Optimizing Medication Use in Older Adults in Primary Care: A Systematic Review of the Effectiveness of Deprescribing Interventions
Abstract
Objective: The increasing prevalence of polypharmacy and potentially inappropriate medications (PIMs) among older adults in Primary Health Care (PHC) poses significant risks to older patients. However, the best deprescribing approach is not well established. This systematic review aimed to evaluate the effectiveness and applicability of various deprescribing techniques in PHC.
Methods: We conducted a systematic review of randomized clinical trials from 2010 to 2026 across the PubMed, EMBASE, and LILACS databases that compared deprescribing techniques with usual care in older patients in PHC. A narrative synthesis was employed to present the findings, and the quality of included studies was rigorously assessed using the Cochrane Risk of Bias Tool (RoB 2) and the GRADE system.
Results: From a screening of 1032 unique citations, 17 studies met the inclusion criteria. These studies investigated a range of deprescribing interventions, including automated algorithms, multidisciplinary approaches, educational activities, pharmacist-led, and physician-conducted medication reviews. Automated algorithms and pharmacist-led interventions consistently demonstrated significant efficacy in reducing potentially inappropriate medications. Conversely, multidisciplinary interventions and educational activities yielded mixed results regarding overall medication reduction. Notably, medication reviews performed solely by family physicians did not reduce PIMs. No significant effects on mortality…
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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