RESULTS
All studies identified were assessed to have at least a moderate risk of
bias and most had a critical risk of bias. Five RCTs and 2 pilot RCTs
were identified. Four of these studies reported a statistically
significant reduction of medications or PIMS in the control group.
However, many studies were of small size, completed at a single centre,
and were pilot studies or prospective in design.
The identified studies span a range of specialist outpatient clinics.
The majority of interventions have been evaluated within geriatric
outpatient clinics.25-32 Two studies measured
deprescribing interventions in oncology/haematology
clinics,33,34 and 2 studies examined outpatient
haemodialysis patients.35,36 Other locations included
a memory clinic,37 heart failure
clinic,38 and geriatric preoperative
clinic39 and pilot studies looking at designated
polypharmacy/multimorbidity review clinics.40-43
The included studies ranged from no follow-up post-intervention, to
2-years of follow-up. They have used a range of screening instruments to
identify PIMs and to review, optimize, and assess deprescription of
medications. The well validated Beers criteria44 and
STOPP/START criteria45 were the most often used
explicit tools applied to identify PIMS. The Medicines Appropriateness
Index (MAI) was also used in some instances as an implicit tool to
assess the appropriateness of all medication by looking at indication,
efficacy, dose, directions, interactions, duration, duplication, and
cost.46 Less well published tools adopted include the
Individualised Medication Assessment and Planning (iMAP) tool that has
been more recently developed specifically for assessing and resolving
medication-related problems in outpatients47 and the
FORTA (Fit for the Aged) list and scoring system, which evaluates
patients medication for undertreatment, overtreatment, and
mistreatment.48 Several other studies have used their
own algorithms and grouped medication related issues into a set of
‘drug-related problems’.33,38 Within specialized
settings, such as oncology, palliative care, and haemodialysis, the need
for additional screening tools has been identified as essential to
address condition-specific considerations, such as specific
drug-interactions or intolerances and treatment
goals.36,49