ABSTRACT
Aim: Deprescribing interventions may reduce inappropriate
polypharmacy and the associated negative clinical consequences. This
systematic review examined current research on the effectiveness of
deprescribing interventions implemented within specialist outpatient
clinics.
Methods: This systematic review was informed by a literature
search on 18/10/21 of publications from January 1990 in PubMed and
Embase. Studies were included if they focused on patients ≥60 years and
measured change in medication burden (defined by number of medications
or number of inappropriate medications) as result of an intervention
conducted within a specialist outpatient clinic. Methodological quality
was assessed by 2 authors using the revised Cochrane risk-of-bias tools.
Due to significant heterogeneity between trials, a qualitative synthesis
was completed. The primary outcome reviewed was change in medication
count or potentially inappropriate medication. Secondary outcomes were
maintenance of deprescription and clinical benefits.
Results : 19 studies were included for review that included
10,914 participants. They included geriatric outpatient clinics,
oncology/haematology clinics, haemodialysis clinics and designated
polypharmacy/multimorbidity clinics. Seven RCTs were identified. Other
studies included retrospective evaluations and prospective/pilot
studies. Four RCTs reported statistically significant reduction of
medication burden with intervention, however all studies were assessed
as having a high risk of bias. The studies could be grouped into those
where the deprescribing intervention was physician-led and implemented,
delivered from a multidisciplinary team, or pharmacist-led and physician
implemented.
Conclusion: The evidence for deprescribing interventions in
outpatient clinics is very limited and further research is recommended.
The addition of a pharmacist and validated medication assessment tools
appear to be enablers.