. 2020 Aug 20;35(11):3323–3332. doi: 10.1007/s11606-020-06089-2

Table 3.

Effect of Deprescribing Interventions on Potentially Inappropriate Medication (PIM) Use

Author Number enrolled.	Findings
Comprehensive medication review
Allard, 2001¹⁵ n = 266	Odds of NOT being on a PIM at 12 months in the intervention group: 1.83 (95% CI: 0.94 to 3.57)
Boyé, 2017¹⁶ Polinder, 2016¹⁷ n = 612	% with decreased PIMs at 12 months: 37% (intervention) vs 19% (control) (P < .0001, calculated)
Denneboom, 2007²⁵ n = 738	% of clinically relevant recommendations leading to a medication change: 29.8% (intervention) vs 17.2% (control) (P = .02) % maintained at 6 months: 25.5% (intervention) vs 14.8% (control) (P = .03) % maintained at 9 months: 23.9% (intervention) vs 15.1% (control) (P = .08)
Haag, 2016²⁷ n = 25	No difference between groups in any of multiple measure of PIMs at 1 month
Hanlon, 1996²⁸ Schmader, 1997²⁹ n = 208	Improvement in MAI scores 3 months: 24% (intervention) vs 6% (control); adjusted change score − 4.3 vs − 1.1 (P = .0006) 12 months: 28% (intervention) vs 5% (control); adjusted change score − 4.9 vs − 0.9 (P = .0002)
Köberlein-Neu, 2016³⁴ n = 142	MAI scores lower (i.e., better) at 3 months in intervention phase compared with control phase (mean difference − 4.51, 95% CI − 6.66 to − 2.36, P < .001) Mean difference in PIMs: − 0.04 (95% CI: − 0.09 to 0.01)
Lampela, 2010³⁷ Rikala, 2011³⁸ n = 644	% of patients taking inappropriate drugs or dosages at 12 months: 18% (intervention) vs 24% (control) (P = .08, calculated)
Meredith, 2002⁴¹ n = 259	Therapeutic duplications discontinued at 6–12 weeks: 71% (intervention) vs 24% (control) (P = .003) “More appropriate” cardiovascular medication regimen: 55% (intervention) vs 18% (control) (P = .02) No effect on either psychotropic or NSAID use
Moga, 2017⁴² n = 50	Improvement in MAI at 8 weeks (change score, mean (SD)): − 3.6 (1.1) (intervention) vs − 1.0 (0.9) (control) (P = .04)
Muth, 2018⁴³ n = 505	MAI score-adjusted mean difference between groups at 9 months: 0.6 (95% CI: − 0.5 to 1.7) (P = .27)
Olsson, 2012⁴⁵ n = 150	Change from baseline to 12 months in % of patients on PIMs was not significant in intervention or control groups
Shim, 2018⁵⁴ n = 160	MAI scores lower (i.e., better) in intervention group at 6 months: median score 8.0 (IQR 9.0) (intervention) vs 20.0 (IQR 16.0) (control) (P < .001)
van der Meer, 2018⁵⁹ n = 157	Odds of a decrease in Drug Burden Index ≥ 0.5 at 3 months in intervention vs control: 1.09 (95% CI: 0.45 to 2.63)
Educational interventions
Bregnhoj, 2009¹⁸ n = 212	5-point reduction (i.e., improvement) in MAI in combined intervention group at 12 months (95% CI: − 7.3 to − 2.6); no change in other groups
Clyne, 2015, 2016^21,22 Gillespie, 2017²³ n = 190	Intervention group less likely to be taking a PIM than control group at intervention completion (4–6 months) (OR 0.32, 95% CI: 0.15 to 0.70, P = .02) and 12 months (OR 0.28, 95% CI: 0.11, 0.76, P = .01)
Coleman, 1999²⁴ n = 169	Mean number of high-risk medications at 24 months: intervention: 1.86, control: 2.54 (P = .17)
Jager, 2017³⁰ n = 273	Risk difference between groups in number of subjects with ≥ 1 PIM per year (assessed at 9 months): 0.9 (0.4 to 2.0) (P = .81)
Martin, 2018⁴⁰ n = 489	Complete cessation of fills for targeted drugs at 6 months: intervention: 43%, control: 12% (risk difference 31%, 95% CI: 23 to 38).
Pimlott, 2003⁴⁶ n = 374	Change in number of benzodiazepine prescriptions at 6 months: intervention: − 0.7%, control: + 1.1% (P = .036)
Pit, 2007⁴⁷ n = 849	Odds of improved medication use composite score in intervention group compared with control at 4 months: OR 1.86, 95% CI: 1.21 to 2.85 (composite score reflected use of benzodiazepines, NSAIDs, and thiazide diuretics)
Rognstadt, 2013⁵¹ Rognstadt, 2018⁵⁰ n = 81,810	PIMs per 100 patients decreased at 12 months by 12% (95% CI: 16.8 to 6.9%), intervention vs control
Schmidt-Mende, 2017⁵³ n = 119,910	Risk difference in number on ≥ 10 medications at 9 months: − 0.1 (95% CI: − 0.5 to 0.3)
Simon, 2006⁵⁵ n = 50,924	Decrease of 19.7 medications per 10,000 members (intervention) vs 13.0 (control) over 18 months (P = .52)
Tannenbaum, 2014⁵⁷ n = 303	Benzodiazepine discontinuation at 6 months: intervention: 27%, control: 5% (risk difference 23%, 95% CI: 14 to 32%).
Computerized decision support
Fried, 2017²⁶ n = 128	Proportion of reconciliation errors corrected at 90 days: 48.4% (intervention) vs 14.3% (control) (P < .001)
Price, 2017⁴⁸ n = 81,905	Change in PIM rates from baseline at 16 weeks: 0.1% (intervention), 0.1% (control) (P = .80)
Raebel, 2007⁴⁹ n = 59,680	Percentage of patients newly dispensed ≥ 1 PIM over 12 months: 1.8% (intervention), 2.2% (control) (P = .002)
Tamblyn, 2003⁵⁶ n = 12,560	Percentage of patients given PIMs during over 13 months: 16% (intervention), 20% (control) (RR 0.82, 95% CI: 0.69, 0.98)

Author
Number enrolled.

Findings

Comprehensive medication review

Allard, 2001¹⁵

n = 266

Odds of NOT being on a PIM at 12 months in the intervention group: 1.83 (95% CI: 0.94 to 3.57)

Boyé, 2017¹⁶

Polinder, 2016¹⁷

n = 612

% with decreased PIMs at 12 months: 37% (intervention) vs 19% (control) (P < .0001, calculated)

Denneboom, 2007²⁵

n = 738

% of clinically relevant recommendations leading to a medication change: 29.8% (intervention) vs 17.2% (control) (P = .02)

% maintained at 6 months: 25.5% (intervention) vs 14.8% (control) (P = .03)

% maintained at 9 months: 23.9% (intervention) vs 15.1% (control) (P = .08)

Haag, 2016²⁷

n = 25

No difference between groups in any of multiple measure of PIMs at 1 month

Hanlon, 1996²⁸

Schmader, 1997²⁹

n = 208

Improvement in MAI scores

3 months: 24% (intervention) vs 6% (control); adjusted change score − 4.3 vs − 1.1 (P = .0006)

12 months: 28% (intervention) vs 5% (control); adjusted change score − 4.9 vs − 0.9 (P = .0002)

Köberlein-Neu, 2016³⁴

n = 142

MAI scores lower (i.e., better) at 3 months in intervention phase compared with control phase (mean difference − 4.51, 95% CI − 6.66 to − 2.36, P < .001)

Mean difference in PIMs: − 0.04 (95% CI: − 0.09 to 0.01)

Lampela, 2010³⁷

Rikala, 2011³⁸

n = 644

% of patients taking inappropriate drugs or dosages at 12 months: 18% (intervention) vs 24% (control) (P = .08, calculated)

Meredith, 2002⁴¹

n = 259

Therapeutic duplications discontinued at 6–12 weeks: 71% (intervention) vs 24% (control) (P = .003)

“More appropriate” cardiovascular medication regimen: 55% (intervention) vs 18% (control) (P = .02)

No effect on either psychotropic or NSAID use

Moga, 2017⁴²

n = 50

Improvement in MAI at 8 weeks (change score, mean (SD)): − 3.6 (1.1) (intervention) vs − 1.0 (0.9) (control) (P = .04)

Muth, 2018⁴³

n = 505

MAI score-adjusted mean difference between groups at 9 months: 0.6 (95% CI: − 0.5 to 1.7) (P = .27)

Olsson, 2012⁴⁵

n = 150

Change from baseline to 12 months in % of patients on PIMs was not significant in intervention or control groups

Shim, 2018⁵⁴

n = 160

MAI scores lower (i.e., better) in intervention group at 6 months: median score 8.0 (IQR 9.0) (intervention) vs 20.0 (IQR 16.0) (control) (P < .001)

van der Meer, 2018⁵⁹

n = 157

Odds of a decrease in Drug Burden Index ≥ 0.5 at 3 months in intervention vs control: 1.09 (95% CI: 0.45 to 2.63)

Educational interventions

Bregnhoj, 2009¹⁸

n = 212

5-point reduction (i.e., improvement) in MAI in combined intervention group at 12 months (95% CI: − 7.3 to − 2.6); no change in other groups

Clyne, 2015, 2016^21,22

Gillespie, 2017²³

n = 190

Intervention group less likely to be taking a PIM than control group at intervention completion (4–6 months) (OR 0.32, 95% CI: 0.15 to 0.70, P = .02) and 12 months (OR 0.28, 95% CI: 0.11, 0.76, P = .01)

Coleman, 1999²⁴

n = 169

Mean number of high-risk medications at 24 months: intervention: 1.86, control: 2.54 (P = .17)

Jager, 2017³⁰

n = 273

Risk difference between groups in number of subjects with ≥ 1 PIM per year (assessed at 9 months): 0.9 (0.4 to 2.0) (P = .81)

Martin, 2018⁴⁰

n = 489

Complete cessation of fills for targeted drugs at 6 months: intervention: 43%, control: 12% (risk difference 31%, 95% CI: 23 to 38).

Pimlott, 2003⁴⁶

n = 374

Change in number of benzodiazepine prescriptions at 6 months: intervention: − 0.7%, control: + 1.1% (P = .036)

Pit, 2007⁴⁷

n = 849

Odds of improved medication use composite score in intervention group compared with control at 4 months: OR 1.86, 95% CI: 1.21 to 2.85 (composite score reflected use of benzodiazepines, NSAIDs, and thiazide diuretics)

Rognstadt, 2013⁵¹

Rognstadt, 2018⁵⁰

n = 81,810

PIMs per 100 patients decreased at 12 months by 12% (95% CI: 16.8 to 6.9%), intervention vs control

Schmidt-Mende, 2017⁵³

n = 119,910

Risk difference in number on ≥ 10 medications at 9 months: − 0.1 (95% CI: − 0.5 to 0.3)

Simon, 2006⁵⁵

n = 50,924

Decrease of 19.7 medications per 10,000 members (intervention) vs 13.0 (control) over 18 months (P = .52)

Tannenbaum, 2014⁵⁷

n = 303

Benzodiazepine discontinuation at 6 months: intervention: 27%, control: 5% (risk difference 23%, 95% CI: 14 to 32%).

Computerized decision support

Fried, 2017²⁶

n = 128

Proportion of reconciliation errors corrected at 90 days: 48.4% (intervention) vs 14.3% (control) (P < .001)

Price, 2017⁴⁸

n = 81,905

Change in PIM rates from baseline at 16 weeks: 0.1% (intervention), 0.1% (control) (P = .80)

Raebel, 2007⁴⁹

n = 59,680

Percentage of patients newly dispensed ≥ 1 PIM over 12 months: 1.8% (intervention), 2.2% (control) (P = .002)

Tamblyn, 2003⁵⁶

n = 12,560

Percentage of patients given PIMs during over 13 months: 16% (intervention), 20% (control) (RR 0.82, 95% CI: 0.69, 0.98)

CI, confidence interval; IQR, interquartile range; MAI, Medication Appropriateness Index; NSAID, non-steroidal anti-inflammatory drugs; OR, odds ratio; PIM, potentially inappropriate medication; RR, relative rate; SD, standard deviation