title: Improving the appropriateness of prescribing in older patients: a systematic review and meta-analysis of pharmacists' interventions in secondary care.
abstract: BACKGROUND
  potentially inappropriate prescribing (PIP) in older hospitalised patients, and in particular those with dementia, is associated with poorer health outcomes. PIP reduction is therefore essential in this population.
  
  
  METHODS
  a comprehensive electronic literature search was conducted using 12 databases from inception up to and including September 2014. Inclusion criteria were controlled trials (randomised or non-randomised) of interventions involving pharmacists conducted in hospitals, with an objective of the study being PIP reduction in patients 65 years or older or patients with dementia of any age, using any validated PIP tool as an outcome measure. Risk of bias assessments were conducted utilising the Cochrane Collaboration's tool.
  
  
  RESULTS
  a total of 1,752 records were found after duplicates were removed. Four trials (n = 1,164 patients; two randomised, two non-randomised) from three countries were included in the quantitative analysis. All studies were at moderate risk of bias. No study focused specifically on dementia patients. Three trials reported statistically significant reductions in the Medication Appropriateness Index score in the intervention group (mean difference from admission to discharge = -7.45, 95% CI: -11.14, -3.76) and other PIP tools such as Beers Criteria. One trial reported reduced drug-related readmissions and another reported increased adverse drug reactions.
  
  
  CONCLUSIONS
  multi-disciplinary teams involving pharmacists may improve prescribing appropriateness in older inpatients, though the clinical significance of observed reductions is unclear. More research is required into the effectiveness of pharmacists' interventions in reducing PIP in dementia patients. Additionally, easily assessed and clinically relevant measures of PIP need to be developed.
authors.affiliation: Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
authors.forename: Kieran Anthony
authors.initials: KA
authors.lastname: Walsh
authors.affiliation: Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: O'Riordan
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Kearney
authors.affiliation: Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Timmons
authors.affiliation: Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Byrne
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D017146:Models, Organizational; D016017:Odds Ratio; D010348:Patient Care Team / Q000458:organization & administration; D010593:Pharmaceutical Services / Q000458:organization & administration* / Q000592:standards; D010595:Pharmacists / Q000458:organization & administration* / Q000592:standards; D024382:Professional Role; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D063127:Secondary Health Care / Q000458:organization & administration* / Q000592:standards
keywords: dementia; inappropriate prescribing; pharmacist; secondary care; systematic review