Joanna Ulley|Deborah Harrop|Ali Ali|Sarah Alton|Sally Fowler?Davis
Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review
Sheffield Teaching Hospitals NHS Foundation Trust|Sheffield Hallam University|Sheffield Teaching Hospitals NHS Foundation Trust|Sheffield Teaching Hospitals NHS Foundation Trust|Sheffield Hallam University
polypharmacy associated adverse drug events nonadherence prescriptions common problem elderly people living multiple comorbidities deprescribing ie gradual withdrawal medications supervision healthcare professional regarded means reducing adverse effects multiple medications including nonadherence systematic review examines evidence deprescribing effective strategy improving medication adherence amongst older community dwelling adults mixed methods review undertaken eight bibliographic database two clinical trials registers searched may december 2017 results double screened accordance predefined inclusionexclusion criteria related polypharmacy deprescribing adherence older community dwelling populations mixed methods appraisal tool mmat used quality appraisal priori data collection instrument used quantitative studies narrative synthesis approach taken qualitative data analysed using framework analysis findings integrated using mixed methods technique review performed accordance prisma reporting statement total 22 original studies included 12 rcts deprescribing adherence outcome measure identified randomised controlled trials rcts observational cohort studies 13 countries 1996 2017 17 pharmacyled interventions others led general practitioners gp nurses four studies demonstrated overall reduction medications studies corresponded improved adherence total thirteen studies reported improved adherence 5 rcts adherence reported secondary outcome one study insufficient evidence show deprescribing improves medication adherence 13 studies 22 reported adherence 5 randomised controlled trials older people particularly susceptible nonadherence due multimorbidity associated polypharmacy biopsychosocial factors including health literacy multidisciplinary team interventions influence adherence authors recommend study efficacy outcomes medicines management interventions consensus priority outcome measurements prescribed medications indicated prospero number crd42017075315