Tools and guidelines to assess the appropriateness of medication and aid
the deprescribing: an umbrella review
Abstract
AIMS The aim of this umbrella review was to identify tools and
guidelines available to aid the deprescribing process of potentially
inappropriate medications (PIM), evaluate their methods of development
and validation, and describe at what level of evidence medications are
included in the tools and guidelines. METHODS Searches were conducted on
MEDLINE(Ovid), Embase.com, Cochrane CDSR, CINAHL (EBSCO), Web of Science
Core Collection, and guideline databases from the date of inception to
July 7, 2022. We described and compared the different characteristics
and contents of tools and guidelines. RESULTS From 10,606 records
screened, 23 systematic reviews and guidelines met the inclusion
criteria. We then identified 90 tools (67 explicit, 12 mixed, 11
implicit), and 9 guidelines. The majority were developed for use in
older adults (n = 74). Nineteen tools targeted older adults with limited
life expectancy (LLE), and 7 targeted children <18 years. The
majority (97%) of explicit/mixed tools were validated through Delphi
techniques (n = 61). Two tools and eight guidelines provided information
on the level of evidence for the included medications, of which less
than a quarter were included based on high-quality evidence. CONCLUSION
Existing tools are available for a diversity of populations.
Discrepancies identified in categorizing medications as appropriate or
not can be a result of low quality evidence. Particularly, tools for
patients with LLE were developed based on very limited evidence, and
research to generate this evidence is highly needed. Our medication
lists, along with the level of evidence, could facilitate efforts to
strengthen the evidence.