Summary of findings table
| Effect estimate | ||||||
|---|---|---|---|---|---|---|
| Outcome | Number of studies | Number of participants | Usual care | Pharmaceutical care | Quality of the evidence (GRADE approach) | Comments |
| Summated MAI score (postintervention) | 5 (27–31) | 965 | Mean summated MAI score ranged across control groups from 6.5 to 19.3 | Mean summated MAI score in the intervention groups was 3.88 lower (5.4 to 2.35 lower) | Low*† | |
| Change in MAI score (from baseline to follow-up) | 4 (27 28 31 33) | 424 | Mean change in MAI score ranged across control groups from 0.41 to 2.86 | Mean change in MAI score in the intervention groups was 6.78 lower (12.34 to 1.22 lower) | Very low*†‡§ | A sensitivity analysis showed that the mean change in MAI score in the intervention group was 1.79 lower (3.73 lower to 0.16 higher)¶ |
| Number of Beers drugs per patient (post-intervention) | 2 (30 31) | 586 | Mean number of Beers drugs per participant ranged across control groups from 0.04 to 0.4 | Mean number of Beers drugs per participant in the intervention groups was 0.1 lower (0.28 lower to 0.09 higher) | Very low*ठ| |
GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.
*Limitations in the design of studies included in the analysis such as lack of protection against contamination and lack of allocation concealment resulted in downgrading of the quality of evidence.
†A validated assessment of underprescribing was not included in all studies; therefore, the findings answered a restricted version of the research question. This resulted in downgrading of the quality of evidence.
‡Statistically significant heterogeneity, variation in effect estimates and non-overlapping CIs between studies resulted in downgrading of the quality of evidence.
§Imprecision in effect estimates was observed whereby CIs were wide and/or crossed the line of no effect.
¶Two studies were excluded from the analysis because of a unit of analysis error33 and an outlying effect estimate with a high risk of bias.31
GRADE, Grades of Recommendation, Assessment, Development and Evaluation; MAI, Medication Appropriateness Index.