A systematic review of the outcomes reported in trials of medication review in older patients: the need for a core outcome set

AIM: Medication review has been advocated as one of the measures to tackle thechallenge of polypharmacy in older patients, yet there is no consensus on howbest to evaluate its efficacy. This study aimed to assess outcome reporting intrials of medication review in older patients.METHODS: Randomized controlled trials (RCTs), prospective studies and RCTprotocols involving medication review performed in patients aged 65 years orolder in any setting of care were identified from: (1) a recent systematicreview; (2) RCT registries of ongoing studies; (3) the Cochrane library. Thetype, definition, and frequency of all outcomes reported were extractedindependently by two researchers.RESULTS: Forty-seven RCTs or prospective published studies and 32 RCT protocolswere identified. A total of 327 distinct outcomes were identified in the 47published studies. Only one fifth (21%) of the studies evaluated the impact ofmedication reviews on adverse events such as drug reactions or drug-relatedhospital admissions. Most of the outcomes were related to medication use(n = 114, 35%) and healthcare use (n = 74, 23%). Very few outcomes werepatient-related (n = 24, 7%). A total of 248 distinct outcomes were identified inthe 32 RCT protocols. Overall, the number of outcomes and the number and type of health domains covered by the outcomes varied largely.CONCLUSION: Outcome reporting from RCTs concerning medication review in olderpatients is heterogeneous. This review highlights the need for a standardizedcore outcome set for medication review in older patients, to improve outcome