Structured Medication Review for Polypharmacy

Duration: April 2025 – November 2025 (4 PM)
Language: English (with German summary)

Background:
The simultaneous, long-term use of several medicines (at least five different active ingredients) is often associated with multimorbidity and is referred to as polypharmacy (synonyms: polymedication, multimedication) [1]. Drug-related problems are very common, especially in older patients who take multiple medications. These problems include adverse drug reactions, interactions, ineffectiveness, taking medications without indication, inappropriate dosages and lack of adherence to therapy [2].

A careful structured medication review is therefore considered for most people with polypharmacy. This involves a structured conversation with patients to identify any problems with use, knowledge of the indications, indications of side effects or lack of adherence to treatment [3]. Propositions and solutions are then developed for relevant drug-related problems, e.g. dose adjustments, medication changes, or the review of the structured discontinuation of medication (deprescribing) for the sake of drug safety [1, 2]. According to a 2023 Cochrane systematic review of interventions to improve polypharmacy, it is unclear whether polypharmacy interventions can actually lead to clinically significant improvements. Nevertheless, the authors emphasise that interventions are increasingly being implemented by multidisciplinary teams and the number of studies on potential prescribing errors has increased [4]. According to a further Cochrane analysis from 2023, the evidence suggests that medication reviews in hospital patients have little to no effect on mortality, but can probably reduce the number of contacts with the emergency department as well as reduce the number of re-admissions [5].

In Austria, about 500,000 people are affected by polypharmacy [6]. In a cooperation project between the Umbrella Organisation of Austrian Social Insurances, the Austrian Chamber of Pharmacists and the Medical University of Vienna, a structured medication review was piloted and evaluated on 198 patients using a randomized controlled trial (RCT) [7]. The study was able to identify interactions and misuse of medications. The results on adherence to treatment and patient-reported outcomes indicated a possible 70 percent reduction of drug-related problems [8]. Based on these results, efforts are being made in Austria to establish structured medication review as a standardized, reimbursed intervention [7]. In Germany, the costs of structured medication reviews for patients with polypharmacy have been covered by health insurances since 2022. The costs are covered once a year, or in the event of a significant change in medication [9].

Project aims and research questions:
The aim of the project is to create a systematic review of the evidence for structured medication reviews and to give an overview of similar projects in selected European countries in order to provide a knowledge base for decision-making.

In addition, the legal situation regarding structured medication reviews in Austria, as well as information on the mechanism of action (mode of action model for weighting the different components of the medication review) will be described in the report’s background chapter.

The aim of this study is not to carry out a cost-effectiveness analysis, or to develop a detailed implementation plan for structured medication analysis in Austria. Two research questions (RQ) will be answered:

RQ1: What evidence on the benefits, safety, organisational aspects and costs of structured medication review is described in the literature?

RQ2: How is structured medication review implemented in selected countries, and what recommendations can be derived for Austria?

Methods:
The following methods are used to answer the research questions:

RQ1: Systematic search for systematic reviews and meta-analyses (PubMed/MEDLINE, Embase, Epistemonikos, Cochrane Library), HTA reports (INAHTA database) and guidelines (databases: AWMF, GIN, TRIPS). Quality assessment using ROBIS (systematic reviews) [10]and AGREE II (for guidelines) [11]with regard to the domains effectiveness and safety. Descriptive analysis of the organisational and economic domains. In case of a high number of available literature, restriction to recent, high-quality literature.

Inclusion and exclusion criteria (PICO):

RQ2: Structured country selection (focus on countries with established programmes for structured medication analysis, selection of case studies); structured hand search: Websites of health ministries, professional association websites of pharmacies, websites of transnational organisations (WHO, OECD, EU), evaluation reports of pilot projects; data extraction (iterative addition to preliminary categories); qualitative content analysis, narrative summary, description of the transferability of the implementation of other countries to the Austrian setting.

Preliminary data extraction categories:

Schedule and milestones:

References:
[1]  Pschyrembel Online. Polypharmazie. 2025 [cited 22.04.2025]. Available from: https://www.pschyrembel.de/Polypharmazie/P038B.
[2]  UpToDate. Deprescribing. 2025 [cited 22.04.2025]. Available from: https://www.uptodate.com/contents/deprescribing.
[3]  Bundesvereinigung Deutscher Apothekerverbände. Grundsatzpapier zur Medikationsanalyse und zum Medikationsmanagement. 2014 [cited 28.04.2025]. Available from:https://www.abda.de/fileadmin/user_upload/assets/Medikationsmanagement/Grundsatzpapier_MA_MM_GBAM.pdf.
[4]  Cole J. A., Gonçalves-Bradley D. C., Alqahtani M., Barry H. E., Cadogan C., Rankin A., et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2023;10(10):Cd008165. Epub 20231011. DOI: 10.1002/14651858.CD008165.pub5.
[5]  Bülow C., Clausen S. S., Lundh A. and Christensen M. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database of Systematic Reviews. 2023(1). DOI: 10.1002/14651858.CD008986.pub4.
[6]  Dachverband der Sozialversicherungsträger. Vorsicht Wechselwirkung! : 2020 [cited 22.04.2025]. Available from: https://www.sozialversicherung.at/cdscontent/?contentid=10007.844500.
[7]  Österreichische Apothekerkammer. Alle Arzneimittel im Blick: Pilotprojekt Medikationsanalyse. 2025 [cited 22.04.2025]. Available from: https://www.apothekerkammer.at/oesterreichs-apothekerinnen/fort-und-weiterbildung/pilotprojekt-medikationsanalyse.
[8]  Österreichische Apothekerkammer. Medikationsanalyse Ergebnisse Studie. 2025 [cited 22.04.2025]. Available from: https://www.apothekerkammer.at/aktuelles/aktuelle-themen/medikationsanalyse-ergebnisse-studie.
[9] Verbraucherzentrale NRW e.V. Medikationsanalyse: Apotheken prüfen, ob sich die Medikamente vertragen. 2024 [cited 22.04.2025]. Available from: https://www.verbraucherzentrale.de/wissen/gesundheit-pflege/medikamente/medikationsanalyse-apotheken-pruefen-ob-sich-die-medikamente-vertragen-76005.
[10]  Whiting P., Savovi? J., Higgins J. P., Caldwell D. M., Reeves B. C., Shea B., et al. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol. 2016;69:225-234. Epub 20150616. DOI: 10.1016/j.jclinepi.2015.06.005.
[11]  Consortium A. N. S. The AGREE II Instrument [Electronic Version]. 2017 [cited 22.04.2025]. Available from: https://www.agreetrust.org/wp-content/uploads/2017/12/AGREE-II-Users-Manual-and-23-item-Instrument-2009-Update-2017.pdf.