Core Outcome Set for Trials Aimed at Improving the Appropriateness of Polypharmacy in Older People in Primary Care

Rankin, Audrey; Cadogan, Cathal; Ryan, Cristí­n; Clyne, Barbara; Smith, Susan M; Hughes, Carmel

doi:10.1111/jgs.15245

Cited by 77 publications

(103 citation statements)

References 26 publications

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“…It is advisable to establish an interdisciplinary research team, including consumer representation, to ensure the research is relevant to key stakeholders. Where applicable, core outcome sets for trials aimed at improving medicines use in older people should be used . Research Ethics Committee approval should be sought for all intervention studies and for audits or quality improvement projects that will be presented or published.…”

Section: Objectives Of the Servicementioning

confidence: 99%

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Standard of practice in geriatric medicine for pharmacy services

Elliott

Chan

Godbole

et al. 2020

Pharmacy Practice and Res

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Section: Objectives Of the Servicementioning

confidence: 99%

“…Where applicable, core outcome sets for trials aimed at improving medicines use in older people should be used. [71][72][73][74] Research Ethics Committee approval should be sought for all intervention studies and for audits or quality improvement projects that will be presented or published.…”

Section: Researchmentioning

confidence: 99%

Standard of practice in geriatric medicine for pharmacy services

Elliott

Chan

Godbole

et al. 2020

Pharmacy Practice and Res

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“…Researchers and clinicians should focus on developing quality tools using systematic and explicit methods. Such tools should be tested in well‐designed clinical trials that are powered to measure meaningful clinical outcomes (e.g., quality of life, mortality, patient function) . Trials should clearly describe their implementation approach to allow for reproducibility of the intervention.…”

Section: Discussionmentioning

confidence: 99%

“…16 Lack of clinical outcome data and inconsistency in outcome measurement have also been highlighted as limitations in deprescribing studies. 54,55 A 2018 systematic review evaluating deprescribing interventions in older persons found that few studies measured clinical outcomes and that none were adequately powered to detect differences in clinical outcomes between intervention and control groups. 56 A number of deprescribing tools have been developed in recent years, but they remain largely untested.…”

Section: Implementation Of Toolsmentioning

confidence: 99%

Tools for Deprescribing in Frail Older Persons and Those with Limited Life Expectancy: A Systematic Review

Thompson

Lundby

Graabæk

et al. 2018

J American Geriatrics Society

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OBJECTIVES To summarize available tools that can assist clinicians in identifying and reducing or stopping (deprescribing) potentially inappropriate medications and that specifically consider frailty or limited life expectancy. DESIGN Systematic review and narrative synthesis. SETTING We searched MEDLINE (via Ovid SP), EMBASE (via Ovid SP), and CINAHL from inception to December 2017, along with grey literature. We included articles that described a tool to guide deprescribing of medications. PARTICIPANTS Frail older persons and older persons with limited life expectancy. MEASUREMENTS Narrative description of tools. RESULTS We identified 15 tools and organized them into three main categories: tools (n = 2) that described a model or framework for approaching deprescribing, tools (n = 9) that outlined a deprescribing approach for the entire medication list, and tools (n = 4) that provided medication‐specific advice. The complexity of the tools ranged from simple lists to detailed, step‐wise protocols. The development methodology varied widely, and the methods used to synthesize the tools were generally not well described. Most tools were based on expert opinion. Only four of the 15 tools have been tested in clinical practice (in very low‐quality studies). CONCLUSION Tools exist to help clinicians deprescribe in frail older persons and those with limited life expectancy. These tools may assist clinicians at various stages in the deprescribing process. However, it remains to be investigated whether use of such tools in practice is likely to improve clinical outcomes or reduce inappropriate medication use. J Am Geriatr Soc 67:172–180, 2019.

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“…Some have suggested that use of a core outcome set (COS) for studies of medication review in older people would reduce the heterogeneity between trials, increase research output that has relevant outcomes and result in more usable data to inform evidence synthesis [42]. Whilst a couple of COSs have recently been developed [43,44], they will only have impact if used consistently in research trials.…”

Section: Implications For Research and Practicementioning

confidence: 99%

Effectiveness of pharmacist home visits for individuals at risk of medication-related problems: a systematic review and meta-analysis of randomised controlled trials

Abbott

Moore

Rogers

et al. 2020

BMC Health Serv Res

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Background: Medication mismanagement is a major cause of both hospital admission and nursing home placement of frail older adults. Medication reviews by community pharmacists aim to maximise therapeutic benefit but also minimise harm. Pharmacist-led medication reviews have been the focus of several systematic reviews, but none have focussed on the home setting. Review methods: To determine the effectiveness of pharmacist home visits for individuals at risk of medicationrelated problems we undertook a systematic review and meta-analysis of randomised controlled trials (RCTs). Thirteen databases were searched from inception to December 2018. Forward and backward citation of included studies was also performed. Articles were screened for inclusion independently by two reviewers. Randomised controlled studies of home visits by pharmacists for individuals at risk of medication-related problems were eligible for inclusion. Data extraction and quality appraisal were performed by one reviewer and checked by a second. Random-effects meta-analyses were performed where sufficient data allowed and narrative synthesis summarised all remaining data. Results: Twelve RCTs (reported in 15 articles), involving 3410 participants, were included in the review. The frequency, content and purpose of the home visit varied considerably. The data from eight trials were suitable for meta-analysis of the effects on hospital admissions and mortality, and from three trials for the effects on quality of life. Overall there was no evidence of reduction in hospital admissions (risk ratio (RR) of 1.01 (95%CI 0.86 to 1.20, I 2 = 69.0%, p = 0.89; 8 studies, 2314 participants)), or mortality (RR of 1.01 (95%CI 0.81 to 1.26, I 2 = 0%, p = 0.94; 8 studies, 2314 participants)). There was no consistent evidence of an effect on quality of life, medication adherence or knowledge. Conclusion: A systematic review of twelve RCTs assessing the impact of pharmacist home visits for individuals at risk of medication related problems found no evidence of effect on hospital admission or mortality rates, and limited evidence of effect on quality of life. Future studies should focus on using more robust methods to assess relevant outcomes.

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Core Outcome Set for Trials Aimed at Improving the Appropriateness of Polypharmacy in Older People in Primary Care

Abstract: A COS for interventions aiming to improve the appropriateness of polypharmacy for older people in primary care has been developed. Future work will focus on identifying appropriate tools to measure.

Cited by 77 publications

References 26 publications

Standard of practice in geriatric medicine for pharmacy services

Standard of practice in geriatric medicine for pharmacy services

Tools for Deprescribing in Frail Older Persons and Those with Limited Life Expectancy: A Systematic Review

Effectiveness of pharmacist home visits for individuals at risk of medication-related problems: a systematic review and meta-analysis of randomised controlled trials

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