Efectividad y seguridad de las intervenciones de desprescripción lideradas por el médico de familia en adultos mayores de la comunidad: Una revisión sistemática de ensayos clínicos aleatorizados
Palabras clave:
desprescripción, médico de familia, atención primaria, polifarmacia, adulto mayor, ensayos clínicos aleatorizadosResumen
Antecedentes: El manejo de la polifarmacia en la atención primaria es un desafío crítico debido a su asociación con resultados adversos en adultos mayores. Aunque existen guías de desprescripción, la implementación efectiva en la práctica rutinaria enfrenta barreras significativas de tiempo y confianza.
Objetivo: Evaluar la efectividad y seguridad de las intervenciones estructuradas de desprescripción lideradas por médicos de familia en adultos mayores de la comunidad.
Métodos: Se realizó una revisión sistemática siguiendo la normativa PRISMA 2020. Se buscó en PubMed/MEDLINE, CENTRAL y LILACS (2020-2025) ensayos clínicos aleatorizados (ECA) que evaluaran intervenciones de desprescripción iniciadas por el médico de familia en pacientes >= 65 años. La calidad metodológica se evaluó con la herramienta Cochrane RoB 2.
Resultados: Se incluyeron 7 ECAs (n=5299). Las intervenciones focalizadas en una enfermedad o clase terapéutica demostraron mayor éxito. Grant et al. (2025) lograron una reducción significativa de hipoglucemiantes (15.8 % vs 9.0 %, P=0.01) mediante educación al médico y activación del paciente. Sheppard et al. (2024) confirmaron la seguridad a largo plazo de retirar antihipertensivos (HR mortalidad/hospitalización 0.93, IC 95 % 0.76-1.12). Por el contrario, las intervenciones generalistas de revisión integral (p. ej., ensayos OPTICA, RIME) no mostraron reducciones significativas en desenlaces clínicos duros ni mejoras consistentes en la adecuación de la medicación global.
Conclusiones: La desprescripción liderada por el médico de familia es segura y efectiva cuando se focaliza en objetivos terapéuticos específicos. Las estrategias focalizadas superan a las revisiones generalistas al reducir la carga cognitiva y facilitar la toma de decisiones compartida.
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Derechos de autor 2025 Sandra González, Charles Daniel Sosa Chamorro, Pablo Javier Frutos Fernández, Liz Vanessa Vega, Karen Andrea Sosa Blanco, Alma Graciela González de Lamas, Luis Fernández, Ides Ferronato, Kelly López, Nínive Urunaga Romero
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
