Overuse of medications in low- and middle-income countries: a scoping review

Abstract

Objective To identify and summarize the evidence about the extent of overuse ofmedications in low- and middle-income countries, its drivers, consequences andpotential solutions.Methods We conducted a scoping review by searching the databases PubMed{\textregistered}, Embase{\textregistered}, APA PsycINFO{\textregistered} and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 and were reporting on the extent of overuse, its drivers, consequences and solutions.Findings We screened 3489 unique records and included 367 studies reportingon over 5.1 million prescriptions across 80 low- and middle-income countries – with studies from 58.6% (17/29) of all low-, 62.0 % (31/50) of all lower-middle and 60.0% (33/55) upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2–64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patients harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit–feedback initiatives.Conclusion Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data ofsolutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications.