Análise dos sistemas de apoio à decisão clínica para desprescrição em idosos polimedicados na Atenção Primária à Saúde: uma revisão de escopo

Romário Gomes Rodrigues; Gabriel Rodrigues Martins de Freitas Freitas; João Felipe Bezerra; Rozane Pereira de Sousa

doi:10.5712/rbmfc21(48)4442

Authors

Romário Gomes Rodrigues Universidade Federal do Rio Grande do Norte, Departamento de Medicina Clínica – Natal (RN), Brasil https://orcid.org/0000-0003-1020-7251
Gabriel Rodrigues Martins de Freitas Freitas Universidade Federal da Paraíba – João Pessoa (PB), Brazil https://orcid.org/0000-0001-9938-3977
João Felipe Bezerra Universidade Federal da Paraíba – João Pessoa (PB), Brazil https://orcid.org/0000-0002-9978-628X
Rozane Pereira de Sousa Universidade Federal da Paraíba – João Pessoa (PB), Brazil https://orcid.org/0000-0002-2619-8161

DOI:

https://doi.org/10.5712/rbmfc21(48)4442

Keywords:

Sistemas de apoio a decisões clínicas, Desprescrições, Envelhecimento, Saúde do idoso, Atenção primária à saúde

Abstract

Introduction: Polypharmacy may lead to risks such as adverse events and drug–drug interactions, particularly among older adults. Deprescribing has emerged as a structured strategy to optimize medication use in polymedicated older individuals, aiming to improve patient-specific outcomes. In this context, clinical decision support systems (CDSS) are used as tools to assist in identifying potentially inappropriate medications and drug interactions, thereby facilitating deprescribing in Primary Health Care (PHC). Objective: To map and analyze CDSS used for deprescribing medications in polymedicated older adults receiving care in PHC, assessing the impact of these tools on quality of care and patient safety. Methods: A scoping review was conducted, with a protocol registered in the Open Science Framework (10.17605/OSF. IO/5Q37V), following the Joanna Briggs Institute (JBI) manual and the PRISMA Extension for Scoping Reviews. Search strategies used keywords covering DeCS/MeSH terms across Scopus, PubMed, and LILACS, as well as related terms in EMBASE’s Emtree, within the last 10 years. Inclusion and exclusion criteria were applied to select relevant studies, with article selection conducted independently by two reviewers. Data were extracted and analyzed qualitatively, identifying the CDSS used, as well as the results and conclusions of the included studies. Results: Of the 198 initial records, 117 titles and abstracts were screened, resulting in the inclusion of 7 publications. The included studies showed a diversity of research designs, predominantly randomized clinical trials. Six CDSS were identified, employing various approaches such as computerized alerts, decision-support reports, and outcome prioritization tools. Most tools were based on criteria addressing potentially inappropriate medications for older adults. Discussion: CDSS show potential to improve medication management in older adults; however, they face challenges such as limited integration with electronic health records and barriers to the adoption of information and communication technologies. Despite these limitations, the tools demonstrated benefits in reducing polypharmacy and improving patients’ quality of life. Conclusions: This review highlighted the need for greater efforts in implementing and improving CDSS in PHC, as well as the necessity for further research to develop tools that enhance care for polymedicated older populations. The findings provide support for guiding policies and clinical practices aimed at improving the safety and effectiveness of treatment for older adults in PHC.

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Author Biography

Romário Gomes Rodrigues, Universidade Federal do Rio Grande do Norte, Departamento de Medicina Clínica – Natal (RN), Brasil

Graduated in Medicine from the Faculty of Medical Sciences of Paraíba (2017) and Family and Community Doctor from the Brazilian Medical Association - AMB. Specialist in Public Health from the Federal University of Bahia - UFBA. He is currently a preceptor at the Medical Residency in Family and Community Medicine at the Municipal Health Department of João Pessoa-PB-UNIPÊ and is studying for a master's degree in Family Health at the Federal University of Paraíba-UFPB at PROFSAUDE / FIOCRUZ.

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