Clinical medication review type III of polypharmacy reduced unplanned hospitalizations in older adults: A meta‐analysis of randomized clinical trials

Abstract

Aim: To analyze the impact of clinical medication reviews (CMR) on reducing unplanned hospitalizations owing to polypharmacy among older adults using an intervention.Methods: Our meta-analysis complied with PRISMA guidelines. The literature review comprised a search for articles published between January 1972 and March 2017 on MEDLINE and Google Scholar. We identified randomized controlled trials focusing on CMR that evaluated unplanned hospitalization and re-hospitalization among older adults as a primary outcome. The keywords used were "CMR" or "medication review" in their titles, and the phrases "elderly" or "older adults" or "geriatric" and "polypharmacy." The randomized controlled trials selected were divided according to the three types of CMR to analyze the characteristics of each review. Results:We included nine randomized controlled trials that examined the impact of CMR of polypharmacy in older patients. Five trials corresponded to CMR type I (prescription only review) or II (adherence review), whereas four corresponded to type III (comprehensive clinical evaluation for disease management). Type I/II increased the number of unplanned hospitalizations (RR 1.22, 95% CI 1.07-1.38, P = 0.002), whereas type III decreased hospital admissions (RR 0.86, 95% CI 0.79-0.95, P = 0.001). Conclusions:The present findings show the need for an intervention standardization for CMR, particularly for type III in older adults with polypharmacy, to decrease hospitalizations.

Adecuación de la prescripción en pacientes mayores polimedicados en atención primaria. Ensayo clínico controlado aleatorizado por grupos PHARM-PC

“…Sin embargo, esta reducción significativa de MPI no se correlaciona claramente con reducción de morbimortalidad, acorde con los resultados observados en diversos estudios 16 , 17 , 18 , 27 , 28 ; posiblemente porque el tamaño muestral, calculado para demostrar reducción significativa en la proporción de pacientes con MPI y el tiempo de seguimiento, resultaron insuficientes para obtener diferencias significativas en estas variables.…”

“…Nuestra reducción no significativa de episodios asistenciales hospitalarios está en línea con la amplia variabilidad observada en diversas revisiones sistemáticas, que muestran valores de riesgo relativo (RR) de ingreso hospitalario que oscilan desde 0,87 (IC 95%: 0,52; 1,47) hasta 1,11 (IC 95%: 0,99; 1,24) 16 , 18 , 28 , sin diferencias estadísticamente significativas. Sin embargo, nuestra intervención conllevó un aumento no significativo de episodios asistenciales ambulatorios, acorde con el estudio REMEI 27 ; quizás porque el mayor número de modificaciones de tratamiento en GI supuso un mayor seguimiento a nivel ambulatorio, redundando en una menor frecuentación hospitalaria.…”

Longevity leap: mind the healthspan gap

“…The Hippocratic tenet "first do no harm" embodies the enduring principle of medicine, underscored in the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research axiom 'maximize possible benefits and minimize possible harms'. In the elderly, a point of vulnerability is the risk of unplanned hospitalizations provoked by serious adverse drug reactions 45 . Commitment to non-maleficence is highlighted in evidence-based guidelines, including the American Geriatric Society's Beers Criteria which outline drugs likely to produce unwanted actions in the elderly 46 .…”

A proactive remote pharmaceutical care for rural elderly population: The Houston‐Apollo polypharmacy project

“…6,7 Several studies have established that proactive intervention and appropriate communication with the medical team could help clinical pharmacists optimise prescriptions, decrease PIMs and prevent falls or unplanned hospitalisation. [8][9][10][11][12][13] Nonetheless, the majority of pharmaceutical interventions to improve the problems of polypharmacy have occurred in resourceful areas or developed countries, such as the United Kingdom, Denmark, Australia and Japan. Furthermore, those studies mainly focused on improving the pharmaceutical care of patients who were hospitalised, institutionalised or in nursing homes.…”