Table 1.
Description of the included studies: country, study design, participants’ demographics, setting and study aim.
| Author, Year |
Country | Study Design | Participants’ Demographics | Setting | Study Aim | ||
|---|---|---|---|---|---|---|---|
| No. of Participants (n) | Mean Age, Years (SD) [Range] |
Female | |||||
| Acurcio et al. [31], 2009 |
Brazil | Epidemiological cross-sectional | 377 | 72.4 (61–102) |
69.2% | Home visits. | To examine factors associated with therapeutic regimen complexity of drug prescriptions for elderly people. |
| Bazargan et al. [32], 2017 |
USA | Cross-sectional study | 400 | 73.5 (7) (65–94) |
65% | Sixteen predominantly African-American churches in SPA6 of Los Angeles County. | To examine the association between adherence to drug regimens and a spectrum of medication-related factors, including polypharmacy, medication regimen complexity, use of PIMs, knowledge about their therapeutic purpose and instructions of proper medication use. |
| Chang et al. [33], 2017 |
Australia | Retrospective cohort study | 100 | 82 (9.15) | 60% | General medical units of a tertiary care hospital. | To assess the changes in the MRCI before and after hospitalisation. To examine the prevalence of prescribing PIMs at the time of hospital discharge, using the 2015 Beers Criteria. |
| Elliot [34], 2012 |
Australia | Cohort study | 205 | 81.3 (8.0) | 58% | Two acute general medicine wards and two subacute aged care wards at a major metropolitan public hospital. | To explore the feasibility of incorporating medication regimen simplifications into routine clinical pharmacists’ care for older hospital inpatients, and to identify barriers to regimen simplification. |
| Elliot et al. [10], 2011 |
Australia | Cohort study | 186 Acute wards: 115 Subacute wards: 71 |
Acute wards: 79 (77–80) Subacute wards: 81 (80–83) |
Acute wards: 59% Subacute wards: 55% |
Two acute general medicine wards and two subacute aged care wards at a large public hospital. | To investigate the impact of hospitalisation on the complexity of older patients’ medication regimens, and to determine whether discharge medication regimens could be simplified. |
| Elliot et al. [12], 2013 |
Australia | Cohort study | 391 Pre-intervention: 186 Intervention: 205 |
Pre-intervention: 79.7 (8.2) Intervention: 81.3 (8.0) |
57.8% Pre-intervention: 57.5% Intervention: 58.% |
Two acute general medicine wards and two subacute aged care wards at a major metropolitan public hospital. | To investigate the impact of pharmacists’ medication reviews, together with an educational intervention targeting inpatient clinical pharmacists and junior medical officers on the increase in medication regimen complexity during hospitalisation. |
| Kroenke et al. [35], 1990 |
USA | Prospective controlled trial | 79 Intervention: 38 Control: 41 |
Intervention: 72.3 Control: 71.4 |
40.5% Intervention: 39.5% Control: 41.5% |
Internal Medicine Clinic at Brooke Army Medical Center. | To determine the effectiveness of specific feedback to prescribing physicians in reducing polypharmacy in elderly outpatients. |
| Lakey et al. [36], 2009 |
USA | Cross-sectional | 109 | 85.9 (5.1) (73–98) |
79.8% | Continuing care retirement community in Seattle. | To assess older adults’ current use of, knowledge of and preferences for medication management tools and supports. |
| Lindquist et al. [37], 2014 |
USA | Cross-sectional | 200 | 79.6 (6.4) (70–100) |
58% | Home visits after discharge from Northwestern Memorial Hospital. | To determine whether seniors consolidate their home medications or if there is evidence of unnecessary regimen complexity. |
| Linnebur et al. [38], 2014 |
USA | Retrospective cross-sectional | 200 CA: 100 CO: 100 |
CA: 74.3 (7.4) CO: 79.7 (6.1) |
78.5% CA: 76% CO: 81% |
Ambulatory clinics at the University of CA and the University of CO. | To evaluate the entire medication regimen of older adults with depression, and determine potential targets to simplify the regimen and improve adherence. |
| Mansur et al. [39], 2012 |
Israel | Cohort study | 212 | 81.1 (7.3) (66–103) |
61.8% | Acute Geriatric Ward at the Beilinson Hospital, Rabin Medical Center. | To test the convergent, discriminant and predictive validity of the MRCI in older hospitalised patients with varying functional and cognitive levels. |
| Moczygemba et al. [40], 2012 |
USA | Quasi-experimental | 120 Intervention: 60 Control: 60 |
Intervention: 71.2 (7.5) Control: 73.9 (8.0) |
60% Intervention: 48.3% Control: 71.7% |
Telephone consultation. | To determine the impact of telephone MTM on MHRPs, medication adherence and total drug costs for Medicare Part D participants. |
| Pinto et al. [41], 2016 |
Brazil | Cross-sectional | 227 | 71.4 | 70.9% | Two PHUs in the municipality of Belo Horizonte. | To evaluate the level of understanding of pharmacotherapy and the associated factors amongst older people in two PHUs. |
| Pouranayatihosseinabad et al. [42], 2018 | Australia | Retrospective observational study | 285 | 85.5 (7.7) | 68% | Residential ACFs. | To investigate the impact of RMMRs on simplifying medication regimen complexity in Australian ACF residents using the MRCI. |
| Sevilla-Sánchez et al. [43], 2017 |
Spain | Prospective cross-sectional study | 235 | 86.80 (5.37) | 65.50% | AGU in a second-level hospital. | To determine the prevalence of PIMs among patients with advanced chronic conditions and palliative care needs, and to analyse the associated risk factors and resulting clinical consequences. |
| Wimmer et al. [44], 2014 |
Australia | Prospective cohort | 163 Readmitted: 99 Not readmitted: 64 |
Readmitted: 84.9 (6.2) Not readmitted: 85.6 (6.74) |
72.4% Readmitted: 68.7% Not readmitted: 78.1% |
GEM unit of a public hospital in Adelaide. | To investigate the association between discharge medication regimen complexity and unplanned re-hospitalisation over 12 months. |
| Wimmer et al. [22], 2014 |
Australia | Prospective cohort | 163 DD home: 87 DD NCS: 76 |
85.2 (6.4) (71–101) DD home: 84.6 (6.9) DD NCS: 85.8 (5.8) |
72.4% DD home: 68.7% DD NCS: 77.6% |
GEM unit at the Queen Elizabeth Hospital. | To investigate the association between polypharmacy and medication regimen complexity with hospital discharge destination among older people. |
ACFs, aged care facilities; AGU, acute care geriatric unit; CA, California San Diego; CO, Colorado Anschutz Medical Campus; DD, discharge destination; GEM, geriatric evaluation and management; MHRP, medication- and health-related problems; MRCI, medication regimen complexity index; MTM, medication therapy management; NCS, non-community setting; PHUs, primary health care units; RMMRs, residential medication management reviews; and SPA6, Service Planning Area 6.