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Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review

BACKGROUND: Polypharmacy, and the associated adverse drug events such as non-adherence to prescriptions, is a common problem for elderly people living with multiple comorbidities. Deprescribing, i.e. the gradual withdrawal from medications with supervision by a healthcare professional, is regarded a...

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Autores principales: Ulley, Joanna, Harrop, Deborah, Ali, Ali, Alton, Sarah, Fowler Davis, Sally
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339421/
https://www.ncbi.nlm.nih.gov/pubmed/30658576
http://dx.doi.org/10.1186/s12877-019-1031-4
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author Ulley, Joanna
Harrop, Deborah
Ali, Ali
Alton, Sarah
Fowler Davis, Sally
author_facet Ulley, Joanna
Harrop, Deborah
Ali, Ali
Alton, Sarah
Fowler Davis, Sally
author_sort Ulley, Joanna
collection PubMed
description BACKGROUND: Polypharmacy, and the associated adverse drug events such as non-adherence to prescriptions, is a common problem for elderly people living with multiple comorbidities. Deprescribing, i.e. the gradual withdrawal from medications with supervision by a healthcare professional, is regarded as a means of reducing adverse effects of multiple medications including non-adherence. This systematic review examines the evidence of deprescribing as an effective strategy for improving medication adherence amongst older, community dwelling adults. METHODS: A mixed methods review was undertaken. Eight bibliographic database and two clinical trials registers were searched between May and December 2017. Results were double screened in accordance with pre-defined inclusion/exclusion criteria related to polypharmacy, deprescribing and adherence in older, community dwelling populations. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal and an a priori data collection instrument was used. For the quantitative studies, a narrative synthesis approach was taken. The qualitative data was analysed using framework analysis. Findings were integrated using a mixed methods technique. The review was performed in accordance with the PRISMA reporting statement. RESULTS: A total of 22 original studies were included, of which 12 were RCTs. Deprescribing with adherence as an outcome measure was identified in randomised controlled trials (RCTs), observational and cohort studies from 13 countries between 1996 and 2017. There were 17 pharmacy-led interventions; others were led by General Practitioners (GP) and nurses. Four studies demonstrated an overall reduction in medications of which all studies corresponded with improved adherence. A total of thirteen studies reported improved adherence of which 5 were RCTs. Adherence was reported as a secondary outcome in all but one study. CONCLUSIONS: There is insufficient evidence to show that deprescribing improves medication adherence. Only 13 studies (of 22) reported adherence of which only 5 were randomised controlled trials. Older people are particularly susceptible to non-adherence due to multi-morbidity associated with polypharmacy. Bio-psycho-social factors including health literacy and multi-disciplinary team interventions influence adherence. The authors recommend further study into the efficacy and outcomes of medicines management interventions. A consensus on priority outcome measurements for prescribed medications is indicated. TRIAL REGISTRATION: PROSPERO number CRD42017075315. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12877-019-1031-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-63394212019-01-23 Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review Ulley, Joanna Harrop, Deborah Ali, Ali Alton, Sarah Fowler Davis, Sally BMC Geriatr Research Article BACKGROUND: Polypharmacy, and the associated adverse drug events such as non-adherence to prescriptions, is a common problem for elderly people living with multiple comorbidities. Deprescribing, i.e. the gradual withdrawal from medications with supervision by a healthcare professional, is regarded as a means of reducing adverse effects of multiple medications including non-adherence. This systematic review examines the evidence of deprescribing as an effective strategy for improving medication adherence amongst older, community dwelling adults. METHODS: A mixed methods review was undertaken. Eight bibliographic database and two clinical trials registers were searched between May and December 2017. Results were double screened in accordance with pre-defined inclusion/exclusion criteria related to polypharmacy, deprescribing and adherence in older, community dwelling populations. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal and an a priori data collection instrument was used. For the quantitative studies, a narrative synthesis approach was taken. The qualitative data was analysed using framework analysis. Findings were integrated using a mixed methods technique. The review was performed in accordance with the PRISMA reporting statement. RESULTS: A total of 22 original studies were included, of which 12 were RCTs. Deprescribing with adherence as an outcome measure was identified in randomised controlled trials (RCTs), observational and cohort studies from 13 countries between 1996 and 2017. There were 17 pharmacy-led interventions; others were led by General Practitioners (GP) and nurses. Four studies demonstrated an overall reduction in medications of which all studies corresponded with improved adherence. A total of thirteen studies reported improved adherence of which 5 were RCTs. Adherence was reported as a secondary outcome in all but one study. CONCLUSIONS: There is insufficient evidence to show that deprescribing improves medication adherence. Only 13 studies (of 22) reported adherence of which only 5 were randomised controlled trials. Older people are particularly susceptible to non-adherence due to multi-morbidity associated with polypharmacy. Bio-psycho-social factors including health literacy and multi-disciplinary team interventions influence adherence. The authors recommend further study into the efficacy and outcomes of medicines management interventions. A consensus on priority outcome measurements for prescribed medications is indicated. TRIAL REGISTRATION: PROSPERO number CRD42017075315. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12877-019-1031-4) contains supplementary material, which is available to authorized users. BioMed Central 2019-01-18 /pmc/articles/PMC6339421/ /pubmed/30658576 http://dx.doi.org/10.1186/s12877-019-1031-4 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ulley, Joanna
Harrop, Deborah
Ali, Ali
Alton, Sarah
Fowler Davis, Sally
Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review
title Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review
title_full Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review
title_fullStr Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review
title_full_unstemmed Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review
title_short Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review
title_sort deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339421/
https://www.ncbi.nlm.nih.gov/pubmed/30658576
http://dx.doi.org/10.1186/s12877-019-1031-4
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