The outcomes of considering goals of care in medication reviews for older adults: a systematic review

ABSTRACT

Introduction

This is a systematic review of prescribing, clinical, patient-reported, and health utilization outcomes of goal-directed medication reviews in older adults.

Methods

A systematic review was conducted using MEDLINE, EMBASE, SCOPUS and CINAHL databases to identify studies examining outcomes of goal-directed medication reviews in humans, with mean/median age ≥ 60 years and in English.

Results

Seventeen out of 743 articles identified were included. Whilst there were inconsistent findings regarding changes in the number of medications between groups or post-intervention in one group (n = 6 studies), studies found reductions in drug-related problems (n = 2) and potential to reduce anticholinergics and sedatives (n = 2). Two out of seven studies investigating clinical outcomes found improvements, such as reduced hospital readmissions and improved depression severity. One study found 75% of patients achieved ≥ 1 goals and another found 43% of goals were achieved at six months. Four out of five studies found significant improvements in patient-reported quality of life between groups (n = 2) or post-intervention in one group (n = 2). Both studies investigating cost-effectiveness reported the intervention was cost-effective.

Conclusions

There is evidence of positive impact on medication rationalization, quality of life and cost-effectiveness, supporting goal-directed medication reviews. Larger, longitudinal studies, exploring patient-focused outcomes may provide further insights into the ongoing impact of goal-directed medication reviews.

GRAPHICAL ABSTRACT

KEYWORDS:

• Medication review
• medication optimization
• goal
• goals of care
• personal goals
• geriatrics
• clinical pharmacology
• polypharmacy

Article highlights

• Medication reviews provide an opportunity to align treatment with goals of care.

• We conducted a systematic review of outcomes of goal-directed medication reviews in older adults.

• There is evidence of positive impact on medication rationalization including resolution of drug-related problems, on patient-reported outcomes including improved quality of life and on health utilization outcomes including cost-effectiveness of interventions incorporating goal-directed medication reviews.

• These findings support the use of goal-directed medication reviews for older adults in clinical practice.

Conflicts of interest

N Masnoon is supported by the Rothwell Geriatric Pharmacotherapy Fellowship. S Lo is supported by the Penney Ageing Research Unit. S Hilmer is an author of a paper included in this review. S Hilmer is investigating commercialization of The Goal directed Medication review Electronic Decision Support System (G-MEDSS)©. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors provided guidance on the protocol for the review. C George and A Bordia conducted initial study screening and data extraction, supervised and repeated by N Masnoon and S Lo. N Masnoon and C George drafted the manuscript, with critical review and revisions from the other authors. All authors read and approved the manuscript.

Availability of data

Any data extracted and synthesized from existing studies have been included in the tables and manuscript of this review

Additional information

Funding

This paper was not funded.