Interventions helped reduce potentially inappropriate prescribing for older patients
A review and meta-analysis of 118 randomized clinical trials showed that potentially inappropriate prescribing interventions were associated with approximately 0.5 fewer medications per patient, but no change in mortality.
Interventions to address potentially inappropriate prescribing among older primary care patients were associated with a reduction in the number of medications prescribed but were not linked with reductions in hospitalizations or mortality, a systematic review and meta-analysis found.
Researchers assessed data from 118 randomized clinical trials with 417,412 patients ages 65 years and older who resided in the community or long-term care facilities. Comparators to interventions included usual care or minimal interventions, such as generic reminders about safe prescribing. Any study that only addressed antibiotic prescribing was excluded. Outcomes included the number of medications prescribed, nonserious adverse drug reactions, injurious falls, quality of life, medical visits, ED visits, hospitalizations, and all-cause mortality. Findings were published by JAMA Network Open on June 27.
Interventions were associated with a reduction in the number of medications prescribed (standardized mean difference [SMD], −0.25 [95% CI, −0.38 to −0.13]), equivalent to approximately 0.5 fewer medications per patient. The interventions were not associated with significant differences in nonserious adverse drug reactions (risk ratio [RR], 0.92; 95% CI, 0.58 to 1.46), injurious falls (SMD, 0.01; 95% CI, −0.12 to 0.14), quality of life (SMD, 0.09; 95% CI, −0.04 to 0.23), medical visits (SMD, 0.02; 95% CI, −0.02 to 0.07), ED admissions (RR, 1.02; 95% CI, 0.96 to 1.08), hospitalizations (RR, 0.95; 95% CI, 0.89 to 1.02), or all-cause mortality (RR, 0.94; 95% CI, 0.85 to 1.04). Seventy-six trials (64%) had a low risk of bias, and 40 (34%) had some risk of bias.
Limitations to the review include that outcomes such as adverse effects were reported in different ways and using different terms, sometimes limiting the ability to pool statistically, the authors cautioned.
Overall, potentially inappropriate prescribing and the total number of medications “were reduced in older adult outpatients without a substantial risk of harm,” the researchers wrote. More research is needed to study the effects of such interventions on quality of life, hospitalization, and mortality, they concluded.