A comprehensive analysis of medication review programs targeting potentially inappropriate prescribing among older primary care patients found these programs can safely reduce medication numbers without harming health outcomes. 

Potentially inappropriate prescribing refers to medications with risks that may outweigh benefits or those prescribed without clear clinical indication. According to the study, the likelihood of potentially inappropriate prescribing increases as patients are prescribed more medications due in part to the risk of harmful drug-drug interactions, and older adults are more likely to be exposed to potentially inappropriate prescribing. The systematic review and meta-analysis, published in JAMA Network Open, examined 118 randomized controlled trials involving 417,412 patients aged 65 and older.

The study found that interventions designed to address inappropriate prescribing reduced the average number of medications per patient by approximately 0.5 drugs. This reduction represents a standardized mean difference of -0.25, which researchers noted as statistically significant and clinically meaningful for reducing medication burden.

However, the medication reductions did not translate into substantial improvements in other health measures. The interventions showed no statistically significant effects on hospitalizations, all-cause mortality, injurious falls, quality of life, emergency department visits or nonserious adverse drug reactions.

Most interventions involved pharmacists (51% of trials) reviewing medication lists, while 27% used software-based reviews. The studies included both explicit interventions, which target specific medications known to be problematic; and implicit interventions, which involve general medication reviews without targeting particular drugs.

The research encompassed diverse settings, with 79% of trials conducted in ambulatory care and 21% in long-term care facilities. Follow-up periods ranged from 1.5 to 24 months, with most studies tracking participants for 6-12 months.

Researchers concluded that these interventions can be safely implemented in primary care settings to reduce the number of medications prescribed to older adults. The findings provide reassurance to patients and clinicians that organized approaches to addressing inappropriate prescribing carry minimal risk while achieving meaningful reductions in medication burden.