Optimizing Medication Use in Older Adults in Primary Care: A Systematic Review of the Effectiveness of Deprescribing Interventions

Resumo original em inglês

O que aconteceu

The increasing prevalence of polypharmacy and potentially inappropriate medications (PIMs) among older adults in Primary Health Care (PHC) poses significant risks to older patients. However, the best deprescribing approach is not well established. This systematic review aimed to evaluate the effectiveness and applicability of various deprescribing techniques in PHC.

We conducted a systematic review of randomized clinical trials from 2010 to 2026 across the PubMed, EMBASE, and LILACS databases that compared deprescribing techniques with usual care in older patients in PHC. A narrative synthesis was employed to present the findings, and the quality of included studies was rigorously assessed using the Cochrane Risk of Bias Tool (RoB 2) and the GRADE system.

O que encontraram

From a screening of 1032 unique citations, 17 studies met the inclusion criteria. These studies investigated a range of deprescribing interventions, including automated algorithms, multidisciplinary approaches, educational activities, pharmacist-led, and physician-conducted medication reviews. Automated algorithms and pharmacist-led interventions consistently demonstrated significant efficacy in reducing potentially inappropriate medications. Conversely, multidisciplinary interventions and educational activities yielded mixed results regarding overall medication reduction. Notably, medication reviews performed solely by family physicians did not reduce PIMs. No significant effects on mortality were observed across any interventions, and a cluster-level reduction in hospitalizations was reported by one study.

Por que isso importa

Deprescribing techniques, particularly automated algorithms and pharmacist-led interventions, appear effective in reducing the use of potentially inappropriate medications among older adults in PHC. Future research should prioritize standardizing outcomes and conducting studies designed to comprehensively assess the clinical impacts of deprescribing.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.