METHODS
This systematic review was informed by a literature search performed by
LC on 18th October 2021 of publications from January
1990 until the search date. The search terms included the following:
Outpatients [All Fields] OR Geriatric Assessment [All Fields]
AND Polypharmacy [All Fields] OR Deprescription [All Fields] in
PubMed and Embase, as well as hand searches of reference lists of
initially found publications. Studies were included if they were
published in English and measured change in medication load as a result
of an intervention conducted within the setting of a specialist
outpatient clinic. Articles were excluded if the study was based within
another medical setting or did not include our target patient group of
older patients. Articles examining interventions relating to change in
drug-related problems, but did not measure change in medication burden
(as defined by number of medications or number of inappropriate
medications) were excluded. Where change in number of inappropriate
medications were measured, only trials using validated tools (implicit
or explicit) were included. Studies using expert opinion or
self-developed algorithms were only included if they measured total
medication count, rather than number of potentially inappropriate
medications. For this review, we focused on patients older than 60 years
of age. Studies were included with younger patients if the majority were
within the older age group.
Trials were assessed by two authors (LC and LH) for methodological
quality according to the revised Cochrane risk-of-bias
tools.23,24 Smaller, pilot and prospective studies
were also included in the analysis, given the limited research available
and novel area under review.
The search resulted in 4,362 publications. After exclusion of 4,324
publications based on title and abstract and excluding 19 publications
after full-text review, 19 were deemed to be eligible for inclusion in
the review (Supplement 1).
The key characteristics of the eligible publications are summarized in
Supplement 2. Due to substantial heterogeneity between studies, a
qualitative synthesis of the
literature was completed. The primary outcome reviewed was change in
medication load as measured by a decrease in medication count or
decrease in potentially inappropriate medication. Secondary outcomes
reviewed included maintenance of deprescription and clinical benefits
from deprescription.