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EbM zwischen Best Practice und inflationärem Gebrauch
16. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

Deutsches Netzwerk Evidenzbasierte Medizin e. V.

13.03. - 14.03.2015, Berlin

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Efficacy and safety of drugs commonly used in the management of chronic diseases in older adults: a compilation of systematic reviews for the development of an electronic decision support tool

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  • author Thekraiat Al Qur'an - Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
  • corresponding author presenting/speaker Anna Renom-Guiteras - Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
  • author Yolanda Martinez - Primary Care Research Group, University of Manchester, Manchester, Vereinigtes Königreich
  • author Christina Sommerauer - Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
  • author Anna Vögele - South Tyrolean Academy for General Practice, Bozen, Italien
  • author Roman Schlager - Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
  • author Anja Rieckert - Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
  • author Maren Meinshausen - Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
  • author Barbara Faller - Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
  • author Sabine Weißbach - Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
  • author Germaine Stern-Kuthe - Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
  • author Nik Koneczny - Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
  • author Adrine Woodham - Primary Care Research Group, University of Manchester, Manchester, Vereinigtes Königreich
  • author Neha Kaushik - Primary Care Research Group, University of Manchester, Manchester, Vereinigtes Königreich
  • author Gisela Schott - Drug Commission of the German Medical Association, Berlin, Deutschland
  • author Andreas Sönnichsen - Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland

EbM zwischen Best Practice und inflationärem Gebrauch. 16. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin. Berlin, 13.-14.03.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15ebmP10a

doi: 10.3205/15ebm074, urn:nbn:de:0183-15ebm0744

Published: March 3, 2015

© 2015 Al Qur'an et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License. You are free: to Share - to copy, distribute and transmit the work, provided the original author and source are credited. See license information at http://creativecommons.org/licenses/by-nc-nd/3.0/.

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Background and aims: There is a need to carefully weigh the risks and benefits of medication in older adults with multimorbidity and polypharmacy. Aims are: 1) to identify the evidence on risks and benefits of drugs commonly used in older adults; 2) to provide recommendations on their use, which can be incorporated into an electronic decision support tool (eDS-tool) aimed at supporting general practitioners to reduce inappropriate prescriptions.

Methods: A set of systematic reviews (SR) was planned for n = 24 drugs and indications. For each SR a study protocol was developed, and the PICOS-framework was used for the development of the search terms; literature search comprised three searches, each of which being undertaken only if the previous one did not yield high quality results: searches 1 and 2 identified SRs and meta-analyses in the Cochrane Database of Systematic Reviews and DARE, and in MEDLINE, EMBASE, HTA and IPA, respectively. Search 3 identified clinical trials and observational studies from SRs not included in searches 1 and 2 but containing eligible studies, and from the databases considered in search 2. Inclusion criteria: studies evaluating the risks and benefits of the corresponding drug and indication; significant number of participants aged ≥65 or subgroup analysis of this population; clinically relevant endpoints. Selection of studies, data extraction and quality appraisal were performed by two reviewers independently. Based on the evidence found the recommendations were developed using the GRADE methodology, and integrated in the eDS-tool.

Results: Currently, n = 18 SRs are completed and n = 6 SRs are ongoing. In general, the amount of studies included and the quality of the evidence are low. So far, n = 41 recommendations for the following drugs have been developed: metformin, sulfonylureas, gliptins, glitazones, non-steroidal anti-inflammatory drugs, statins, beta-blocking agents, Vitamin K antagonists, new oral anticoagulants, nitrates, calcium channel blockers, thiazides, platelet inhibitors and high ceiling diuretics.

Discussion: Our work reflects a general lack of high quality evidence regarding drug treatment of older people with multiple conditions. Recommendations are currently checked by external review and will then be integrated in the eDS-tool. The eDS-tool will be tested in a randomised controlled trial with clinically relevant endpoints. This study is part of the 7th Framework European Project PRIMA-eDS (Grant No. 305388-2).