Interventions to improve the appropriate use of polypharmacy for older people - PubMed (original) (raw)
Meta-Analysis
Interventions to improve the appropriate use of polypharmacy for older people
Susan M Patterson et al. Cochrane Database Syst Rev. 2012.
Update in
- Interventions to improve the appropriate use of polypharmacy for older people.
Patterson SM, Cadogan CA, Kerse N, Cardwell CR, Bradley MC, Ryan C, Hughes C. Patterson SM, et al. Cochrane Database Syst Rev. 2014 Oct 7;(10):CD008165. doi: 10.1002/14651858.CD008165.pub3. Cochrane Database Syst Rev. 2014. PMID: 25288041 Updated. Review.
Abstract
Background: Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Choosing the best interventions to improve appropriate polypharmacy is a priority, hence there is growing interest in appropriate polypharmacy, where many medicines may be used to achieve better clinical outcomes for patients.
Objectives: This review sought to determine which interventions alone, or in combination, are effective in improving the appropriate use of polypharmacy and reducing medication-related problems in older people.
Search methods: A range of literature databases including MEDLINE and EMBASE were searched in addition to handsearching reference lists. Search terms included polypharmacy, Beers criteria, medication appropriateness and inappropriate prescribing.
Selection criteria: A range of study designs were eligible. Eligible studies described interventions affecting prescribing aimed at improving appropriate polypharmacy in people aged 65 years and older where a validated measure of appropriateness was used (e.g. Beers criteria or Medication Appropriateness Index - MAI).
Data collection and analysis: Three authors independently reviewed abstracts of eligible studies, extracted data and assessed risk of bias of included studies. Study specific estimates were pooled, using a random-effects model to yield summary estimates of effect and 95% confidence intervals.
Main results: Electronic searches identified 2200 potentially relevant citations, of which 139 were examined in detail. Following assessment, 10 studies were included. One intervention was computerised decision support and nine were complex, multifaceted pharmaceutical care provided in a variety of settings. Appropriateness of prescribing was measured using the MAI score postintervention (seven studies) and/or Beers criteria (four studies). The interventions included in this review demonstrated a reduction in inappropriate medication use. A mean difference of -6.78 (95% CI -12.34 to -1.22) in the change in MAI score in favour of the intervention group (four studies). Postintervention pooled data (five studies) showed a mean reduction of -3.88 (95% CI -5.40 to -2.35) in the summated MAI score and a mean reduction of -0.06 (95% CI -0.16 to 0.04) in the number of Beers drugs per patient (three studies). Evidence of the effect of the interventions on hospital admissions (four studies) was conflicting. Medication-related problems, reported as the number of adverse drug events (three studies), reduced significantly (35%) postintervention.
Authors' conclusions: It is unclear if interventions to improve appropriate polypharmacy, such as pharmaceutical care, resulted in a clinically significant improvement; however, they appear beneficial in terms of reducing inappropriate prescribing and medication-related problems.
Similar articles
- Interventions to improve the appropriate use of polypharmacy for older people.
Rankin A, Cadogan CA, Patterson SM, Kerse N, Cardwell CR, Bradley MC, Ryan C, Hughes C. Rankin A, et al. Cochrane Database Syst Rev. 2018 Sep 3;9(9):CD008165. doi: 10.1002/14651858.CD008165.pub4. Cochrane Database Syst Rev. 2018. PMID: 30175841 Free PMC article. Updated. - Interventions to improve the appropriate use of polypharmacy for older people.
Cole JA, Gonçalves-Bradley DC, Alqahtani M, Barry HE, Cadogan C, Rankin A, Patterson SM, Kerse N, Cardwell CR, Ryan C, Hughes C. Cole JA, et al. Cochrane Database Syst Rev. 2023 Oct 11;10(10):CD008165. doi: 10.1002/14651858.CD008165.pub5. Cochrane Database Syst Rev. 2023. PMID: 37818791 Free PMC article. - Interventions to improve the appropriate use of polypharmacy for older people.
Patterson SM, Cadogan CA, Kerse N, Cardwell CR, Bradley MC, Ryan C, Hughes C. Patterson SM, et al. Cochrane Database Syst Rev. 2014 Oct 7;(10):CD008165. doi: 10.1002/14651858.CD008165.pub3. Cochrane Database Syst Rev. 2014. PMID: 25288041 Updated. Review. - Interventions to optimise prescribing for older people in care homes.
Alldred DP, Kennedy MC, Hughes C, Chen TF, Miller P. Alldred DP, et al. Cochrane Database Syst Rev. 2016 Feb 12;2(2):CD009095. doi: 10.1002/14651858.CD009095.pub3. Cochrane Database Syst Rev. 2016. PMID: 26866421 Free PMC article. - Professional, structural and organisational interventions in primary care for reducing medication errors.
Khalil H, Bell B, Chambers H, Sheikh A, Avery AJ. Khalil H, et al. Cochrane Database Syst Rev. 2017 Oct 4;10(10):CD003942. doi: 10.1002/14651858.CD003942.pub3. Cochrane Database Syst Rev. 2017. PMID: 28977687 Free PMC article.
Cited by
- Adverse drug events as a cause of hospitalization in older adults.
Salvi F, Marchetti A, D'Angelo F, Boemi M, Lattanzio F, Cherubini A. Salvi F, et al. Drug Saf. 2012 Jan;35 Suppl 1:29-45. doi: 10.1007/BF03319101. Drug Saf. 2012. PMID: 23446784 Review. - High risk prescribing in older adults: prevalence, clinical and economic implications and potential for intervention at the population level.
Gnjidic D, Le Couteur DG, Pearson SA, McLachlan AJ, Viney R, Hilmer SN, Blyth FM, Joshy G, Banks E. Gnjidic D, et al. BMC Public Health. 2013 Feb 7;13:115. doi: 10.1186/1471-2458-13-115. BMC Public Health. 2013. PMID: 23388494 Free PMC article. - Potentially inappropriate prescribing and cost outcomes for older people: a cross-sectional study using the Northern Ireland Enhanced Prescribing Database.
Bradley MC, Fahey T, Cahir C, Bennett K, O'Reilly D, Parsons C, Hughes CM. Bradley MC, et al. Eur J Clin Pharmacol. 2012 Oct;68(10):1425-33. doi: 10.1007/s00228-012-1249-y. Epub 2012 Mar 25. Eur J Clin Pharmacol. 2012. PMID: 22447297 - Effects of discontinuation of chronic medication in primary care: a systematic review of deprescribing trials.
Thio SL, Nam J, van Driel ML, Dirven T, Blom JW. Thio SL, et al. Br J Gen Pract. 2018 Oct;68(675):e663-e672. doi: 10.3399/bjgp18X699041. Br J Gen Pract. 2018. PMID: 30249607 Free PMC article. - A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial.
Vasilevskis EE, Shah AS, Hollingsworth EK, Shotwell MS, Mixon AS, Bell SP, Kripalani S, Schnelle JF, Simmons SF; Shed-MEDS Team. Vasilevskis EE, et al. BMC Health Serv Res. 2019 Mar 14;19(1):165. doi: 10.1186/s12913-019-3995-3. BMC Health Serv Res. 2019. PMID: 30871561 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources