fit of the vendors' approach with the organization and the potential for building a strong relationship with the vendor teams were evaluated. A consortium of small Canadian companies was selected to proceed to a proof-of-concept phase and full implementation of the digital solution across the region. This design contest approach resulted in a successful vendor partnership for the organization to co-design, develop, implement and scale an innovative solution to support care transitions across the region.


Assuntos
Aplicações da Informática Médica , Inovação Organizacional , Transferência de Pacientes/organização & administração , Redes Comunitárias , Humanos , Ontário , Estudos de Casos Organizacionais
18.
Am J Health Syst Pharm ; 76(23): 1951-1957, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31724038

RESUMO

PURPOSE: To evaluate the impact of a medication to bedside delivery (meds-to-beds) service on hospital reutilization in an adult population. METHODS: A retrospective, single-center, observational cohort study was conducted within a regional academic medical center from January 2017 to July 2017. Adult patients discharged from an internal medicine unit with at least one maintenance medication were evaluated. The primary outcome was the incidence of 30-day hospital reutilization between two groups: discharged patients who received meds-to-beds versus those who did not. Additionally, the incidence of 30-day hospital reutilization between the two groups was compared within predefined subgroup patient populations: polypharmacy, high-risk medication use, and patients with a principal discharge diagnosis meeting the criteria set by the Centers for Medicare and Medicaid Services 30-day risk standardized readmission measures. RESULTS: A total of 600 patients were included in the study (300 patients in the meds-to-beds group and 300 patients in the control group). The 30-day hospital reutilization (emergency department visits and/or hospital readmissions) related to the index visit was lower in the meds-to-beds group, but the difference was not statistically significant between the two groups (8.0% in the meds-to-beds group versus 10.0% in the control group; odds ratio, 0.78; 95% confidence interval, 0.45-1.37). There was no significant difference in the 30-day hospital reutilization related to the index visit between the control and meds-to-beds groups within the three subgroups analyzed. CONCLUSION: There was no difference in 30-day hospital reutilization related to the index visit with the implementation of meds-to-beds service in the absence of other transitions-of-care interventions.


Assuntos
Reconciliação de Medicamentos/organização & administração , Sistemas de Medicação no Hospital/organização & administração , Alta do Paciente , Transferência de Pacientes/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Idoso , Aconselhamento/organização & administração , Aconselhamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Reconciliação de Medicamentos/estatística & dados numéricos , Sistemas de Medicação no Hospital/estatística & dados numéricos , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Estudos Retrospectivos
19.
BMC Health Serv Res ; 19(1): 734, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640673

RESUMO

BACKGROUND: Veterans who access both the Veterans Health Administration (VA) and non-VA health care systems require effective care coordination to avoid adverse health care outcomes. These dual-use Veterans have diverse and complex needs. Gaps in transitions of care between VA and non-VA systems are common. The Advanced Care Coordination (ACC) quality improvement program aims to address these gaps by implementing a comprehensive longitudinal care coordination intervention with a focus on Veterans' social determinants of health (SDOH) to facilitate Veterans' transitions of care back to the Eastern Colorado Health Care System (ECHCS) for follow-up care. METHODS: The ACC program is an ongoing quality improvement study that will enroll dual-use Veterans after discharge from non-VA emergency department (EDs), and will provide Veterans with social worker-led longitudinal care coordination addressing SDOH and providing linkage to resources. The ACC social worker will complete biopsychosocial assessments to identify Veteran needs, conduct regular in-person and phone visits, and connect Veterans back to their VA care teams. We will identify non-VA EDs in the Denver, Colorado metro area that will provide the most effective partnership based on location and Veteran need. Veterans will be enrolled into the ACC program when they visit one of our selected non-VA EDs without being hospitalized. We will develop a program database to allow for continuous evaluation. Continuing education and outreach including the development of a resource guide, Veteran Care Cards, and program newsletters will generate program buy-in and bridge communication. We will evaluate our program using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, supported by the Practical, Robust Implementation and Sustainability Model, Theoretical Domains Framework, and process mapping. DISCUSSION: The ACC program will improve care coordination for dual-use Veterans by implementing social-work led longitudinal care coordination addressing Veterans' SDOH. This intervention will provide an essential service for effective care coordination.


Assuntos
Transferência de Pacientes , Atenção Primária à Saúde/organização & administração , United States Department of Veterans Affairs/organização & administração , Saúde dos Veteranos , Veteranos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Transferência de Pacientes/organização & administração , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Estados Unidos , Veteranos/psicologia
20.
Am J Health Syst Pharm ; 76(21): 1777-1787, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31612924

RESUMO

PURPOSE: To systematically evaluate and summarize evidence across multiple systematic reviews (SRs) examining interventions addressing polypharmacy. SUMMARY: MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects (DARE) were searched for SRs evaluating interventions addressing polypharmacy in adults published from January 2004 to February 2017. Two authors independently screened, appraised, and extracted information. SRs with Assessment of Multiple Systematic Reviews (AMSTAR) scores below 8 were excluded. After extraction of relevant conclusions from each SR, evidence was summarized and conclusions compared. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess evidence quality. Six SRs met the inclusion criteria, 4 of which used meta-analytic pooling. Five SRs focused on older adults. Four were not restricted to any specific disease type, whereas 1 focused on proton pump inhibitors and another focused on patients with severe dementia. Care settings and measured outcomes varied widely. SRs examining the impact on patient-centered outcomes, including morbidity, mortality, patient satisfaction, and utilization, found inconsistent evidence regarding the benefit of polypharmacy interventions, but most concluded that interventions had either null or uncertain impact. Two SRs assessing medication appropriateness found very low-quality evidence of modest improvements with polypharmacy interventions. CONCLUSION: An overview of SRs of interventions to address polypharmacy found 6 recent and high-quality SRs, mostly focused on older adults, in which both process and outcome measures were used to evaluate interventions. Despite the low quality of evidence in the underlying primary studies, both SRs that assessed medication appropriateness found evidence that polypharmacy interventions improved it. However, there was no consistent evidence of any impact on downstream patient-centered outcomes such as healthcare utilization, morbidity, or mortality.


Assuntos
Ensaios Clínicos como Assunto , Prescrição Inadequada/prevenção & controle , Conduta do Tratamento Medicamentoso/organização & administração , Polimedicação , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Alta do Paciente , Transferência de Pacientes/organização & administração , Revisões Sistemáticas como Assunto , Resultado do Tratamento
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