Table 2 Study characteristics

Pharmacists-led medication review

Khera S 2019 [33]

Quasi-experiment (pre- post- comparison)

Primary care

Canada

N = 54

Age: 81 ± 6.74

Gender: F 61%

Structured medication review in a primary care team-based seniors’ program. Medication review that included

(1) preparing draft medication plan;(2) meet with patient and caregiver; (3) finalise medication plan/report; (4) following up

NR

Pre- and post- intervention

12 months

Electronic Frailty Index (e-FI)

STOPP/START and Beers criteria in addition to pharmacist’s expertise

Primary outcomes: NA

Secondary outcomes Medication-related outcomes: No significant changes in total number (12.1 meds pre to 11.7meds post, P = .254).

Significant decrease in number of PIMs (1.15 meds pre to 0.9 meds post; P = .006).

A statistically significant correlation between number of PIMs and frailty (r = 0.280, P = .040).

Feasibility

72% of the deprescribing recommendations were implemented

Ailabouni N 2019 [34]

Quasi-experiment (pre- and post- comparison)

Three Residential Care Facilities

New Zealand

N = 46

Age: not specified (inclusion ≥65 years old)

Gender: F 74% (n = 34)

Patient-centred collaborative pharmacist-led medication review with GPs including (Medical history, initial consultation, deprescribing medication review, development of medication management plan, monitoring and follow up

anticholinergic and sedative medicines (tramadol, codeine, citalopram, Escitalopram, amitriptyline)

Same participants before the intervention (pre-post design)

6 months

the Edmonton Frailty Scale

peer-reviewed deprescribing guidelines of sedatives and anticholinergic medicines developed by the research team

Primary outcomes:

Significant decrease in -adverse drug reactions by a mean difference of 2.8 (95% CI; p < 0.05) and 4.2 (95% CI; p < 0.05) 3 and 6 months after deprescribing

-Psychiatric adverse effects decreased by a mean difference of 1.8

(p < 0.05; 95%, CI) and 2.24 (p < 0.05; 95%, CI) after 3 and 6 months

Secondary outcomes

Clinical outcomes:

No significant changes in cognition or QoL 6 months after deprescribing.

Significant decrease in -number of falls 6 months post deprescribing.

-depression scores (Median difference: − 2; p < 0.05).

-frailty scores 6 months after deprescribing (mean difference = 1.35 (p < 0.05,95%, CI).

Medication-related outcomes:

Significant reduction in:

-total N of meds (2.13 medicines per patient)

-Drug burden index scores by 0.34 6 months after deprescribing

Feasibility

72% of the recommendations agreed and implemented

Whitty R 2018 [35]

Prospective interventional cohort study

Hospital (General internal medicine ward)

Canada

104 (Intervention = 53

Control = 51

Age: intervention 79.6 ± 11.7 years control 79.2 ± 13.4 years

Gender: intervention F 43%

Control F 63%

1.Medication review by the Medication Rationalization team MERA (pharmacists and physicians) using guideline-based algorithm.

2.Their recommendations to stop, or change dose of medicines then reviewed by the ward pharmacist and physician.

vitamins/minerals, lipid-lowering agents, herbal supplements, proton pump inhibitors, docusate, Antiplatelets

Benzodiazepines, Bisphosphonates, Dihydropyridine, Opioids

eligible patients admitted concurrently to general internal medicine wards where the intervention was not delivered

Follow up: 3 months after discharge

Clinical Frailty Score

Score ≥ 4

a guideline-

based algorithm based on STOPP guidelines,

Beers criteria, Choosing Wisely, and choosing wisely

Canada

Primary Outcomes: NA

Secondary outcomes

Medication-related outcomes:

Reduction in number of medications by a mean of 3 per patient, Significant decrease in number PIMs (3.1 intervention v. 0.9 control meds per patient, p < 0.01).

Feasibility

81% of total recommendations were accepted by the admitting physician

Acceptability

87% participants felt comfortable stopping medications as recommended by the team and only a very small number found the experience stressful or confusing (5 and 11% respectively)

Cost-related outcomes: The total direct cost saved of stopped medications was $1508.47, or $94.28 per 100 patient-days.

Multidisciplinary team (MDT)-led medication review intervention

Curtin D 2019 [36]

Randomized controlled trial

Hospital (in transition to care homes)

Ireland

N = 130 (65 in the intervention group, 65 in the control group)

Age = 85.1 (±5.7) Gender = 61% F.

Single pre-discharge STOPPFrail-guided deprescribing. The research Physician recommended a medication withdrawal plan to one of the participant’s attending physicians and also documented in the patient’s medical record. The attending physician judged whether or not to accept the drug withdrawal plan and implement the recommended changes.

Lipid lowering therapies, neuroleptic antipsychotics, proton pump inhibitors, antiresorptive/bone anabolic drugs, calcium supplementation, and multivitamin combination supplements.

Usual pharmaceutical care

3 months

Clinical Frailty Index (CFS score ≥ 7)

STOPPFrail

Primary outcomes:

No significant difference between groups for hospitalisation, mortality

Secondary outcomes:

Clinical outcomes:

No significant differences between the groups in incident of falls or fractures.

QoL deteriorated significantly in both the intervention and control groups from baseline to 3-months, but no statistically significant differences were found between the groups

Medication-related outcomes

Reduction in the number of meds of 2.6 in the intervention group vs 0.36 in the control group (p < 0.001).

Cost-related outcomes

mean difference in the monthly medications cost of $61.74 ± $26.60; 95% CI; P = 0.02) between the intervention and the control groups.

Garfinkel D 2017 [37]

A longitudinal, prospective, nonrandomized study

Community dwelling people

Israel

177 (122 in the intervention group and 55 in the comparator group)

64% female)

Age: 83.4 ± 5.3 in the PDP group, and 80.8 ± 6.3 in the NR group

Gender: F 64%

Medication review performed at home by a geriatrician to implement poly-deprescribing (PDP) of 3 or more drugs in collaboration with GPs. it combines ethics, EBM and clinical judgement while giving the highest priority to patient/ family preferences.

Statins, aspirin, benzodiazepines, proton pump inhibitor, antihypertension drugs, SSRI/SNRIs

The non-response group (NR) including participants who agreed to stop only 2 medication or less

follow up: 3 years

Fried frailty phenotype

concurrent de-prescribing of multiple medications based on the Garfinkel algorithm

Primary Outcomes:

The number of major complications was significantly reduced (p < 0.002 in all).

The rate of hospitalizations (RR = 0.86, 95% CI: 0.58–1.29) and survival (66.7%} 6.4% for the control group versus 77%} 3.8% for the intervention group) were comparable

Secondary outcomes

Clinical outcomes

The PDP group showed significantly less deterioration (sometimes improvement) in health parameter: functional (OR = 4.63, 95% CI: 2–10.72), mental (OR = 60.41,95% CI: 16.38–222.82) and cognitive status (OR = 4.394, 95% CI: 1.93–9.98) night sleep quality (OR = 10.65, 95% CI: 4.06–27.96), daily alertness (OR = 5.38, 95% CI: 1.95–14.84), appetite (OR = 15.89, 95% CI: 4.91–51.45), and sphincter control (OR = 6.77, 95% CI: 2.54–18.03).

Medication-related outcomes: the median number of drugs reduced from 11 to 4 in PDP group (p <0.0001).

Feasibility

91% of the recommendations made by a geriatrician were accepted by GPs

Acceptability

The overall satisfaction of patient/family from the changes was defined as high/very high in 89% (n = 109)

O. Dalleur 2014 [38]

Randomised controlled trial

Hospital, Belgium

146 (intervention = 74, control group = 72)

Median age = 85 (IQR 81–88)

Gender: F 63%

Medication review on admission using STOPP criteria by inpatient geriatric consultation team (consisting of nurses, geriatricians, a dietician, an occupational therapist, a physiotherapist, a speech therapist, and a psychologist) who makes recommendation to the hospital physician for the discontinuation of PIMs.

Benzodiazepines, antiplatelet, b-blockers, tricyclic antidepressants, and neuroleptics

Non-matched randomised control group (usual care without using STOPP tool)

Follow up: 12 months (only for those with PIMs identified, 50 patients; 26 in intervention group and 24 in the control group)

Identification of Seniors At Risk (ISAR) score of ≥2/6

Median score = 3

STOPP criteria

Primary outcomes: NA

Secondary outcomes

Medication-related outcomes

At discharge, the reduction in PIMs was twice as high for the intervention group as for the control group (39.7 and 19.3%, respectively; [OR] 2.75 [95% CI = 1.22–6.24]; p = 0.013).

PIM discontinuation rate of benzodiazepines tended to be higher in the intervention than in the control group (34.6 vs. 6.7%; p = 0.063)

At the patient level, the reduction in the prevalence of PIMs (i.e. patients having one or more PIM) did not differ between the intervention group and the control group (23.1 vs. 16.1%; OR 1.5 [95% CI 0.49–4.89]; p = 0.454). However, the proportion of patients with at least one improvement to their drug treatment was higher for the intervention group than for the control group (25.7 vs. 13.9%; p = 0.034).