P-592: Intervention elements to reduce inappropriate prescribing for older adults with multimorbidity receiving outpatient care: a scoping review

摘要

Introduction: Polypharmacy occurs in approximately 30% of older adults aged 65 years or more [1], particularly among those with multimorbidity. With polypharmacy, there is an associated risk of potentially inappropriate prescribing (PIP). This scoping review aims to identify the intervention elements that have been adopted to reduce PIP in the outpatient setting. Methods: The scoping review was guided by the methodological framework developed by Arksey and O'Malley [2]. Electronic databases (PubMed, CINAHL, EMBASE, Web of Science, Cochrane), grey literature sources, six key geriatrics journals (e.g., Journal of the American Geriatrics Society, Age and Ageing) and the reference lists of review papers were searched. Intervention elements extracted from the included studies were mapped onto the intervention functions of the Behaviour Change Wheel [3]. Results: Of 8204 studies identified, 79 studies were included in the final analysis. Included studies comprised randomized controlled trials, study protocols and abstracts. From the 79 interventions, 14 elements were identified. An average of two to three elements was adopted in each intervention. The top three most commonly used intervention elements were medication review (87%), training (26%) and tool/instrument(s) (23%). 60% of the medication reviews involved pharmacists. The 14 intervention elements were mapped onto five intervention functions: "education", "persuasion", "training", "environmental restructuring" and "enablement". Key conclusion: PIP is a multi-faceted problem that involves multiple stakeholders. An intervention against PIP will require multiple elements to target the behaviours of each stakeholder. The intervention elements and their respective functions identified in this scoping review will provide invaluable insight when designing a complex intervention that aims to reduce PIP.