Introduction

Medication reviews are used as a tool to combat inappropriate polypharmacy and associated adverse effects.1 In numerous trials, medication reviews have decreased the number of potentially inappropriate medicines and increased the prescribing appropriateness.2
We have previously reported on the clinical effects of medication reviews as a supplement to usual care in a geriatric outpatient clinic.3 In a randomized clinical trial, medication reviews reduced the number of medicines after 4 months and led to relative increases in the patient’s health-related quality of life (HRQoL) and reduced mortality. The combined beneficial effect on HRQoL and mortality support that the discontinued and dose-reduced medicines were in fact inappropriate and not merely potentially inappropriate. Thus, a detailed description of these medicines seem warranted as these medicines could be discontinued in a pragmatic clinical trial setting and thus are of clinical relevance for medication reviews in geriatric outpatients.
The purpose of this paper is twofold: 1) to provide a detailed description of the medication changes implemented during medication reviews to better understand the observed beneficial clinical effects and to guide future medication review interventions; and 2) to explore patient- and medication-related factors that may identify patients that will benefit most from medication reviews. To fulfill these purposes, the detailed descriptions include: 1) the actual changes to the medicine; 2) the persistence of the changes; 3) the medicines most often discontinued; 4) the reasons for discontinuing; 5) the medicines that most often were prescribed again after discontinuation; and 6) an exploratory analysis of factors that predicted the number of overprescribed medicines to help identify patients that may benefit the most from medication reviews.