Royal College of Surgeons in Ireland
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Prescribing cascades in community-dwelling adults: protocol for a systematic review [version 2; peer review: 2 approved]

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journal contribution
posted on 2021-12-02, 10:30 authored by Ann Doherty, Frank MoriartyFrank Moriarty, Fiona BolandFiona Boland, Barbara ClyneBarbara Clyne, Tom FaheyTom Fahey, Seán Kennelly, Emma WallaceEmma Wallace
Introduction: Internationally, health systems face the challenge of managing a growing ageing population living with multimorbidity and polypharmacy. Potentially inappropriate prescribing is common among patients with polypharmacy, increasing the risk for adverse drug reactions (ADRs). Several prescribing indicator sets exist to improve prescribing and reduce potentially inappropriate prescribing, but do not address prescribing cascades. Prescribing cascades occur when a medication is prescribed to treat an ADR to another prescribed medication, whether intentionally or unintentionally, and constitute an important area to consider when characterising problematic polypharmacy. This is a protocol for a systematic review examining prescribing cascades in community-dwelling adults.
Methods: The review will be reported adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of Medline (Ovid), EMBASE, PsycINFO, CINAHL and the Cochrane Library will be conducted from inception to March 2021, using a predetermined strategy. Grey literature will be searched using Open Grey, MedNar, Dart Europe, and the Turning Research Into Practice (TRIP) databases. No restrictions will be placed on language or publication year. Inclusion criteria are: population - community-dwelling adults (≥18 years); risk - prescription medication with the potential to cause side effects; outcomes - initiation of a new medicine to ‘treat’ or reduce the risk of experiencing an ADR. Prospective and retrospective cohort studies, case control and case series studies will be included. Two reviewers will independently screen titles and abstracts; studies meeting inclusion criteria will undergo independent full-text screening by two reviewers. A narrative synthesis will be conducted. Study quality will be independently assessed using the relevant Joanna Briggs Institute Critical Appraisal Checklist.
Discussion: This systematic review will identify examples of prescribing cascades for community-dwelling adults and contribute to developing an evidence base regarding such cascades.
Registration: PROSPERO [ CRD42021243163 , 31/03/2021].


Health Research Board Ireland [Health Research Board Emerging Clinician Scientist Awards-2020-02]

Health Research Board (HRB) Emerging Investigator Award (EIA-2019-09)



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Published Citation

Doherty A, et al. Prescribing cascades in community-dwelling adults: protocol for a systematic review [version 2; peer review: 2 approved]. HRB Open Res 2021, 4:72

Publication Date

21 Sep 2021

PubMed ID



  • General Practice
  • School of Pharmacy and Biomolecular Sciences
  • Data Science Centre

Research Area

  • Population Health and Health Services


F1000 Research Ltd


  • N/A