REDUCING INAPPROPRIATE POLYPHARMACY FOR OLDER PATIENTS AT SPECIALIST
OUTPATIENT CLINICS: A SYSTEMATIC REVIEW
Abstract
Aim: Deprescribing interventions may reduce inappropriate polypharmacy
and the associated negative clinical consequences. This systematic
review examined current research on the effectiveness of deprescribing
interventions implemented within specialist outpatient clinics. Methods:
This systematic review was informed by a literature search on 18/10/21
of publications from January 1990 in PubMed and Embase. Studies were
included if they focused on patients ≥60 years and measured change in
medication burden (defined by number of medications or number of
inappropriate medications) as result of an intervention conducted within
a specialist outpatient clinic. Methodological quality was assessed by 2
authors using the revised Cochrane risk-of-bias tools. Due to
significant heterogeneity between trials, a qualitative synthesis was
completed. The primary outcome reviewed was change in medication count
or potentially inappropriate medication. Secondary outcomes were
maintenance of deprescription and clinical benefits. Results: 19 studies
were included for review that included 10,914 participants. They
included geriatric outpatient clinics, oncology/haematology clinics,
haemodialysis clinics and designated polypharmacy/multimorbidity
clinics. Seven RCTs were identified. Other studies included
retrospective evaluations and prospective/pilot studies. Four RCTs
reported statistically significant reduction of medication burden with
intervention, however all studies were assessed as having a high risk of
bias. The studies could be grouped into those where the deprescribing
intervention was physician-led and implemented, delivered from a
multidisciplinary team, or pharmacist-led and physician implemented.
Conclusion: The evidence for deprescribing interventions in outpatient
clinics is very limited and further research is recommended. The
addition of a pharmacist and validated medication assessment tools
appear to be enablers.