Evidence map›Paper›PMID 27059768›Full record

SynthesisBritish journal of clinical pharmacology2016

Impact of strategies to reduce polypharmacy on clinically relevant endpoints: a systematic review and meta-analysis.

Tim Johansson, Muna E Abuzahra, Sophie Keller, Eva Mann, Barbara Faller, Christina Sommerauer, Jennifer Höck, Christin Löffler, Anna Köchling, Jochen Schuler and 2 more

2 registry-linked trialsAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in British journal of clinical pharmacology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 97 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
97citing papers in PubMed, 11 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03903484 nacompletednot on this mapstarted 2019, after this paper: background citation

A Collaborative Intervention for Streamlining Medication Appropriateness and Deprescribing Within Integrated Health-Care Teams

TypeinterventionalSponsorNova Scotia Health AuthorityRan2019 to 2022Enrolled7ConditionsInappropriate Prescribing, Primary Health Care, PolypharmacyArmsDeprescribing toolbox and intervention
NCT06324045 narecruitingnot on this mapstarted 2024, after this paper: background citation

Development and Evaluation of a Multidisciplinary Team Delivered Deprescribing Intervention for Patients With Chronic Kidney Disease in Qatar: A Randomized Controlled Trial

TypeinterventionalSponsorHamad Medical CorporationRan2024 to 2026Enrolled424ConditionsChronic Kidney DiseasesArmsDeprescribing
3 · Its place in the literature

Who cites it

97 citing papers in PubMed, 11 syntheses or guidelines pooled it.

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  6. A systematic overview of systematic reviews evaluating interventions addressing polypharmacy.American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists · 2019
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37 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Tim JohanssonInstitute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, 5020, Salzburg, Austria.
Muna E AbuzahraInstitute of General Practice and Evidence-based Health Services Research, Medical University of Graz, 8036, Graz, Austria.
Sophie KellerInstitute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, 5020, Salzburg, Austria.
Eva MannInstitute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, 5020, Salzburg, Austria.
Barbara FallerInstitute of General Practice and Family Medicine, University of Witten/Herdecke, 58448, Witten, Germany.
Christina SommerauerInstitute of General Practice and Family Medicine, University of Witten/Herdecke, 58448, Witten, Germany.
Jennifer HöckInstitute of General Practice, Rostock University Medical Center, 18057, Rostock, Germany.
Christin LöfflerInstitute of General Practice, Rostock University Medical Center, 18057, Rostock, Germany.
Anna KöchlingInstitute of General Practice, Rostock University Medical Center, 18057, Rostock, Germany.
Jochen SchulerInstitute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, 5020, Salzburg, Austria.
Maria FlammInstitute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, 5020, Salzburg, Austria.
Andreas SönnichsenInstitute of General Practice and Family Medicine, University of Witten/Herdecke, 58448, Witten, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimThe aim of the present study was to explore the impact of strategies to reduce polypharmacy on mortality, hospitalization and change in number of drugs.

methodsSystematic review and meta-analysis: a systematic literature search targeting patients ≥65 years with polypharmacy (≥4 drugs), focusing on patient-relevant outcome measures, was conducted. We included controlled studies aiming to reduce polypharmacy. Two reviewers independently assessed studies for eligibility, extracted data and evaluated study quality.

resultsTwenty-five studies, including 10 980 participants, were included, comprising 21 randomized controlled trials and four nonrandomized controlled trials. The majority of the included studies aimed at improving quality or the appropriateness of prescribing by eliminating inappropriate and non-evidence-based drugs. These strategies to reduce polypharmacy had no effect on all-cause mortality (odds ratio 1.02; 95% confidence interval 0.84, 1.23). Only single studies found improvements, in terms of reducing the number of hospital admissions, in favour of the intervention group. At baseline, patients were taking, on average, 7.4 drugs in both the intervention and the control groups. At follow-up, the weighted mean number of drugs was reduced (-0.2) in the intervention group but increased (+0.2) in controls.

conclusionsThere is no convincing evidence that the strategies assessed in the present review are effective in reducing polypharmacy or have an impact on clinically relevant endpoints. Interventions are complex; it is still unclear how best to organize and implement them to achieve a reduction in inappropriate polypharmacy. There is therefore a need to develop more effective strategies to reduce inappropriate polypharmacy and to test them in large, pragmatic randomized controlled trials on effectiveness and feasibility.

Indexed as

PolypharmacyAgedDrug-Related Side Effects and Adverse ReactionsHospitalizationHumansInappropriate PrescribingOutcome Assessment, Health CarePractice Patterns, Physicians'Randomized Controlled Trials as Topicagedhospitalisationmedication therapy managementmeta-analysismortalitypolypharmacy

Identifiers

PMID27059768
PMCPMC4972170

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.