129DEPRESCRIBING INTERVENTIONS AND THEIR IMPACT ON MEDICATION ADHERENCE IN COMMUNITY-DWELLING OLDER ADULTS WITH POLYPHARMACY: A SYSTEMATIC REVIEW

Abstract

Introduction: Polypharmacy, and the associated adverse drug events such as nonadherence to prescriptions, is a common problem for elderly people living with multiple comorbidities. Deprescribing, i.e. the gradual withdrawal from medications with supervision by a healthcare professional, is regarded as a means of reducing adverse effects of multiple medications, including non-adherence. This systematic review examined the evidence for deprescribing as an effective strategy for improving medication adherence amongst older, community dwelling adults. Methods: Eight scientific databases were searched for quantitative and qualitative studies evaluating the effect of deprescribing or medication review interventions on medication adherence measures in community dwelling older adults with polypharmacy, in accordance with the PRISMA reporting statement. Prospero number CRD42017075315 Results: A total of 22 original studies, involving 5118 participants, met the eligibility criteria and underwent quality appraisal and data extraction processes. Deprescribing and adherence (as a secondary outcome) was identified in randomised controlled trials, observational and cohort studies in 13 countries between 1996-2017. There was a large variation in assessment of adherence and follow-up period. A range of health care professions led a variety of deprescribing interventions, but they were most commonly delivered by pharmacists (16/21 studies). 4 of 22 studies showed a statistically significant reduction in medication with improved adherence. Thirteen studies reported improved adherence. Conclusion: Deprescribing did not routinely improve medication adherence in this patient population. Interventions described in the studies did not convincingly reduce medication burden. A range of bio-psycho-social factors influence adherence that is mostly reported as a secondary outcome. The authors recommend further study into the efficacy and outcomes of medicines management interventions and a consensus on priority outcome measurements for such interventions are indicated.