Abstract
Background
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.
Objectives
Our objective was to systematically review interventions to reduce the incidence of ADEs measured by health outcomes in older patients in primary care settings.
Methods
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 ≥ 65 years) receiving medical treatment in primary care were included. Interventions were aimed 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.
Results
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.
Conclusions
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.
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Change history
27 January 2020
Unfortunately, the co-author name was incorrectly published as ‘ ‘Lamona’’ instead of ‘ ‘Lamorna’’ in the original article
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Acknowledgements
The authors acknowledge Paul Murphy, medical library in RCSI, who assisted with the searches in the systematic review.
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Contributions
KB, CC and CB prepared the protocol on the review; CB, CC, ST refined the search terms; CB, ST and LB reviewed abstracts and full papers with CC; ST, KB and CC conducted analysis. All involved in the interpretation and preparation of the manuscript.
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Funding
KB, CC, CB and ST were funded by a Health Research Board (HRB) Research Leader Award (HRB-RL-2015-1579). The sponsor had no role in the design, methods, data collection, analysis and preparation of the paper.
Conflict of interest
Sarah Tecklenborg, Catherine Byrne, Caitriona Cahir, Lamorna Brown and Kathleen Bennett have no conflicts of interest that are directly relevant to the content of this article.
Data Availability
The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.
Additional information
The original version of this article was revised: The co-author name was corrected to “Lamorna” in the original article.
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Tecklenborg, S., Byrne, C., Cahir, C. et al. Interventions to Reduce Adverse Drug Event-Related Outcomes in Older Adults: A Systematic Review and Meta-analysis. Drugs Aging 37, 91–98 (2020). https://doi.org/10.1007/s40266-019-00738-w
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DOI: https://doi.org/10.1007/s40266-019-00738-w