Effectiveness of different medication management measures in older patients with chronic diseases and Polypharmacy: A systematic review and network meta-analysis.

PURPOSE

Currently there is still no network meta-analysis of the effectiveness of different medication management measures for older adults with chronic diseases and polypharmacy. Therefore, a network meta-analysis was conducted to assess the impact of different management measures on older patients with chronic diseases and polypharmacy.

METHODS

Multiple databases, including PubMed, Web of Science, Embase, Cochrane Library, and CINAHL, were searched from inception to February 28, 2024. The inclusion criteria were the following: Population: older adults with chronic diseases who required long-term polypharmacy; Intervention: medication management measures; Comparison: usual care or a blank control; Outcome: 1) number of medications; 2) self-rated quality of life; 3) mortality, hospital admission rate, and fall rate; Study design: randomized controlled trials (RCTs).Methodological quality was assessed by version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). In this study, R4.3.3 and Stata 17.0 were used to generate a flow diagram for network meta-analysis (NMA).

RESULTS

A total of 25 RCTs were included in the study. They involved 15794 patients and 7 medication management measures below: medication review (MR), medication record (MRD), deprescribing interventions (DI), medication review with follow-up (MRF), medicine electronic decision support tool (EDS), medication therapy management (MTM), and pharmacotherapy consultation and education (CE). The league table results showed that DI was superior to the control in improving prescription appropriateness (MD = -0.90, 95 % CI: -1.83,-0.11, P < 0.05), and MRF was superior to DI in decreasing the hospital admission rate (RR = 0.26, 95 % CI: 0.06, 0.93, P < 0.05). The surface under the cumulative ranking curve (SUCRA) values showed that DI (88.30 %) was the most promising management measure to improve prescription appropriateness. MRF was the most promising management measure to improve self-rated quality of life (93.04 %) and reduce the hospital admission rate (96.41 %). CE was the most promising management measure to reduce mortality (68.69 %). EDS was the most promising management measure to reduce the fall rate (69.46 %). The results of cluster analysis showed that MR was the most promising management measure to evaluate all outcome measures.

CONCLUSION

Currently, for polypharmacy management in older patients with chronic diseases, DI, MRF, CE, and EDS are the most promising management measures to improve the appropriateness of prescribing, improve self-rated quality of life and reduce the hospital admission rate, reduce mortality, and reduce the fall rate, respectively. However, this conclusion needs to be confirmed by more large-sample, multicenter RCTs due to the limitations of existing studies.

REGISTRATION

The registration number was CRD42024540141.