研究背景：衰弱高齡者常有多重疾病以致需要使用多重藥物，但會隨之增加藥物不良反應、交互作用之風險及增加藥物負擔，且於末期衰弱的病人可能無法得到長期藥物的效益。處方優化為減少潛在不適當用藥(Potentially inappropriate medication, PIM)的流程，目的為減少藥物衍生之問題並改善病人的臨床結果。STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy)為輔助醫師於末期衰弱族群執行處方優化的工具，但較少隨機分派研究探索該準則的成效。本研究的目的為比較STOPP和STOPPFrail準則之PIM介入成效。
研究方法：本研究為務實性單盲平行組別隨機分派對照臨床試驗，於台灣南部某醫學中心一般內科及高齡醫學病房收案，研究對象納入嚴重不可逆衰弱(Clinical Frailty Scale≥7)、使用多重用藥 (≥6種藥物)且預期餘命一年內之住院高齡者，隨機分派至STOPPFrail 組、STOPP 組以及對照組。三組均由藥師訪視並評估其長期藥物以及PIM，介入組依其分派之組別提供醫師不同的PIM清單。主要結果為出院時PIM及藥物總數量的變化。次要結果為出院後一個月的門診、急診、非預期入院、死亡事件，並收集病人於研究期間之停藥不良反應。
研究結果：研究對象共完成146人。所有病人之長期藥物數量平均為10.83 (±3.4)種，87.0％的病人至少使用一種STOPPFrail-PIM，71.9％的病人至少使用一種STOPP-PIM。其中，最常見的STOPPFrail-PIM依序為降血糖藥(36.3%)、降血壓藥(38.4%)、降血脂藥(37.0%)。STOPPFrail組使用STOPPFrail介入之後， STOPPFrail-PIM減少較其他兩組多(F = 11.39, p < .001)，而STOPP-PIM在三組的減少量沒有組間差異(F = .76, p = .470)。另外，一般內科病房STOPPFrail組使用STOPPFrail介入可以減少長期藥物數量(F = 4.63, p = .012)，但在高齡醫學病房不論使用何種準則均無介入效果(F = .55, p = .759)。在其他次要結果方面，三組之間沒有顯著差異，研究期間亦未接到任何停藥不良反應相關報告。
研究結論：大部分的末期衰弱高齡者入院時都有使用一種以上的PIM，使用STOPPFrail輔助處方優化可以安全有效地減少PIM並改善多重用藥，特別在一般內科病房。

Frail older adults suffer from multiple illnesses resulting in polypharmacy and increases in drug interactions, adverse effects, and healthcare costs, albeit with little long-term benefits to the patients. STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy) criteria is designed to assist physicians for deprescribing decision of potentially inappropriate medications (PIMs). The objective of the study was to explore the effects of STOPP and STOPPFrail criteria on PIMs among frail older inpatients with limited life expectancy. This was a single-blind, parallel group pragmatic randomized controlled trial. Severely frail older inpatients with life expectancy of less than 1 year and polypharmacy were randomly assigned to STOPP, STOPPFrail and the control groups. All patients were visited by a trained pharmacist to assess their long-term use of medications, and PIMs were assessed based on the different criteria. A total of 146 frail older adults were included. After intervention, the STOPPFrail group showed a significant reduction in the number of STOPPFrail-PIM at discharge (F = 11.39, p < .001). Furthermore, long-term use medications were significantly reduced after STOPPFrail intervention in the general medicine ward (F = 4.63, p = .012), but not in the geriatric ward (F = .55, p = .759). No significant difference was found between three groups in outpatient visits, emergency visits, unplanned hospital admissions, and mortality at 1 month after discharge. STOPPFrail deprescribing intervention was safe and effective in reducing PIMs and polypharmacy at discharge, especially in the general medicine ward.

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