Use of the Drug Burden Index to identify and reduce potentially inappropriate prescribing of anticholinergic and sedative agents in elderly patients in institutionalized care: a systematic review protocol

Abstract

Review question/objective The aim of this review is to critically appraise, synthesize and present evidence on the use of the Drug Burden Index (DBI) to identify and reduce potentially inappropriate prescribing of anticholinergic and sedative agents in elderly patients in institutionalized care. More specifically, this review seeks to answer the following questions: 1.In which specific settings and patient groups has the Drug Burden Index been applied? 2.Which outcomes have been studied? (E.g. occurrence and incidence of adverse drug reactions, physical functioning, mental functioning, cause of admission to hospital, etc.) 3.Has the use of the Drug Burden Index impacted upon inappropriate prescribing of anticholinergic and sedative agents to elderly patients in institutionalized care? (E.g. cessation of therapy, prescribing altered to other agents, reduction in adverse drug reactions, etc.) Inclusion criteria Types of participants The focus of this review will specifically be on ‘elderly patients’ as described within the studies. If no classification is given within studies, then only those studies reporting on patients aged 65 years and over will be included in the review. Furthermore, patients receiving care within either hospital or care home settings (institutionalized care) will be included in the review. The care of these patients and hence the use of the Drug Burden Index is likely to be markedly different to home dwelling patients. Types of intervention(s) Use of the Drug Burden Index tool to identify and reduce potentially inappropriate prescribing of anticholinergic or sedative medications. Types of comparisons Patients with a score of zero on the Drug Burden Index (i.e. no prescription of anticholinergic or sedative medicines) compared to the Drug Burden Index score; or different levels of Drug Burden Index scores between sub-samples of patients. Most studies will have no comparison. Types of outcomes This review will consider studies that include the following outcome measures: 1.Drug Burden Index scores 2.Physical and mental functioning; adverse effects of anticholinergic and sedative medicines 3.Changes to therapy following application of the Drug Burden Index as a tool to identify potentially inappropriate prescribing