Interventions to Reduce Adverse Drug Event-Related Outcomes in Older Adults: ASystematic Review and Meta-analysis.

Abstract

Many studies focus on interventions that reduce the processes that lead to adverse drug events (ADEs), such as inappropriate or high-risk prescribing, without assessing whether they result in a reduction in ADEs or associated adverse health outcomes. Our objective was to systematically review interventions to reduce the incidence of ADEs measured by health outcomes in older patients in primary care settings. The review included randomised controlled trials, controlled clinical trials, controlled before and after studies, interrupted time series studies and cohort studies conducted in the community care setting. Older patients (aged ≥ 65years) receiving medical treatment in primary care were included. Interventions wereaimed at reducing adverse health outcomes associated with ADEs in older patients. Risk of bias was assessed using the Cochrane Collaboration's tool. Outcomes were measured by reductions in hospitalisation, emergency department (ED) visits, mortality and improvements in quality of life (QoL), mental health and physical function. Fixed and random-effects models were used to calculate pooled effect estimates comparing interventions and control groups for the outcomes, where feasible. The literature search identified 1566 abstracts, seven of which were included in the systematic review. The interventions for reducing ADEs included prescription or medication reviews by a pharmacist (n = 4), primary care physician (n = 1) or research team (n = 1), and an educational intervention (n = 1) for nursing staff to improve the recognition of potentially harmful medications and corresponding ADEs. Meta-analysis found no statistically significant benefit from any interventions on hospitalisation, ED visits, mortality, QoL or mental health and physical function. No significant benefit was gained from any of the interventions in terms of the outcomes considered. New approaches are required to reduce ADEs in older adults.