Saturday, April 20, 2024

Impact of Medication Therapy Management on Inappropriate Medication Use in Older Adults

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Medication therapy management (MTM) programs are seen as a potential solution to tackle the issue of potentially inappropriate medications (PIMs) use. The use of PIMs is widespread, expensive, and detrimental to elderly adults. These medications pose a high risk of adverse events and have limited evidence of benefits, especially when safer or more effective alternatives are available.

Despite the potential benefits of medication therapy management, a systematic synthesis of studies exploring its impact on PIM use among the elderly has been lacking. To bridge this gap, a systematic literature review following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines was conducted. The investigation focused on studies that examined an MTM program, had a Medicare population, and was based in the United States.

Of the 221 articles identified, only seven met all inclusion and exclusion criteria. These studies were conducted in various settings, including single-site tertiary medical centers, multisite outpatient clinics, community pharmacies, and nationwide telehealth MTM providers. The patient populations were majorly female and white, with ages ranging from 73 to 78 years.

Medication Therapy Management

Medication Therapy Management’s Role in Reducing Inappropriate Meds in Older Adults

The findings showed that MTM reduced the use of PIMs in five out of the seven studies. However, three studies did not adjust for confounding or use a comparator group. The impacts of MTM on PIM use varied across studies, with most patient-level and plan-level studies assessing shorter-term PIM usage reduction (four months or less), while provider and institutional-level studies evaluated PIM usage reduction trends over consecutive measurement years.

While the current evidence suggests that MTM programs can positively impact the reduction of PIM use in older adults, the evidence is limited due to inconsistencies in study design, lack of uniform outcome measures, and short follow-up periods. Future research should consider these limitations and include longer-term outcomes, comparator groups, and a consistent set of measures across studies.

 

Original Article DOI: 10.18553/jmcp.2024.30.1.03

Original title: Impact of medication therapy management programs on potentially inappropriate medication use in older adults: A systematic review

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