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Inappropriate prescribing among older persons in primary care: protocol for systematic review and meta-analysis of observational studies
  1. Cia Sin Lee1,
  2. Tau Ming Liew2,3
  1. 1SingHealth Polyclinics, Singapore
  2. 2Saw Swee Hock School of Public Health, National University of Singapore, Singapore
  3. 3Department of Geriatric Psychiatry, Institute of Mental Health, Singapore
  1. Correspondence to Dr Tau Ming Liew; tau_ming_liew{at}


Introduction Inappropriate prescribing has a significant impact on older persons in primary care. Previous reviews on inappropriate prescribing included a heterogeneous range of populations and may not be generalisable to primary care. In this study we aim to conduct a comprehensive systematic review and meta-analysis of the prevalence, risk factors and adverse outcome associated with inappropriate prescribing, specifically among older persons in primary care.

Methods and analysis We will search PubMed, Embase, CINAHL, Web of Science, Scopus, PsycINFO and references of other review articles for observational studies related to the keywords ‘older persons’, ‘primary care’ and ‘inappropriate prescribing’. Two reviewers will independently select the eligible articles. For each included article, the two reviewers will independently extract the data and assess the risk of bias using the Newcastle–Ottawa Scale. If appropriate, meta-analyses will be performed to pool the data across all the studies. In the presence of heterogeneity, meta-regression and subgroup analyses will also be performed. The quality of the evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Ethics and dissemination The results will be disseminated through conference presentations and peer-reviewed publications. They will provide consolidated evidence to support informed actions by policymakers to address inappropriate prescribing in primary care, thus reducing preventable and iatrogenic risk to older persons in primary care.

Trial registration number CRD42016048874.

  • Inappropriate prescribing
  • older person
  • prevalence
  • risk factors
  • adverse outcomes

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  • TML and CSL contributed equally to this work.

  • Contributors TML and CSL conceived the idea for this systematic review. TML developed the methodology and search strategy. TML and CSL wrote the manuscript and approved the final version of the manuscript.

  • Funding TML was supported by a research fellowship under the Singapore Ministry of Health's National Medical Research Council (grant number: NMRC/Fellowship/0030/2016). The funding source had no involvement in any part of the project.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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