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Evidence for the impact of interventions for, and medicines reconciliation in, problematic polypharmacy: a rapid review of systematic reviews and scoping searches

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posted on 2024-02-16, 00:56 authored by Rita Faria, Marrissa Martyn-St JamesMarrissa Martyn-St James, Ruth WongRuth Wong, Alison Scope, Mark Sculpher

1. This rapid review and scoping searches aimed to understand the literature on problematic polypharmacy (PP) and identify key areas of uncertainty for future research.

2. PP was defined as “prescribing of multiple medications inappropriately, or where the intended benefit of the medication is not realised” (following the 2013 King’s Fund definition).

3. Researchable questions were specified by topic of interest: burden of PP, interventions to reduce PP, implementation activities to increase uptake of interventions to reduce PP and efficient handover between primary and secondary care to reduce PP.

4. The rapid systematic review included nine systematic reviews (10 references). All reviews were international, with most including UK studies.

5. The findings of the rapid review of systematic reviews are as follows:

5.1. Burden of PP. There is no consensus in the literature regarding the definition of polypharmacy. The prevalence of polypharmacy in people residing in long-term care facilities and of PP is generally high but varies widely depending on the definitions, country and setting. Polypharmacy is associated with greater risk of death, estimates of which are likely to be confounded by poorer health.

5.2. Interventions to reduce PP. The evidence suggests that the interventions can reduce PP, although reductions in polypharmacy are more uncertain. Deprescribing and other interventions to reduce PP appear to have no effect on all-cause mortality. There is no clear evidence of an effect on other relevant outcomes such as quality of life and hospitalisations.

5.3. Implementation activities to increase uptake of interventions to reduce PP. No systematic reviews were found on this topic.

5.4. Efficient handover between primary and secondary care to reduce PP. There is some evidence that medicine reconciliation activities reduce medication discrepancies at care transitions.

6. Further review update or scoping searches retrieved a total of 7,006 records, which suggests that PP is an active topic for research.

7. Given the evidence identified, some areas are suggested for future research:

7.1. Burden of PP. Research on the prevalence of polypharmacy and PP in the UK, the factors that predict PP, and on the causal effect of PP on costs and health outcomes.

7.2. Interventions to reduce PP and Efficient handover between primary and secondary care to reduce PP. Research on the comparative effectiveness of interventions to reduce PP, considering the quality of the primary studies and their generalisability to the UK; on the interventions’ resources and costs; and on their cost-effectiveness.

7.3. Implementation activities to increase uptake of interventions to reduce PP. Research on the current uptake of interventions to reduce PP, the barriers to their implementation, and the implementation activities to address them; on the comparative effectiveness of interventions to reduce PP, considering the quality of the primary studies and their generalisability to the UK; and the cost-effectiveness of investments in implementation activities.

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NIHR Policy Research Unit - Economic Methods of Evaluation in Health and Care Interventions

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