Effectiveness and Cost Effectiveness of Pharmacist-led Deprescribing Interventions in Nursing Homes and Ambulatory Care Settings in Elderly Patients: A Systematic Review

Background: Potentially Inappropriate Medications (PIMs) are drugs in which the adverse risks exceed the clinical benefits, lacking evidence-based indications, potentially interact with other medications. PIM use is common in older adults who are frequently treated with multiple medications. PIM use in older adults is associated with many complications. Aim: To critically appraise and systematically evaluate the existing studies on the effectiveness of pharmacist-led deprescribing in health service utilization, clinical effectiveness, cost effectiveness and cost utility. In nursing home and ambulatory care settings and patients aged 65 years and above. Methods: PubMed, Medline, CINAHL, Embase, and Cochrane Library were searched between 1st to 2nd July 2021 and updated on 25th December 2021 to select studies that compare pharmacist-led deprescribing in nursing home and ambulatory care settings with usual care. Outcomes related to health service utilization, clinical effectiveness, cost effectiveness and cost utility were evaluated. Results: A total of 3944 relevant records were identified through database searching. A further ten records were identified by following up citations and reference lists of the selected studies. After assessment, nine studies were included in the review. Four of the included studies reported outcomes relating to both health service utilization and clinical effectiveness, three studies reported only health service utilization, and the two economic studies reported cost effectiveness and cost utility respectively. Six out of seven studies that reported health service utilization outcomes found improvement in health service utilization after the implementation of the pharmacist-led deprescribing. However, there is no positive clinical effectiveness outcomes, and no worldwide studies for the economic outcomes. Conclusion: This evidence of moderate to high quality. Pharmacist-led deprescribing was effective only in reducing PIMs usage and medication burden for older adults in nursing home and ambulatory care setting, but with no clinical effectiveness outcomes. It is essential to evaluate the economic outcomes in different countries other than Canada (high-income county). Family Medicine and Primary Care: Open Access Alsallal M, et al. J Family Med Prim Care Open Acc 6: 170. www.doi.org/10.29011/2688-7460.100070 www.gavinpublishers.com Citation: Alsallal M, Alsubaiei N, Assiri E, Amireh A, Booth A, Kofi M (2022) Effectiveness and Cost Effectiveness of Pharmacist-led Deprescribing Interventions in Nursing Homes and Ambulatory Care Settings in Elderly Patients: A Systematic Review. J Family Med Prim Care Open Acc 6: 170. DOI: 10.29011/2688-7460.100070 2 Volume 6; Issue 01