• Tau Ming Liew, Cia Sin Lee, Kuan Liang Goh Shawn, and Zi Ying Chang.
• Department of Geriatric Psychiatry, Institute of Mental Health, Singapore tau_ming_liew@imh.com.sg.
• Ann Fam Med. 2019 May 1; 17 (3): 257-266.

PurposePotentially inappropriate prescribing (PIP) is a common yet preventable medical error among older persons in primary care. It is uncertain whether PIP produces adverse outcomes in this population, however. We conducted a systematic review with meta-analysis to pool the adverse outcomes of PIP specific to primary care.MethodWe searched PubMed, Embase, CINAHL, Web of Science, Scopus, PsycINFO, and previous review articles for studies related to "older persons," "primary care," and "inappropriate prescribing." Two reviewers selected eligible articles, extracted data, and evaluated the risk of bias. Meta-analysis was conducted to pool studies with similar PIP criteria and outcome measures.ResultsOf the 2,804 articles identified, we included 8 articles with a total of 77,624 participants. All included studies had cohort design and low risk of bias. Although PIP did not affect mortality (risk ratio [RR] 0.98; 95% CI, 0.93-1.05), it was significantly associated with the other available outcomes, including emergency room visits (RR 1.63; 95% CI, 1.32-2.00), adverse drug events (RR 1.34; 95% CI, 1.09-1.66), functional decline (RR 1.53; 95% CI, 1.08-2.18), health-related quality of life (standardized mean difference -0.26; 95% CI, -0.36 to -0.16), and hospitalizations (RR 1.25; 95% CI, 1.09-1.44). A majority of the pooled estimates had negligible heterogeneity.ConclusionsThis meta-analysis provides consolidated evidence on the wide-ranging impact of PIP among older persons in primary care. It highlights the need to identify PIP in primary care, calls for further research on PIP interventions in primary care, and points to the need to consider potential implications when deciding on the operational criteria of PIP.© 2019 Annals of Family Medicine, Inc.

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