METHODS
This systematic review was informed by a literature search performed by LC on 18th October 2021 of publications from January 1990 until the search date. The search terms included the following: Outpatients [All Fields] OR Geriatric Assessment [All Fields] AND Polypharmacy [All Fields] OR Deprescription [All Fields] in PubMed and Embase, as well as hand searches of reference lists of initially found publications. Studies were included if they were published in English and measured change in medication load as a result of an intervention conducted within the setting of a specialist outpatient clinic. Articles were excluded if the study was based within another medical setting or did not include our target patient group of older patients. Articles examining interventions relating to change in drug-related problems, but did not measure change in medication burden (as defined by number of medications or number of inappropriate medications) were excluded. Where change in number of inappropriate medications were measured, only trials using validated tools (implicit or explicit) were included. Studies using expert opinion or self-developed algorithms were only included if they measured total medication count, rather than number of potentially inappropriate medications. For this review, we focused on patients older than 60 years of age. Studies were included with younger patients if the majority were within the older age group.
Trials were assessed by two authors (LC and LH) for methodological quality according to the revised Cochrane risk-of-bias tools.23,24 Smaller, pilot and prospective studies were also included in the analysis, given the limited research available and novel area under review.
The search resulted in 4,362 publications. After exclusion of 4,324 publications based on title and abstract and excluding 19 publications after full-text review, 19 were deemed to be eligible for inclusion in the review (Supplement 1).
The key characteristics of the eligible publications are summarized in Supplement 2. Due to substantial heterogeneity between studies, a qualitative synthesis of the literature was completed. The primary outcome reviewed was change in medication load as measured by a decrease in medication count or decrease in potentially inappropriate medication. Secondary outcomes reviewed included maintenance of deprescription and clinical benefits from deprescription.