The impact of medication management interventions on healthcare utilisation in people with dementia: a systematic review with meta-analysis

BACKGROUND: Medication management interventions are designed to reduce medication-related harms in older people with dementia; however, their effect on healthcare utilisation remains unclear. OBJECTIVE: To summarise the impact of medication management interventions on healthcare utilisation in people with dementia. DATA SOURCES: Embase, MEDLINE, Web of Science, Cochrane CENTRAL Register of Controlled Trials, CINAHL, PsycINFO. STUDY SELECTION: Interventional studies assessing the impact of medication management interventions on healthcare utilisation in people with dementia aged ≥65. DATA EXTRACTION AND SYNTHESIS: Eligible randomised controlled trials (RCTs) were meta-analysed with risk ratios (RR), 95% confidence intervals (CIs) using a fixed-effect model. Outcomes from non-randomised studies were summarised through narrative synthesis. MAIN OUTCOMES: Healthcare utilisation, including hospitalisation, emergency department visits, primary care and residential aged care home admissions. RESULTS: Seven RCTs and five non-randomised studies were eligible for inclusion. Common interventions were physician education (n = 5), physician and patient/carer education (n = 2), physician targeted prescribing reminders (n = 1) and multidisciplinary team-based interventions (n = 5). Among these, physician and patient/carer targeted education resulted in a reduction in all-cause hospitalisation (RR =0.92, 95% CI [0.84-0.99], P = .04) and emergency department visits (RR = 0.92, 95% CI [0.86-0.98], P = .007) while multidisciplinary team-based interventions were effective in reducing drug-related hospital readmission (Hazard Ratio = 0.49, 95% CI [0.27-0.90], P = .02). CONCLUSION: This review found that physician and patient/carer targeted education showed the most promising effect on all-cause hospitalisation and emergency department visits. Future research should develop tailored educational interventions that address key aspects of medication management to optimise healthcare utilisation in people with dementia.