Structured medication reviews for polypharmacy: evidence and implementation across Europe

Background

Polypharmacy, defined as the long-term use of five or more medicines, is prevalent in ageing populations and associated with drug-related problems such as adverse drug events, drug interactions, inappropriate prescribing and reduced adherence. Structured medication reviews (SMR) are proposed to optimise medication use and improve medication safety. This systematic review synthesised evidence on SMR effectiveness, safety, organisational aspects and costs, and compared implementation and reimbursement across six European countries.

Methods

A systematic search (Medline, Cochrane, Epistemonikos, INAHTA) and a manual search of guideline databases were conducted for studies and guidelines published since 2020. Risk of bias was assessed using ROBIS and AGREE II. A qualitative content analysis was conducted for six European countries.

Results

Two umbrella reviews, three systematic reviews and six clinical guidelines were included. Included reviews were at low risk of bias, though primary study evidence was of low to very low certainty. SMR consistently reduced potentially inappropriate medications and prescribing omissions. No consistent mortality reduction was demonstrated across reviews. Hospitalisation effects were mixed, with reductions mainly in high-intensity interventions. SMR were predominantly pharmacist-led, requiring 30-60 minutes at a cost of 21-146 euros. Included guidelines consistently recommend SMR for patients with multimorbidity and polypharmacy, emphasising multidisciplinary collaboration. Reimbursed programmes share a pharmacist-led model targeting high-risk patients but vary in remuneration and interprofessional integration.

Conclusions

SMR can improve medication-related process outcomes, but evidence for major clinical endpoints remains limited and inconsistent. Implementation should prioritise standardised interventions, interprofessional collaboration and digital medication records, accompanied by real-world effectiveness research.

Key messages

• Structured medication reviews reduce inappropriate prescribing, but evidence for effects on mortality, hospitalisations and quality of life remains limited and inconsistent.

• Reimbursed SMR programmes across six European countries share a pharmacist-led model but differ substantially in remuneration and interprofessional integration.