Abstract
Introduction: Polypharmacy and potentially inappropriate prescribing are common in people with life-limiting conditions. While deprescribing - a structured approach to reducing or discontinuing medications - is one approach to address this, its impact in this population is not well understood. Therefore, this systematic review aimed to synthesise evidence on outcomes of deprescribing medication in this population.
Method: A systematic search of MEDLINE, Embase, Scopus, PyscINFO and CINAHL was conducted to identify original studies reporting clinical-, medication-, and system-related outcomes of deprescribing. Studies published in English between January 2000 and December 2024 were included and analysed.
Results: A total of 17,457 hits were screened, of which 46 original studies met the inclusion criteria. Most eligible studies were pre-post interventional (n=14) or cohort studies (n=14), conducted primarily in nursing homes or long-term care facilities (n=16) and hospitals (n=14). The majority originated from North America (n=20) and Australia (n=7). A wide range of outcome variables were examined, with a primary focus on clinical outcomes. All studies assessing the impact on the number of medications used reported either a reduction in overall medication burden or inappropriate medications (n=15), or no significant change (n=3). Regarding mortality, most studies (10 studies) reported no impact, while three studies each reported increased and decreased mortality. For other outcomes, the majority of studies reported that deprescribing had no effect.
Conclusion: This systematic review suggests that deprescribing has several beneficial outcomes, including reducing medication burden and healthcare cost. While there is no strong evidence for harm, a small proportion of patients may face risks, so a careful monitoring is essential. Further studies should explore how outcome vary by disease conditions and medication types.
Comments
Surprise
I am surprised at the negative cognitive and mood effects of deprescribing suggested. What does this finding signify?
Response
Thank you for your question. I only summarised the various outcome variables into common headings in this poster. Therefore, mood and cognitive mentioned rows don't only represent them. Also, when the studies assessed more than one measure using different validated tools or scale on same outcome, I reported all of them - as single data points. For example, if a study assessed cognitive function using (i) the Mini-Mental State Examination (MMSE) scale and (ii) the Cognitive Performance Scale (CPS) in across the intervention and control groups, all four measurements (i.e. two outcomes from each group) were reported as separate data points. What I mean to say is this summary outcome does not actually reflect that all outcome effects reported on cognitive and mood category are negative. There was only one measure reported by one study on cognitive and mood category reflected negative effects. This signifies the chances of negative/harmful effects, but we need to think of at what specific conditions' patients and what deprescribed medicines was it linked. I hope this might satisfy your query in some extent, all the details of this work is prepared into a paper, which is under under review now and once it is published, I hope you will be able to get complete clarity. Many thanks !!
Medication groups
I am wondering, as this review includes the deprescribing of different medications, was there any difference between different types of medications?
Medicine group
We actually did not explore the outcome based on the medicine types.