Interventions to Address Potentially Inappropriate Prescribing for Older Primary Care Patients

Importance: Prescriptions for potentially inappropriate medications are common and, by definition, may carry risks that outweigh benefits. Objective: To determine whether interventions to address potentially inappropriate prescribing for older primary care patients are associated with changes in the number of medications prescribed, drug-related harms, hospitalizations, and mortality. Data Sources: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 6, 2024. Study Selection: Randomized clinical trials of interventions to address potentially inappropriate prescribing for older primary care patients (aged ≥65 years) residing in the community or in long-term care facilities, such as nursing homes or assisted-living facilities, were included. Data Extraction and Synthesis: Two researchers independently screened the records and abstracted data using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were pooled using random-effects models. Main Outcomes and Measures: The planned outcomes were the number of medications, nonserious adverse drug reactions, injurious falls, quality of life, medical visits, emergency department visits, hospitalizations, and all-cause mortality. Random-effects meta-analyses were performed using the inverse variance method for similar studies, reporting risk ratios (RRs) or standardized mean differences (SMDs). Heterogeneity was assessed with I2 values, and publication bias was assessed with funnel plots and the Egger regression test. Results: Of the 14 649 records identified, 118 randomized clinical trials (comprising 417 412 patients) were included in this review. Interventions to address potentially inappropriate prescribing were associated with a reduction in the number of medications prescribed (SMD, -0.25 95% CI, -0.38 to -0.13), equivalent to approximately 0.5 fewer medications per patient. However, there were no substantial differences in the other outcomes, including nonserious adverse drug reactions (RR, 0.92 95% CI, 0.58-1.46), injurious falls (SMD, 0.01 95% CI, -0.12 to 0.14), quality of life (SMD, 0.09 95% CI, -0.04 to 0.23), medical visits (SMD, 0.02 95% CI, -0.02 to 0.07), emergency department admissions (RR, 1.02 95% CI, 0.96-1.08), hospitalizations (RR, 0.95 95% CI, 0.89-1.02), or all-cause mortality (RR, 0.94 95% CI, 0.85-1.04). Conclusions and Relevance: In this systematic review and meta-analysis, interventions to address potentially inappropriate prescribing were associated with reductions in the number of medications prescribed, with no substantial change in other outcomes. These findings suggest that inappropriate prescribing interventions may be implemented to safely reduce the number of medications prescribed to older adults in the primary care setting. Future studies should continue to evaluate these interventions using standardized criteria and consistently report potential harms to support data synthesis and capture key outcomes such as quality of life, hospitalization, and mortality.