A set of systematic reviews to help reduce inappropriate prescribing to older people: study protocol

BMC Geriatrics

Study Protocol

Ilkka Kunnamo¹  Anja Rieckert²  Christina Sommerauer²  Andreas Sönnichsen²  Anna Renom-Guiteras³  Aneez Esmail⁴  David Reeves⁴  Yolanda V. Martinez⁴  R. Erandie Ediriweera de Silva⁵ 

[1] Duodecim Medical Publications Ltd, Helsinki, Finland;Institute of General Practice and Family Medicine, Witten/Herdecke University, Witten, Germany;Institute of General Practice and Family Medicine, Witten/Herdecke University, Witten, Germany;Department of Geriatrics, University Hospital Parc de Salut Mar, Barcelona, Spain;NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, England, UK;NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, England, UK;Family Medicine Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;

关键词: Polypharmacy;    Multimorbidity;    Older adults;    Inappropriate prescribing;   

DOI  :  10.1186/s12877-017-0570-9

来源: Springer

【 摘 要 】

BackgroundMultimorbidity and polypharmacy are common in older people. Assessment tools or lists of criteria aimed at supporting prescription decisions for older people exist, but have often been based on expert opinion with insufficient consideration of the evidence available. The present paper describes the methods we are using to systematically review the existing evidence on the efficacy and safety of the most commonly prescribed drugs for older people in the management of their chronic medical conditions and to develop recommendations to reduce inappropriate prescriptions for incorporation into the Comprehensive Medication Review (CMR) tool developed by the PRIMA-eDS European project.MethodsWe selected the 20 most relevant drugs/drug classes in terms of prescription volumes and risk of hospitalisation for older people and the most relevant indications for the most common chronic conditions among older people and a total of 35 distinct drug-indication pairs were chosen. Based on clinical considerations we collapsed some indications together, reducing the 35 pairs to a final total of 22 separate systematic reviews (SR). A common methodology will be used for each individual SR, based on the methodological manuals of the Cochrane collaboration and the PRISMA statement for reporting systematic reviews. Our search strategy will have a staged approach where we initially search for systematic reviews and meta-analyses, but if relevant reviews are not found, then search for individual studies (controlled intervention and observational studies). Our pilot work and initial scoping of the literature suggested that very few, relevant individual trials or existing systematic reviews have researched or reported exclusively on older people. Therefore, sufficient data might not be available to perform meta-analysis but we will provide a narrative synthesis describing characteristics and findings of included studies. The collected evidence will be used to construct recommendations on when not to use or to discontinue a drug, or when to reduce its dose. Recommendations will be developed in team meetings using the GRADE methodology to reflect the strength of the recommendation and the quality of the evidence. Recommendations will be built into the CMR tool.DiscussionThis protocol has been prepared for a series of systematic reviews which will provide research-based evidence to develop recommendations to reduce inappropriate polypharmacy in older people as part of the CMR tool of the PRIMA-eDS project.

【 授权许可】

CC BY   
© The Author(s). 2017