Acceptability of Interventions to Address Polypharmacy in Older Adult Outpatients: A Systematic Review and Meta-Analysis

Abstract

Background and Aims: Interventions to address potentially inappropriate prescribing (PIP), where risks outweigh benefits, are effective but often not implemented due to barriers (e.g., patient, provider, systems). Concerns about questioning healthcare providers or symptom resurgence when discontinuing medications may make PIP interventions less acceptable. This systematic review aims to determine the acceptability of PIP interventions among older adult outpatients. Methods: We searched MEDLINE, Embase, and other databases for controlled studies of PIP interventions including older adults (≥ 65 years) residing in community or care home settings. The review included interventions aimed at reducing PIP, whether clinical or external providers. We assessed risk of bias and performed a meta-analysis. Results: Nine studies (n = 4,843) were included: six randomized controlled trials, two prospective cohort studies, and one pre-post study. Studies spanned the US, England, Ireland, Lebanon, the Netherlands, Spain, and Switzerland. Seven out of nine (78%) studies were assessed as having a low risk of bias; two out of nine (22%) at moderate risk. Meta-analysis showed no significant difference in patient satisfaction between PIP interventions and standard care, though satisfaction was slightly higher with PIP interventions (SMD 0.45; 95% CI −0.14 to 1.04, I² = 96%, n = 4,414). Meta-analysis showed more patients discussed discontinuing medications with their prescriber after a PIP intervention (RR 4.32; 95% CI 0.0 to 56,270, I² = 43%, n = 429). Conclusion: PIP interventions are as acceptable to patients as usual care, despite some burden for patients and prescribers. Patients are more willing to engage in deprescribing conversations when a deprescribing intervention is present.