Table 5.
General Characteristics of Each Tool Focusing on Polypharmacy
| Tool(s) | Primary Study (Year Published) |
Systematic Review and Modified Evidence GRADE | Primary Study Characteristics | Who Used Tool? | Study Measurement Methods | Results | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Setting (Country) | Follow-up Duration | Patient Population |
||||||||
| No. Subjects (I/C) | Data Source | Outcome Variable | ||||||||
| 17. Clinician Rated Anticholinergic Score (CR-ACHS) | Yeh et al (2013)20 | Kroger et al (2015) Very low |
Veterans home (Taiwan) |
12 weeks | Adults with dementia | Physician | 40/27 | CR-ACHS | CR-ACHS (scale: 0 = no effect 3 = strong effect) | Significant reduction in anticholinergic scores in intervention group vs control group at 12 weeks (mean [SD], 0.5 [1.1] vs 1.1 [1.3], P = 0.021) |
| 18. Medication Appropriateness Index (MAI): structured medication review | Verrue (2012)21 | Kroger et al (2015) Very low |
Nursing home (Belgium) |
6 months | Older adults with any medical condition | Pharmacist | 230/154 | Medication list review | Quality of prescribing assessed with MAI scale | Significant reduction in MAI in intervention group vs control group (OR, 3.91; 95% CI, 1.88-8.15) |
| Assessing Care of Vulnerable Adults (ACOVE): structured medication review for older adults | Verrue (2012)21 | Kroger et al (2015) Very low |
Nursing home (Belgium) |
6 months | Older adults with any medical condition | Pharmacist | 230/154 | Medication list review | Drug underuse assessed with ACOVE scale | Significant reduction in inappropriate ACOVE ratings in intervention group vs control group (OR, 4.35; 95% CI, 0.87-21.67) |
| Beers criteria: structured medication review of potentially inappropriate medications for older adults based on patient age, comorbidities, medications, and kidney function | Verrue (2012)21 | Kroger et al (2015) Very low |
Nursing home (Belgium) |
6 months | Older adults with any medical condition | Pharmacist | 230/154 | Medication list review | Drug overuse assessed with Beers criteria | Significant reduction in the number of Beers criteria drugs in intervention groups vs control group (OR, 6.52; 95% CI, 1.38-30.92) |
| STOPP/START: structured medication review for older adults | Verrue (2012)21 | Kroger et al (2015) Very low |
Nursing home (Belgium) |
6 months | Older adults with any medical condition | Pharmacist | 230/154 | Medication list review | Drug overuse assessed with STOPP/START scales | No statistically significant between-group difference in inappropriate START ratings per patient (OR, 10.92; 95% CI, 0.58-206.64); no statistically significant between-group difference in number of STOPP drugs per patient (OR, 2.86; 95% CI, 0.71-11.53) |
| 19. Deprescribing algorithm for psychoactive medications | Patterson et al (2010)22 | Kroger et al (2015) Very low |
Nursing home (Northern Ireland) |
NA | Older adults with any medical condition | Nursing home | 173/161 | Manual medication list review | Proportion of patients prescribed 1 or more inappropriate psychoactive medications | Proportion of patients taking inappropriate psychoactive medications was significantly lower in intervention nursing homes compared to control nursing homes (OR, 0.26; 95% CI, 0.14-0.49) |
| 20. Deprescribing tool for antipsychotic and benzodiazepine use | Westbury (2010)23 | Kroger et al (2015) Very low |
Nursing home (Australia) |
26 weeks | Older adults with dementia | Nursing home | 898/693 | Drug Use Evaluation Audit Program | Prescribing rates (mean proportion) of benzodiazepines and antipsychotics in nursing homes | Significant reductions in mean use of benzodiazepines in the intervention group from baseline to 26 weeks (mean [SD], 31.8 [8.6] vs 26.9 [8.6], P < 0.005); significant reductions in mean use of antipsychotics within the intervention group from baseline to 26 weeks (mean [SD], 20.3 [8.7] vs 18.6 [8.4], P < 0.05) |
| 21. Algorithm for improving drug therapy in disabled/frail elderly patients in nursing facilities | Garfinkel et al (2007)24 | Kroger et al (2015) Very low |
Geriatric medical center (Israel) |
12 months | Adults with any medical condition | Physician and nurse | 119/71 | Medication list review | Annual incidence of death and referral to acute care hospital | Significant difference in 1-year mortality rate in intervention vs control (21% vs 45%, P < 0.001); significant decrease in yearly referrals to acute care hospital in intervention group vs control group (11.8% vs 30.0%, P < 0.002) |
| 22. Deprescribing algorithm for NSAIDs | Stein et al (2001)25 | Kroger et al (2015) Very low |
Nursing home (United States) |
3 months | Adults 65 years of age or older with muscle or joint pain | Nursing home | 1,065/1,067 | Medication list review | Post-intervention change: 3-months follow-up value minus baseline value | Significant decrease in mean number of days of NSAID use from baseline to 3-months follow-up in intervention group (from 7.0 days to 1.9 days) vs control group (from 7.0 days to 6.2 days); P = 0.0001 |
Abbreviations: CI, confidence interval; GRADE, Grading of Recommendations Assessment, Development and Evaluation5; NA, not applicable; NSAID, nonsteroidal anti-inflammatory drug; OR, odds ratio; SD, standard deviation; STOPP, Screening Tool for Older Persons of Potentially inappropriate Prescriptions; START, Screening Tool to Alert doctors to Right Treatment.