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Meta-Analysis
. 2019 May;17(3):257-266.
doi: 10.1370/afm.2373.

Potentially Inappropriate Prescribing Among Older Persons: A Meta-Analysis of Observational Studies

Tau Ming Liew  1   2 , Cia Sin Lee  3 , Kuan Liang Goh Shawn  3 , Zi Ying Chang  3
Affiliations
Meta-Analysis

Potentially Inappropriate Prescribing Among Older Persons: A Meta-Analysis of Observational Studies

Tau Ming Liew et al. Ann Fam Med. 2019 May.

Abstract

Purpose: Potentially inappropriate prescribing (PIP) is a common yet preventable medical error among older persons in primary care. It is uncertain whether PIP produces adverse outcomes in this population, however. We conducted a systematic review with meta-analysis to pool the adverse outcomes of PIP specific to primary care.

Method: We searched PubMed, Embase, CINAHL, Web of Science, Scopus, PsycINFO, and previous review articles for studies related to "older persons," "primary care," and "inappropriate prescribing." Two reviewers selected eligible articles, extracted data, and evaluated the risk of bias. Meta-analysis was conducted to pool studies with similar PIP criteria and outcome measures.

Results: Of the 2,804 articles identified, we included 8 articles with a total of 77,624 participants. All included studies had cohort design and low risk of bias. Although PIP did not affect mortality (risk ratio [RR] 0.98; 95% CI, 0.93-1.05), it was significantly associated with the other available outcomes, including emergency room visits (RR 1.63; 95% CI, 1.32-2.00), adverse drug events (RR 1.34; 95% CI, 1.09-1.66), functional decline (RR 1.53; 95% CI, 1.08-2.18), health-related quality of life (standardized mean difference -0.26; 95% CI, -0.36 to -0.16), and hospitalizations (RR 1.25; 95% CI, 1.09-1.44). A majority of the pooled estimates had negligible heterogeneity.

Conclusions: This meta-analysis provides consolidated evidence on the wide-ranging impact of PIP among older persons in primary care. It highlights the need to identify PIP in primary care, calls for further research on PIP interventions in primary care, and points to the need to consider potential implications when deciding on the operational criteria of PIP.

Keywords: adverse outcomes; aged; family physicians; family practice; general practice; general practitioners; inappropriate prescribing; medication errors; meta-analysis; primary health care; systematic review.

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Figures

Figure 1.
Figure 1.
Flowchart of the study selection.
Figure 2.
Figure 2.
Forest plots for the adverse outcomes of potentially inappropriate prescribing based on the Beers Criteria.
Figure 2.
Figure 2.
Forest plots for the adverse outcomes of potentially inappropriate prescribing based on the Beers Criteria.
Figure 2.
Figure 2.
Forest plots for the adverse outcomes of potentially inappropriate prescribing based on the Beers Criteria.
Figure 3.
Figure 3.
Forest plots for the adverse outcomes of potentially inappropriate prescribing based on the STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) criteria. A&E = accident and emergency department; HRQoL = health-related quality of life.
Figure 3.
Figure 3.
Forest plots for the adverse outcomes of potentially inappropriate prescribing based on the STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) criteria. A&E = accident and emergency department; HRQoL = health-related quality of life.
Figure 3.
Figure 3.
Forest plots for the adverse outcomes of potentially inappropriate prescribing based on the STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) criteria. A&E = accident and emergency department; HRQoL = health-related quality of life.
Figure 3.
Figure 3.
Forest plots for the adverse outcomes of potentially inappropriate prescribing based on the STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) criteria. A&E = accident and emergency department; HRQoL = health-related quality of life.
Figure 3.
Figure 3.
Forest plots for the adverse outcomes of potentially inappropriate prescribing based on the STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions) criteria. A&E = accident and emergency department; HRQoL = health-related quality of life.
See this image and copyright information in PMC

References

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