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- Title
A systematic overview of systematic reviews evaluating interventions addressing polypharmacy.
- Authors
Anderson, Laura J; Schnipper, Jeffrey L; Nuckols, Teryl K; Shane, Rita; Sarkisian, Catherine; Le, Michael M; Pevnick, Joshua M; group, Members of the PHARM-DC
- Abstract
Purpose To systematically evaluate and summarize evidence across multiple systematic reviews (SRs) examining interventions addressing polypharmacy. Summary MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects (DARE) were searched for SRs evaluating interventions addressing polypharmacy in adults published from January 2004 to February 2017. Two authors independently screened, appraised, and extracted information. SRs with Assessment of Multiple Systematic Reviews (AMSTAR) scores below 8 were excluded. After extraction of relevant conclusions from each SR, evidence was summarized and conclusions compared. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess evidence quality. Six SRs met the inclusion criteria, 4 of which used meta-analytic pooling. Five SRs focused on older adults. Four were not restricted to any specific disease type, whereas 1 focused on proton pump inhibitors and another focused on patients with severe dementia. Care settings and measured outcomes varied widely. SRs examining the impact on patient-centered outcomes, including morbidity, mortality, patient satisfaction, and utilization, found inconsistent evidence regarding the benefit of polypharmacy interventions, but most concluded that interventions had either null or uncertain impact. Two SRs assessing medication appropriateness found very low-quality evidence of modest improvements with polypharmacy interventions. Conclusion An overview of SRs of interventions to address polypharmacy found 6 recent and high-quality SRs, mostly focused on older adults, in which both process and outcome measures were used to evaluate interventions. Despite the low quality of evidence in the underlying primary studies, both SRs that assessed medication appropriateness found evidence that polypharmacy interventions improved it. However, there was no consistent evidence of any impact on downstream patient-centered outcomes such as healthcare utilization, morbidity, or mortality.
- Subjects
MORTALITY risk factors; DEMENTIA; DISEASES; INFORMATION storage &; retrieval systems; MEDICAL databases; MEDICAL care use; MEDLINE; HEALTH outcome assessment; PATIENT satisfaction; SYSTEMATIC reviews; PROTON pump inhibitors; SEVERITY of illness index; POLYPHARMACY
- Publication
American Journal of Health-System Pharmacy, 2019, Vol 76, Issue 21, p1777
- ISSN
1079-2082
- Publication type
Article
- DOI
10.1093/ajhp/zxz196