Interventions to improve the appropriate use of polypharmacy for older people

作者：Judith A. Cole, Daniela C. Gonçalves, Mubarak Alqahtani, Heather E. Barry, Cathal A. Cadogan, Audrey Rankin, Susan M. Patterson, Ngaire M Kerse, Chris R. Cardwell, Cristín A. Ryan, Carmel M Hughes · 发表于：Cochrane Database of Systematic Reviews · 年份：2023 · DOI：10.1002/14651858.cd008165.pub5 · 被引用次数：162 · 研究领域：Pharmaceutical Practices and Patient Outcomes、Medication Adherence and Compliance、Pharmacovigilance and Adverse Drug Reactions

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, so that many medicines may be used to achieve better clinical outcomes for patients. This is the third update of this Cochrane Review. OBJECTIVES: To assess the effects of interventions, alone or in combination, in improving the appropriate use of polypharmacy and reducing medication-related problems in older people. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL and two trials registers up until 13 January 2021, together with handsearching of reference lists to identify additional studies. We ran updated searches in February 2023 and have added potentially eligible studies to 'Characteristics of studies awaiting classification'. SELECTION CRITERIA: For this update, we included randomised trials only. Eligible studies described interventions affecting prescribing aimed at improving appropriate polypharmacy (four or more medicines) in people aged 65 years and older, which used a validated tool to assess prescribing appropriateness. These tools can be classified as either implicit tools (judgement-based/based on expert professional judgement) or explicit tools (criterion-based, comprising lists of drugs to be avoided in older people). DATA COLLECTION AND ANALYSIS: Four review authors independently reviewed abstracts of eligible studies, and two authors extr...