ABSTRACT
Background: Patients over 65 years of age taking multiple medications face several
risks, and pharmaceutical interventions can be useful to improve quality of care and
reduce those risks. However, there is still no consensus on the effectiveness of
these interventions aimed at promoting changes in clinical, epidemiological, economic,
and humanistic outcomes for various service delivery, organizational, financial, and
implementation-based interventions. The objective of this overview of systematic reviews
was to summarize evidence on the effectiveness of community-level pharmaceutical
interventions to reduce the risks associated with polypharmacy in the population over
65 years of age.
Method: This overview used a previously described protocol to search for systematic
review articles, with and without meta-analysis, and economic evaluations, without any
language or time restrictions, including articles published up to May 2018. The following
databases were searched: the Cochrane Library, Epistemonikos, Health Evidence,
Health Systems Evidence, Virtual Health Library, and Google Scholar. The basic
search terms used were “elderly,” “polypharmacy,” and “pharmaceutical interventions.”
The findings for outcomes of interest were categorized using a taxonomy for health
policies and systems. Equity-related questions were also investigated. The studies were
evaluated for methodological quality and produced a narrative synthesis.
Results: A total of 642 records were retrieved: 50 from Health Evidence, 197 from
Epistemonikos, 194 from Cochrane, 116 from Health Systems Evidence, and 85 from
the Virtual Health Library. Of these, 16 articles were selected: 1 overview of systematic
reviews, 12 systematic reviews, and 3 economic evaluations. There is evidence of
improvement in clinical, epidemiological, humanistic, and economic outcomes for various
types of community-level pharmaceutical interventions, but differences in observed
outcomes may be due to study designs, primary study sample sizes, risk of bias, difficulty
in aggregating data, heterogeneity of indicators and quality of evidence included in the
systematic reviews that were assessed. It is necessary to optimize the methodological
designs of future primary and secondary studies.
Conclusion: Community-level pharmaceutical interventions can improve various
clinical, epidemiological, humanistic and economic outcomes and potentially reduce risks
associated with polypharmacy in the elderly population.
Keywords: elderly, polypharmacy, pharmaceutical interventions, overview, systematic review