Patient/provider education, multidisciplinary teams and computer support lead to improvements in prescribing multiple medications

Cooper JA, Cadogan CA, Patterson SM, et al.  Interventions to improve the appropriate use of polypharmacy in older people: A Cochrane systematic review BMJ Open. 2015 October;5:e009235.

Review question

Do interventions focused on improving multiple medication prescribing in older patients reduce inappropriate prescribing and hospital admissions?

Background

The growth in the population of older people poses a significant challenge for healthcare systems since they tend to use more resources (e.g., medications).

There is potential for unintended negative outcomes when older people use multiple medications, which has considerable cost implications for healthcare systems.

It is important to determine the effectiveness of interventions aimed at improving appropriate use of multiple medications to ensure the use of these medications is safe and effective for older people.

How the review was done

A detailed search of a number of electronic databases for studies published through November 2013 was conducted. Studies that focused on interventions in any setting that targeted older people who had more than one long-term medical condition and were receiving more than four regular medications, were included in the review.

A total of 5,214 studies were identified in searches, and 12 were included in the review after assessments for eligibility.

This review was funded by The Dunhill Medical Trust.

What the researchers found

The interventions identified by the review included patient education, prescriber education, multidisciplinary teams, and a computerized decision support system.

The findings of this review indicated that education and multidisciplinary interventions appear to reduce inappropriate prescribing for older people. Computerized decision support systems were identified to show potential for improving outcomes, however the evidence was limited.

Due to limited evidence, it is unclear if the identified interventions resulted in clinical improvements such as fewer hospitalizations, reduction in medication-related problems, and improved quality of life.

Conclusion

The review found that interventions altering pharmaceutical care appear to demonstrate benefits based on observed reductions in inappropriate prescribing in older patients. More evidence is needed to determine improvements in clinical outcomes such as hospital admissions, medication-related problems and patients’ overall quality of life.