Table 2.
Certainty of Evidence for Educational Interventions for Deprescribing Compared with Usual Care in Elderly Populations
|
Outcome* No. of participants (studies) |
Relative effect (95% CI) | Absolute effects (95% CI) | Certainty | What happens | ||
|---|---|---|---|---|---|---|
| Usual care | Deprescribing—medication review | Difference | ||||
|
All-cause mortality Follow-up: range 6 to 24 months No. of participants: 121,320 (6 CRCTs) |
- | Range 1–16% | Range 0.6–16% |
Risk differences (range) − 1 to 5% Largest study (n = 119,910) reported a 0.1% (95% CI − 0.1 to 0.6) |
⨁⨁⨁◯ Moderatea |
Educational interventions likely result in little to no difference in all-cause mortality. |
|
Hospitalizations (≥ 1 admission) Follow-up: range 9 months No. of participants: study 1 n = 119,910 (CRCT); study 2 n = 196 (CRCT). 1 other trial (n = 169) reported > 1 hospitalization in frail high-risk participants (NS between group) |
NA |
Study 1 12.6% Study 2 1.6 mean inpatient admissions |
Study 1 12.8% Study 2 1.9 mean inpatient admissions |
Study 1 0.2% (95% CI − 0.8 to 1.2) Study 2 0.3 admissions (95% − 1.8 to 2.4) |
⨁⨁⨁◯ Moderatea |
Educational interventions likely result in little to no difference in hospitalization. |
|
Quality of life measures (QoL) Assessed with: EQ-5D Follow-up: range 12–15 months No. of participants: 1364 (3 CRCTs) |
- | SMD 0.09 (95% CI − 0.05 to 0.22) |
⨁⨁◯◯ Lowa,b |
Educational interventions may result in little to no difference in quality of life measures. | ||
|
Falls Follow-up: range 12 to 24 months No. of participants: 1018 (2 CRCTs) |
Study 1 Ranges over time intervals 36–38% |
Study 1 Ranges over time intervals 44% |
Risk differences (range) − 6 to − 8% (NS between groups) |
⨁◯◯◯ Very lowa,b |
It is uncertain if educational interventions result in a reduction or an increase in falls. | |
|
Study 2 30% |
Study 2 20% |
− 10% (95% CI − 17 to − 4) | ||||
GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
CI, confidence interval; NS, not significant; OR, odds ratio; RR, risk ratio
aDowngraded for study limitations (medium risk of bias)
bDowngraded for imprecision
*Three primary outcomes (adverse drug withdrawal events, major adverse cardiac events, and delirium) were not reported