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. Trial registration Current Controlled Trials [ISRCTN10137559][1]. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN10137559

中文翻译：

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使用电子决策支持工具减少患有慢性疾病的老年人的综合药房：随机分组的随机对照试验。

目的评估计算机决策支持工具对综合性老年人的综合药物审查的效果。设计实用，多中心，集群随机对照试验。在奥地利，德国，意大利和英国设定359种常规做法。参加者3904名年龄在75岁及以上的成年人，由其全科医生定期定期使用八种或更多种药物。干预新开发的电子决策支持工具，包括全面的药品审查，以支持全科医生开处方可能不适当且无证据的药品。医生被随机分配到电子决策支持工具或照常提供治疗。主要结局指标主要结局指标是计划外医院入院或24个月死亡的综合结果。主要的次要结果是减少药物数量。结果2015年1月至10月之间招募了3904名成年人。电子决策支持（干预组）被分配了181种做法和1953名参与者，常规组（对照组）被分配了178种做法和1951名参与者进行了治疗。主要结局（24个月计划外入院或死亡的综合结果）发生在干预组的871人（44.6％）和对照组的944人（48.4％）中。在意向治疗分析中，综合结果的优势比为0.88（95％置信区间0.73至1.07； P = 0.19，1953年的997和1951年的1055）。在一项仅限于根据协议参加练习的参与者的分析中，发现有利于干预的差异（赔率0.82，95％置信区间0.68至0.98； 1682年的774对1712年的873，P = 0.03）。与对照组相比，到24个月时，干预组的处方药数量有所减少（非控制平均变化-0.42 v 0.06：调整后平均差异-0.45，95％置信区间-0.63至-0.26； P <0.001）。结论在意向性治疗分析中，使用计算机化的决策支持工具对具有多药房的老年人进行全面药物审查的结果表明，对于计划外医院入院或死亡的复合因素在24个月内没有结论性影响。尽管如此，在不损害患者预后的情况下实现了药物减少。试用注册当前控制的试用[ISRCTN10137559] [1]。[1]：/ external-ref？link_type = ISRCTN＆access_num = ISRCTN10137559