J Patient Saf. 2025 Aug 14. doi: 10.1097/PTS.0000000000001406. Online ahead of print.
ABSTRACT
BACKGROUND: Medication-related inappropriateness (MRI) poses a significant risk to elderly patients, particularly in aged care settings, where complex medication regimens and health care challenges increase the likelihood of errors. Addressing MRI is critical to enhancing patient safety and improving health outcomes for older adults. This study aims to evaluate the effectiveness of interventions designed to reduce MRI and improve prescribing practices in elderly populations through a systematic review and meta-analysis.
METHODS: A systematic review and meta-analysis were conducted following the Cochrane Handbook for Systematic Reviews of Interventions. Databases including MEDLINE, EMBASE, CINAHL, PubMed, and EBSCOhost were searched from April 2020 to November 2023. Randomized controlled trials (RCTs) and nonrandomized controlled studies evaluating interventions for reducing MRI in elderly patients receiving care in various healthcare settings were included. Eight studies involving a total of 33,170 participants across 7 countries qualified for analysis. The pooled odds ratio (OR) with a 95% CI was calculated to measure intervention effectiveness. Statistical heterogeneity was assessed using the Higgins I² statistic, and a random-effects model was applied to account for variability.
RESULTS: Interventions ranged from educational programs and peer reviews to computerised decision-support systems. The meta-analysis demonstrated a significant reduction in MRI, with a pooled OR of 0.43 (95% CI: 0.31-0.60), indicating a 57% reduction in inappropriate prescribing. Educational interventions were particularly effective, fostering improved prescriber behavior and medication safety. However, high heterogeneity (I²=92%) underscored variations in patient demographics, care settings, and intervention designs.
CONCLUSIONS: Educational interventions and decision-support systems are found to significantly reduce the inappropriate prescribing of medication in older patients. More research is required to address variability, determine long-term outcomes, and facilitate broader implementation to improve medication safety.
PMID:40810201 | DOI:10.1097/PTS.0000000000001406
