A systematic overview of systematic reviews evaluating interventions addressing polypharmacy

Area of Science:

• Gerontology
• Pharmacology
• Evidence-Based Medicine

Background:

• Polypharmacy, the use of multiple medications, is a prevalent issue, particularly in older adults.
• Managing polypharmacy is crucial for patient safety and effective healthcare.
• Systematic reviews (SRs) provide valuable insights into interventions addressing polypharmacy.

Purpose of the Study:

• To systematically evaluate and summarize evidence from multiple systematic reviews (SRs) on interventions targeting polypharmacy.
• To assess the quality of evidence and compare conclusions across relevant SRs.
• To synthesize findings on the impact of polypharmacy interventions on various outcomes.

Main Methods:

• Searched MEDLINE, Cochrane Database of SRs, and DARE for SRs on polypharmacy interventions (2004-2017).
• Included SRs with Assessment of Multiple Systematic Reviews (AMSTAR) scores ≥ 8.
• Extracted and summarized evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

Main Results:

• Six high-quality SRs were included, primarily focusing on older adults.
• Interventions showed modest improvements in medication appropriateness (very low-quality evidence).
• Evidence for impact on patient-centered outcomes (morbidity, mortality, utilization) was inconsistent or null.

Conclusions:

• Polypharmacy interventions may improve medication appropriateness.
• There is a lack of consistent evidence demonstrating benefits on downstream patient-centered outcomes.
• High-quality SRs highlight the need for further research into effective polypharmacy management strategies.