week 8

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Author &

Date/

Level of Evidence

Title & Topic/

Focus/Question

Research

Method/

Paradigm

Context/ Setting/ Sample

Limitations of Study / Risk of Bias/

Gaps

Findings

Possible Themes

1

Ie et al. (2024) / Level II

Medication Optimization Protocol

Efficacy for Geriatric Inpatients: A Randomized Clinical Trial. Examined whether a multidisciplinary medication optimization/deprescribing intervention improves outcomes and reduces medications and potentially inappropriate medications (PIMs) in older adults with polypharmacy.

Randomized clinical trial

Older hospitalized adults with polypharmacy in Japan; 442 participants ≥65 years. Multidisciplinary intervention included medication review using STOPP/START criteria.

Conducted in a hospital setting, which may limit generalizability to primary care. The intervention did not demonstrate improvement in the primary composite clinical outcome.

Intervention significantly reduced the number of medications and PIMs without increasing adverse events. It did not significantly reduce death, unscheduled hospital visits, or rehospitalization.

Medication optimization; deprescribing; reduction of PIMs; multidisciplinary medication review

2

Vasilevskis et al. (2023) / Level II

Deprescribing Medications Among Older Adults From End of Hospitalization Through Postacute Care: A Shed-MEDS Randomized Clinical Trial. Examined whether patient-centered deprescribing reduces medication burden during transitions from hospital to postacute care.

Randomized clinical trial

372 older adults with polypharmacy transitioning from hospitalization to postacute-care facilities. Intervention was pharmacist- or nurse practitioner-led and patient-centered.

Clinicians were not blinded, creating possible contamination between groups. Large number of postacute-care sites prevented adjustment for some site-level effects. Long-term patient-reported outcomes require further study.

Intervention patients had significantly fewer medications than usual-care patients at postacute-care discharge, and the reduction was sustained at 90 days

Deprescribing; medication burden; patient-centered medication review; transitions of care

3

Grischott et al. (2023) / Level II

Medication Review and Enhanced Information Transfer at Discharge of Older Patients with Polypharmacy: a Cluster-Randomized Controlled Trial in Swiss Hospitals. Examined whether medication review plus better communication between hospital and primary-care physicians improves outcomes after discharge.

Cluster-randomized controlled trial; 6-month follow-up

21 Swiss hospitals; 609 patients ≥60 years taking ≥5 medications. Hospitals used either checklist-guided medication review/enhanced communication or usual discharge procedures.

Hospital-based intervention limits direct application to outpatient primary care. Cluster design and differences in implementation between hospitals may influence results.

Structured medication review and enhanced communication were tested to improve medication safety during transition from hospital to primary care; the intervention did not significantly delay hospital readmission, although it addressed medication appropriateness and communication at discharge.

Medication reconciliation/review; transitions of care; provider communication; medication safety

4

Quek et al. (2023) / Level II

Deprescribing for Older People Living in Residential Aged Care Facilities: Pharmacist Recommendations, Doctor Acceptance and Implementation. Examined pharmacist deprescribing recommendations, GP acceptance, and whether accepted recommendations were actually implemented.

Study conducted within a randomized controlled trial; pharmacist-led algorithm-based medication review

Older adults living in residential aged-care facilities. Pharmacists reviewed medications and made deprescribing recommendations to GPs; implementation was evaluated over 12 months.

Residential aged-care setting may limit generalizability to independent community-dwelling older adults. Deprescribing depended on GP acceptance and subsequent implementation of pharmacist recommendations.

Pharmacist-led medication review identified medications appropriate for deprescribing. Recommendations were acceptable to physicians and contributed to reducing inappropriate medication use.

Pharmacist-led medication review; deprescribing; interdisciplinary collaboration; inappropriate polypharmacy

5

Kornholt et al. (2022) / Level II

Effects of a comprehensive medication review intervention on health-related quality of life and other clinical outcomes in geriatric outpatients with polypharmacy. Evaluated whether comprehensive medication review improves outcomes in older adults with polypharmacy.

Pragmatic, nonblinded RCT; follow-up at 4 and 13 months

Geriatric outpatient setting in Denmark; 408 patients, mean age 80.6; taking ≥9 medications

Nonblinded study; specialized geriatric population may limit generalizability; some benefits were mainly short term.

Medication review, patient education, and improved communication reduced medication number and improved some short-term outcomes, including HRQoL

Medication review; patient education; provider communication; reducing medication burden

6

Lee et al. (2023) / Level II

Effect of Pharmacist-Led Intervention in Elderly Patients through a Comprehensive Medication Reconciliation. Evaluated pharmacist/hospitalist medication reconciliation for older adults

Prospective, open-label RCT

Hospitalized adults ≥65 years; n=32 in Korea

Very small sample; open-label; single setting; short 30-day follow-up

Pharmacist-led comprehensive reconciliation had 83% acceptance. No ADEs were reported in the intervention group at 30-day follow-up compared with five in controls; regimen complexity also decreased.

Medication reconciliation; pharmacist collaboration; medication safety; regimen simplification

7

Jungo et al., 2023 (OPTICA) / Level II

Optimizing prescribing in older adults with multimorbidity and polypharmacy in primary care. Evaluated whether clinical decision support for GPs improves medication appropriateness.

Cluster randomized clinical trial

Swiss primary care; older adults with multimorbidity and polypharmacy

Complex intervention; cluster design; medication recommendations still depended on physician/patient decisions; limited evidence for major clinical outcome improvement

The intervention supported medication optimization in primary care, but improvements in the main clinical outcomes were limited compared with usual care.

Primary care medication review; decision support; appropriate prescribing; deprescribing

8

Gillespie et al., 2025 (SPPiRE) / Level III*

Cost effectiveness of a GP delivered medication review to reduce polypharmacy and potentially inappropriate prescribing.

Within-trial economic evaluation of cluster RCT; 6-month follow-up

Irish primary care; 403 older patients with multimorbidity, 208 intervention/195 control

Missing data created uncertainty; differences in costs and QALYs were not statistically significant; economic rather than primary clinical-outcome paper

GP-led individualized medication review produced a small significant reduction in medication number; economic findings were promising but uncertain.

GP-led medication review; primary care; PIM reduction; feasibility/cost effectiveness

9

Meurant et al., 2023 / Level III*

Implementation of clinical medication review in a geriatric ward to reduce potentially inappropriate prescriptions among older adults. Examined implementation of medication review for older hospitalized adults.

Retrospective observational study

Geriatric hospital ward in France; 137 older patients

Nonrandomized and retrospective; single-center design; possible confounding; hospital setting limits primary-care generalizability

Clinical medication review identified medication-related problems and supported reduction/correction of potentially inappropriate prescribing in geriatric patients

PIM identification; clinical medication review; interdisciplinary care; medication safety

10

Abou et al., 2025 (LeMON) / Level II

Pharmacist-led deprescribing of cardiovascular and diabetes medication within a clinical medication review. Tested whether deprescribing-focused pharmacist training improves deprescribing.

Cluster RCT

Netherlands community pharmacies; 140 patients ≥70 years with polypharmacy; 71 intervention, 69 control

Focused only on cardiovascular/diabetes medications; relatively small sample; short 3-month follow-up

At 3 months, ≥1 targeted drug was stopped in 32% intervention vs 26% control , which was not statistically significant. The study emphasized the need for pharmacist-GP communication.

Deprescribing; pharmacist training; primary care; interdisciplinary communication

11

Baas et al., 2026 / Level II

Deprescribing in older patients with hyperpolypharmacy: a cluster-randomized trial in primary care. Examined a deprescribing-focused clinical medication review for patients taking many chronic medications.

Cluster randomized trial

Dutch primary care/community pharmacy; older adults with hyperpolypharmacy (≥10 chronic medications)

Deprescribing depends on cooperation among pharmacists, physicians, and patients; results may not generalize to patients with less severe polypharmacy

A structured clinical medication review focused on deprescribing was tested as a practical strategy for reducing medication burden in older primary-care patients with hyperpolypharmacy.

Hyperpolypharmacy; deprescribing; clinical medication review; primary care collaboration

12

Somerville et al., 2026 / Level II

Feasibility, Acceptability, and Preliminary Efficacy of a Medication Intervention for Older Adults. Evaluated tailored medication management (TIMM).

Single-blind, parallel-group randomized trial

Community-dwelling older adults; 26 completed; pharmacist medication review plus in-home occupational therapy intervention

Very small pilot sample; only 78.8% completed study; physician response to pharmacist recommendations was a barrier

TIMM was feasible and acceptable and significantly improved medication-management barriers and performance, but did not significantly reduce inappropriate medications or improve adherence

Patient-centered medication management; pharmacist collaboration; patient education; implementation barriers

13

Duncan et al. (2026) / Level III*

Patients’ experiences of a patient-centered polypharmacy medication review intervention: a mixed-methods study. Explored patients’ experiences with a patient-centered medication review intervention in primary care.

Mixed-methods process evaluation embedded within the IMPPP cluster randomized controlled trial; survey, interviews, and audio-recorded medication reviews.

English primary care/general practices. 767 intervention patients were invited to complete the survey; 556 responded (72.5%), 28 were interviewed, and 27 medication reviews were recorded. Median age of survey responders was 73

Participants were predominantly White British; survey responders differed somewhat from nonresponders. This paper focuses on patient experience, and the main IMPPP trial effectiveness results were not yet published, so it does not establish whether the intervention reduced PIP

73.2% were satisfied with their medication review and 79.9% were satisfied with how it was delivered. Patients valued being informed and prepared, clear follow-up, shared decision-making, and collaborative care. Pharmacist-led reviews were generally acceptable.

Patient-centered medication review; shared decision-making; patient preparation/education; pharmacist-led care; communication

14

Gama et al. (2025) / Level III*

Effectiveness of Pharmacist Interventions in Improving Medication Use in Hospitalized Older Patients Diagnosed With Cardiovascular Diseases: INFAR Before-and-After Study. Evaluated pharmacist medication review for reducing polypharmacy, PIMs, and prescribing omissions

Before-and-after uncontrolled intervention study. Pharmacists reviewed medications and compared admission with discharge prescriptions.

Cardiovascular hospital in Brazil; 319 hospitalized adults ≥60 years with cardiovascular disease; mean age 68.9 years.

No control group or randomization; non-probability sample; hospital cardiovascular population may limit generalizability to primary care.

PIMs decreased from 291 to 28 (~90% reduction). Mean medications decreased from 9.8 to 6.5. Potentially inappropriate prescribing fell from 79.3% to 6.9%, with significant reductions in polypharmacy and prescribing omissions.

Pharmacist-led medication review; deprescribing; PIM reduction; reducing polypharmacy; medication safety

15

Hellemans et al. (2026) / Level III*

Implementation evaluation of a pharmacist-led complex intervention: A mixed-methods analysis embedded within the ASPIRE randomized controlled trial. Evaluated implementation, fidelity, feasibility, and acceptability of a pharmacist-led medication intervention.

Convergent parallel mixed-methods implementation evaluation embedded within the ASPIRE RCT; quantitative data plus interviews and a focus group.

Three acute geriatric wards at University Hospitals Leuven, Belgium. Quantitative sample included 415 intervention patients, mean age 85.9 years; qualitative component included healthcare professionals, patients, and family members.

Single tertiary hospital; implementation-focused rather than an effectiveness analysis. Primary RCT outcome on hospital revisits was still being analyzed separately, so this article cannot determine the intervention's clinical effectiveness.

87% of patients received all intervention components. The intervention was considered feasible and acceptable. Adequate staffing/time, training, established working relationships, shared information systems, and a detailed intervention guide supported successful implementation.

Medication reconciliation; pharmacist-led care; implementation; interdisciplinary communication; transitions of care

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