Impact of telemedicine on minimizing polypharmacy in older adult patients receiving primary care: a systematic review

Polypharmacy is common among older adults and is associated with an increased risk of adverse drug events, hospitalization, and mortality; recently, telemedicine has emerged as a potential strategy for optimizing medication management and reducing polypharmacy. This systematic review evaluated the effectiveness, feasibility, and acceptability of telemedicine interventions aimed at reducing the risk of polypharmacy among older adults. A systematic research was conducted in PubMed, Embase, CINAHL/EBSCO, and Cochrane databases. Studies involving adults aged ≥ 60 years with polypharmacy who received telemedicine interventions (teleconsultation, telemonitoring, or tele-education) were included. Two independent reviewers screened articles, extracted data, and assessed the risk-of-bias, and any disagreements were resolved through discussion with senior reviewers. The certainty of evidence was evaluated using the GRADE approach. The primary outcome was a reduction in polypharmacy and its adverse drug events through medication management. Secondary outcomes included patient satisfaction, feasibility and acceptability, provider perspectives, and intervention cost-effectiveness. Eleven studies, including randomized controlled trials and observational studies, met the inclusion criteria. Telemedicine interventions, commonly involving asynchronous medication reviews and synchronous consultations, were associated with minor reductions in overall medication burden and consistent decreases in potentially inappropriate medication use. The deprescribing rates were higher in the intervention group compared with the control group. Feasibility and acceptability were high among patients and healthcare providers. Economic evaluations were limited but suggested cost savings. Barriers included limited access to technology and increased provider workloads. Telemedicine interventions present a promising approach for reducing polypharmacy and optimizing medication use among older adults. Although the findings suggest beneficial effects and good acceptability, the overall evidence base remains limited by heterogeneity and methodological constraints. Larger, well-designed randomized trials are needed to confirm the effectiveness and cost-effectiveness of telemedicine strategies in this population. PROSPERO (registration no. PROSPERO 2024 CRD42024571974).