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Review
. 2019 Jan 31:53:7.
doi: 10.11606/S1518-8787.2019053000781.

Interventions to reduce the prescription of inappropriate medicines in older patients

[Article in English, Portuguese]
Nathalia Serafim Dos Santos  1 , Lívia Luize Marengo  1 , Fabio da Silva Moraes  1 , Silvio Barberato Filho  1
Affiliations
Review

Interventions to reduce the prescription of inappropriate medicines in older patients

[Article in English, Portuguese]
Nathalia Serafim Dos Santos et al. Rev Saude Publica. .

Abstract
in English, Portuguese

Objective: Identify and critically evaluate systematic reviews addressing the effectiveness of interventions to reduce the number of prescriptions of potentially inappropriate medication to older patients.

Methods: This is an overview of systematic reviews. The studies were searched and selected from Medline, Cochrane Library, Embase, CINAHL, Virtual Health Library, and Web of Science databases, combining the terms aged, prescriptions, inappropriate prescribing and potentially inappropriate medication list with their entry terms and other related descriptors, published by June 2017. This study included systematic reviews with or without meta-analysis that addressed the effectiveness of any intervention or combined interventions to reduce the number of prescriptions of potentially inappropriate medications to older patients, without restriction in terms of design, language or date of publication of primary studies. AMSTAR - A MeaSurement Tool to Assess systematic Reviews - was used to evaluate the methodological quality of selected systematic reviews. Study selection and the methodological quality evaluation were performed by two independent evaluators, who resolved any divergence by consensus. The main findings were grouped into thematic categories, defined after a content analysis and discussed qualitatively as narrative synthesis.

Results: This study analyzed 24 systematic reviews. In terms of study design and methodological quality evaluation, most were systematic reviews of randomized controlled clinical trials and studies of moderate quality, respectively. The interventions were analyzed in five thematic categories: medication review services, pharmaceutical interventions, computerized systems, educational interventions, and others. The interventions analyzed showed good results and most of them helped reduce the number of prescriptions of potentially inappropriate medication to older patients.

Conclusions: The systematic reviews included in this overview showed potential benefits of different interventions. However, it was not possible to determine the most effective intervention. Combined interventions are likely to provide better results than isolated interventions.

OBJETIVO:: Identificar e avaliar criticamente revisões sistemáticas sobre a efetividade de intervenções para reduzir a prescrição de medicamentos potencialmente inapropriados para pacientes idosos.

MÉTODOS:: Overview de revisões sistemáticas. A busca e a seleção dos estudos foram feitas nas bases de dados Medline, Biblioteca Cochrane, Embase, CINAHL, Biblioteca Virtual em Saúde e Web of Science, combinando os termos aged, prescriptions, inappropriate prescribing e potentially inappropriate medication list com seus sinônimos remissivos e outros descritores associados até junho de 2017. Foram incluídas revisões sistemáticas com ou sem metanálise, que tenham abordado a efetividade de qualquer intervenção ou a combinação de intervenções para reduzir a prescrição de medicamentos potencialmente inapropriados para pacientes idosos, sem restrição quanto ao desenho dos estudos primários, idioma ou data de publicação. Para avaliação da qualidade metodológica das revisões sistemáticas selecionadas, foi utilizado o instrumento A MeaSurement Tool to Assess systematic Reviews. A seleção e a avaliação da qualidade metodológica foram realizadas por dois avaliadores independentes. As divergências foram superadas por consenso. Os principais achados foram agrupados em categorias temáticas, definidas com base em análise de conteúdo e discutidas qualitativamente na forma de síntese narrativa.

RESULTADOS:: Vinte e quatro revisões sistemáticas foram incluídas no estudo. Quanto ao desenho do estudo e à avaliação da qualidade metodológica, prevaleceram revisões sistemáticas de ensaios clínicos controlados randomizados e estudos de qualidade moderada, respectivamente. As intervenções foram analisadas em cinco categorias temáticas: serviços de revisão de medicamentos, intervenções farmacêuticas, sistemas informatizados, intervenções educacionais e outras. As intervenções estudadas apresentaram bons resultados e a maioria contribuiu para reduzir a prescrição de medicamentos inapropriados para pacientes idosos.

CONCLUSÕES:: As revisões sistemáticas incluídas nesse overview apontaram benefícios potenciais de diferentes intervenções. No entanto, não foi possível determinar qual a mais efetiva. É provável que intervenções multifacetadas alcancem resultados melhores do que intervenções isoladas.

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Conflict of interest statement

Conflict of Interest: The authors declare no conflict of interest.

Figures

Figure
Figure. Flow diagram showing the selection process of systematic reviews about interventions to reduce the number of prescriptions of potentially inappropriate medications to older patients.
See this image and copyright information in PMC

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