Interventions to address potentially inappropriate prescriptions and over-the-counter medication use among adults 65 years and older in primary care settings: protocol for a systematic review

Andrew Beck; Navindra Persaud; Laure A Tessier; Roland Grad; Michael R Kidd; Scott Klarenbach; Christina Korownyk; Ainsley Moore; Brett D Thombs; Dee Mangin; Rita K McCracken; Emily G McDonald; Caroline Sirois; Salmaan Kanji; Frank Molnar; Stuart G Nicholls; Kednapa Thavorn; Alexandria Bennett; Nicole Shaver; Becky Skidmore; Bradley R Mitchelmore; Marc Avey; Elizabeth Rolland-Harris; Julian Little; David Moher

doi:10.1186/s13643-022-02044-w

Interventions to address potentially inappropriate prescriptions and over-the-counter medication use among adults 65 years and older in primary care settings: protocol for a systematic review

Syst Rev. 2022 Oct 20;11(1):225. doi: 10.1186/s13643-022-02044-w.

Authors

Andrew Beck¹, Navindra Persaud², Laure A Tessier³, Roland Grad⁴, Michael R Kidd^{5

6}, Scott Klarenbach⁷, Christina Korownyk⁸, Ainsley Moore⁹, Brett D Thombs¹⁰, Dee Mangin^{9

11}, Rita K McCracken¹², Emily G McDonald¹³, Caroline Sirois¹⁴, Salmaan Kanji¹⁵, Frank Molnar^{16

17}, Stuart G Nicholls¹⁸, Kednapa Thavorn¹⁹, Alexandria Bennett²⁰, Nicole Shaver²⁰, Becky Skidmore¹⁹, Bradley R Mitchelmore³, Marc Avey³, Elizabeth Rolland-Harris³, Julian Little²⁰, David Moher²⁰

Affiliations

¹ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. andrew.e.beck@outlook.com.
² Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
³ Global Health and Guidelines Division, Public Health Agency of Canada, Ottawa, Ontario, Canada.
⁴ Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
⁵ College of Health & Medicine, The Australian National University, Canberra, Australia.
⁶ Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
⁷ Department of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
⁸ Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁹ Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
¹⁰ Lady Davis Institute of the Jewish General Hospital and Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
¹¹ Department of General Practice, University of Otago, Dunedin, New Zealand.
¹² Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
¹³ Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
¹⁴ Faculty of Pharmacy, Laval University; Centre d'excellence sur le vieillissement de Québec, VITAM research Centre, Québec, Québec, Canada.
¹⁵ The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹⁶ Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁷ Division of Geriatric Medicine, The Ottawa Hospital, The Ottawa Hospital Research Institute, Bruyere Research Institute, Ottawa, Ontario, Canada.
¹⁸ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹⁹ Independent Information Specialist, Ottawa, Ontario, Canada.
²⁰ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Abstract

Purpose: To inform recommendations by the Canadian Task Force on Preventive Health Care on potentially inappropriate prescribing and over-the-counter (OTC) medication use among adults aged 65 years and older in primary care settings. This protocol outlines the planned scope and methods for a systematic review of the benefits and harms and acceptability of interventions to reduce potentially inappropriate prescriptions and OTC medication use.

Methods: De novo systematic reviews will be conducted to synthesize the available evidence on (a) the benefits and harms of interventions to reduce potentially inappropriate prescriptions and OTC medications compared to no intervention, usual care, or non- or minimally active intervention among adults aged 65 years and older and (b) the acceptability of these interventions or attributes among patients. Outcomes of interest for the benefits and harms review are all-cause mortality, hospitalization, non-serious adverse drug reactions, quality of life, emergency department visits, injurious falls, medical visits, and the number of medications (and number of pills). Outcomes for the acceptability review are the preference for and relative importance of different interventions or their attributes. For the benefits and harms review, we will search MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for randomized controlled trials. For the acceptability review, we will search MEDLINE, Embase, PsycInfo, Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database for experimental and observational studies with a comparator. Websites of relevant organizations, other grey literature sources, and reference lists of included studies and reviews will be searched. Title and abstract screening will be completed by two independent reviewers using the liberal accelerated approach. Full-text review, data extraction, risk of bias assessments, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) will be completed independently by two reviewers, with any disagreements resolved by consensus or by consulting with a third reviewer. The GRADE approach will be used to assess the certainty of the evidence for outcomes.

Discussion: The results of this systematic review will be used by the Canadian Task Force on Preventive Health Care to inform their recommendation on potentially inappropriate prescribing and OTC medication use among adults aged 65 years and older.

Systematic review registration: PROSPERO (KQ1: CRD42022302313; KQ2: CRD42022302324); Open Science Framework ( https://osf.io/urj4b/ ).

Keywords: Guideline; Inappropriate prescribing; Older adults; Over-the-counter medication; Polypharmacy; Primary health care; Systematic review.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bias
Canada
Humans
Inappropriate Prescribing* / prevention & control
Primary Health Care
Quality of Life*
Systematic Reviews as Topic