Characteristics of included studies
| Study and design | Study participants and setting | Duration and follow-up | Intervention elements | Outcomes |
|---|---|---|---|---|
| Hanlon et al29 RCT | 208 participants (105 intervention, 103 control), Veteran Affairs Medical Centre, USA | Duration: unclear. Follow-up: 3 and 12 months after randomisation | Medication review, therapeutic recommendations, patient education | Prescribing appropriateness (MAI), HRQoL, patients’ self-reported medication compliance and knowledge, potential ADEs, participant satisfaction |
| Bucci et al27 RCT | 80 participants (39 intervention, 41 control), university hospital clinic, Canada | Duration: unclear Follow-up: 1 month | Medication review, therapeutic recommendations, provision of medication-related information | Prescribing appropriateness (MAI), rating of pharmaceutical care activities (Purdue Pharmacist Directive Guidance score) |
| Tamblyn et al34 RCT | 107 primary care physicians, Canada | Duration: 13 months Follow-up: terminated after an inappropriate prescription had been initiated or discontinued | Computerised decision support; computer system alerted prescribers of 159 clinically relevant prescribing problems among the elderly (McLeod criteria), the nature of the problem, possible consequences and suggested alternative therapy | Initiation and discontinuation rates of 159 prescription-related problems (McLeod criteria) |
| Taylor et al32 RCT | 69 participants (33 intervention, 36 control), community-based family medicine clinics, USA | Duration: 12 months Follow-up: 12 months | Medication review, therapeutic recommendations, therapeutic monitoring, education of patients and healthcare professionals | Prescribing appropriateness (MAI), hospitalisations and emergency department visits, medication misadventures, medication compliance, quality of life |
| Crotty et al33 cRCT | 154 participants (100 intervention and internal control, 54 external control), high-level residential aged care facilities, Australia | Duration: 2 case conferences 6 to 12 weeks apart Follow-up: 3 months | Medication review, multidisciplinary case conference, development of a problem list | Prescribing appropriateness (MAI), residents’ behaviour (Nursing Home Behaviour Problem Scale), monthly drug costs |
| Crotty et al28 RCT | 110 participants (56 intervention, 54 control), hospital/long-term residential care facility interface, Australia | Duration: unclear Follow-up: 8 weeks | Transfer of medication-related information to care providers in long-term care facilities, evidence-based medication review, case conference | Prescribing appropriateness (MAI), hospital usage (unplanned visits to the emergency department and hospital readmissions), ADEs, falls, worsening of mobility behaviours, pain and increasing confusion |
| Schmader et al30 RCT | 834 participants (430 intervention, 404 control), Veterans Affairs hospitals, USA | Duration: 12 months Follow-up: 12 months after randomisation | Medication review, therapeutic evaluation and management protocols | Prescribing appropriateness (MAI, Beers’ list), adverse drug reactions, serious adverse drug reactions, polypharmacy, medication under use |
| Trygstad et al36 CBA | Medicaid-dependent nursing home residents, USA | Duration: 6 months Follow-up: 3 months | Medication review, therapeutic recommendations | Prescribing appropriateness (Beers’ list), number of PAL alerts, potential medication problems |
| Spinewine et al31 RCT | 186 participants (96 intervention, 90 controls), university teaching hospital, Belgium | Duration: from admission to discharge Follow-up: 1, 3 and 12 months | Medication review, pharmaceutical care plan, therapeutic recommendations, information provision to healthcare professionals, patient/carer education, communication with GP | Prescribing appropriateness (MAI, Beers’ list, ACOVE), mortality, hospitalisation (readmission or visit to an emergency department), medication use (including unnecessary drug use), satisfaction with information provided at admission and discharge |
| Trygstad et al35 CBA | Medicaid-dependent nursing home residents, USA | Duration: 3 months Follow-up: 3 months | Medication reviews, computerised prescribing alerts, therapeutic recommendations | Prescribing appropriateness (Beers’ list), number of PAL alerts, potential medication problems |
| Gallagher et al25 RCT | 382 participants (190 intervention, 192 control), university hospital, Ireland | Duration: unclear Follow-up: 2, 4 and 6 months post discharge | Medication review, discussion with attending medical team, follow-up written communication, recommendations (STOPP/START), communication of medication changes to GPs using discharge summary | Prescribing appropriateness (MAI and AUM), mortality, hospital readmissions, falls, frequency of general practitioner visits |
| Dalleur et al26 RCT | 146 participants (74 intervention, 72 control), university teaching hospital, Belgium | Duration: unclear Follow-up: at discharge and 1 year after discharge | Medication review, therapeutic recommendations, standard IGCT care | Discontinuation of potentially inappropriate medications (STOPP criteria), clinical significance of prescribing recommendations (STOPP criteria) |
ACOVE, Assessing Care of Vulnerable Elderly; ADE, adverse drug event; AUM, Assessment of Underutilisation of Medication; CBA, controlled before-and-after studies; cRCT, cluster randomised controlled trial; GP, general practitioner; HRQoL, health-related quality of life; IGCT, inpatient geriatric consultation team; MAI, Medication Appropriateness Index; PAL, Prescription Advantage List; RCT, randomised controlled trial; START, Screening Tool to Alert doctors to Right Treatment; STOPP, Screening Tool of Older Person's Prescriptions.