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Cumulative Update of a Systematic Overview Evaluating Interventions Addressing Polypharmacy.

Michelle S Keller^1,2,3, Nabeel Qureshi^1,4, Allison M Mays⁵

¹Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.

JAMA Network Open

|January 10, 2024

Summary

Polypharmacy interventions show limited evidence for improving key clinical outcomes. More research is needed to identify effective strategies and target populations for polypharmacy management.

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Area of Science:

Gerontology
Clinical Pharmacy
Health Services Research

Background:

Polypharmacy is linked to adverse outcomes including mortality, falls, hospitalizations, and cognitive decline.
The increasing focus on polypharmacy interventions necessitates an updated systematic overview.

Purpose of the Study:

To systematically evaluate and synthesize evidence from multiple systematic reviews on interventions addressing polypharmacy.

Main Methods:

A comprehensive literature search was conducted for systematic reviews published from January 2017 to October 2022, supplemented by a previous overview.
Systematic reviews were included irrespective of study design, setting, or outcomes.
Evidence was categorized into medication-related process outcomes, clinical/functional outcomes, healthcare use/economic outcomes, and intervention acceptability.

Main Results:

Fourteen systematic reviews were included, representing 179 unique studies.
Interventions showed reductions in potentially inappropriate medications (PIMs) and medication burden, but evidence for clinical outcomes like mortality and falls was predominantly null or low quality.
Hospitalization reductions were observed in some higher-intensity reviews, but overall evidence for healthcare use outcomes was limited.

Conclusions:

This overview found limited evidence supporting polypharmacy interventions for improving major clinical and healthcare utilization outcomes.
Further research is required to determine the most effective interventions and identify specific populations that would benefit most from polypharmacy management strategies.