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Tools for Assessment of the Appropriateness of Prescribing and Association with Patient-Related Outcomes: A Systematic Review

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Abstract

Background

There are tools and criteria in the literature aimed at distinguishing between appropriate and inappropriate medicines use. However, many have not been externally validated with regard to patient-related outcomes, potentially limiting their use in clinical practice.

Objectives

The aim of the study was to conduct a systematic review to summarise (1) available prescribing appropriateness assessment tools and criteria, and (2) their associations with patient-related outcomes (external validity).

Methods

A systematic review was conducted using MEDLINE, EMBASE and Informit (Health Collection) databases to screen for articles in English that examined (1) tools to assess the appropriateness of prescribing and (2) associations of tools with patient-related outcomes, published between 2000 and 2016, without any limits placed on the study design, participant age or setting.

Results

After screening 1710 articles, removing duplicates and shortlisting relevant articles, 42 prescribing assessment tools were identified. Out of the 42 tools, 78.6% (n = 33) provided guidance around stopping inappropriate medications, 28.6% (n = 12) around starting appropriate medications, 61.9% (n = 26) were explicit (criteria based) and 31.0% (n = 13) had been externally validated, with hospitalisation being the most commonly used patient-related outcome (n = 9, 21.4%).

Conclusion

The results of this systematic review highlight the need for evidence-based and externally validated tools, which combine the different aspects of medication management to optimise patient-related outcomes. PROSPERO registration number: CRD42017067233.

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Authors and Affiliations

  1. Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, SA, Australia

    Nashwa Masnoon, Lisa Kalisch-Ellett & Gillian E. Caughey

  2. Department of Pharmacy, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia

    Nashwa Masnoon

  3. Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia

    Sepehr Shakib & Gillian E. Caughey

  4. Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia

    Sepehr Shakib & Gillian E. Caughey

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Nashwa Masnoon is supported by an Australian Government Research Training Program (RTP). No other sources of funding were used to assist in the preparation of this article.

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Nashwa Masnoon, Sepehr Shakib, Lisa Kalisch-Ellett and Gillian Caughey declare that they have no conflicts of interest relevant to the content of this review.

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Masnoon, N., Shakib, S., Kalisch-Ellett, L. et al. Tools for Assessment of the Appropriateness of Prescribing and Association with Patient-Related Outcomes: A Systematic Review. Drugs Aging 35, 43–60 (2018). https://doi.org/10.1007/s40266-018-0516-8

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