Introduction
Medication reviews are used as a tool to combat inappropriate
polypharmacy and associated adverse effects.1 In numerous trials, medication
reviews have decreased the number of potentially inappropriate medicines
and increased the prescribing
appropriateness.2
We have previously reported on the clinical effects of medication
reviews as a supplement to usual care in a geriatric outpatient
clinic.3 In a randomized clinical trial, medication
reviews reduced the number of medicines after 4 months and led to
relative increases in the patient’s health-related quality of life
(HRQoL) and reduced mortality. The combined beneficial effect on HRQoL
and mortality support that the discontinued and dose-reduced medicines
were in fact inappropriate and not merely potentially inappropriate. Thus, a detailed description of these medicines seem
warranted as these medicines could be discontinued in a pragmatic
clinical trial setting and thus are of clinical relevance for medication
reviews in geriatric outpatients.
The purpose of this paper is twofold: 1) to provide a detailed
description of the medication changes implemented during medication
reviews to better understand the observed beneficial clinical effects
and to guide future medication review interventions; and 2) to explore
patient- and medication-related factors that may identify patients that
will benefit most from medication reviews. To fulfill these purposes,
the detailed descriptions include: 1) the actual changes to the
medicine; 2) the persistence of the changes; 3) the medicines most often
discontinued; 4) the reasons for discontinuing; 5) the medicines that
most often were prescribed again after discontinuation; and 6) an
exploratory analysis of factors that predicted the number of
overprescribed medicines to help identify patients that may benefit the
most from medication reviews.