Theoretically derived interventions aimed at improving appropriate polypharmacy in primary care: A systematic review

Area of Science:

• Geriatric Medicine
• Clinical Pharmacy
• Health Services Research

Background:

• Polypharmacy is prevalent in older adults, posing challenges for prescribers balancing appropriate and inappropriate medication use.
• Developing complex interventions often benefits from theoretical underpinnings, yet the efficacy of theory-driven approaches for appropriate polypharmacy remains unclear.

Purpose of the Study:

• To systematically review the effectiveness of theoretically derived interventions in improving appropriate polypharmacy.
• To assess the extent to which theory informed the design of these interventions.

Main Methods:

• A systematic review of seven databases (inception to August 2021) and reference lists.
• Inclusion criteria: theory-based interventions, validated prescribing assessment tools, primary care, participants aged ≥65 years, ≥four medications.
• Theory Coding Scheme (TCS) and Cochrane Risk of Bias (RoB) 2.0 tool were used for evaluation.

Main Results:

• Only two studies (one feasibility, one RCT) met the inclusion criteria, preventing an overall effectiveness assessment.
• Interventions utilized the Theoretical Domains Framework and Reason's risk management theory.
• The RCT had high RoB, and neither study fully incorporated theory per TCS.

Conclusions:

• The effectiveness of theoretically derived interventions for appropriate polypharmacy in primary care remains undetermined due to limited, heterogeneous studies.
• Further integration of theory into intervention development is necessary to ascertain the value of this approach.