Introduction: Polypharmacy (≥5 long-term medicines) is common among older, multimorbid adults and increases medication-related risks. Structured medication reviews (SMRs) aim to improve medication safety. This report synthesised evidence on effectiveness, safety, organisation and costs, and compared European implementation to inform decision-making in Austria.

Methods: Systematic searches for umbrella reviews, systematic reviews and guidelines published since 2020. Outcomes included medication-related, clinical, organisational and economic endpoints; quality was assessed using ROBIS and AGREE II. A qualitative analysis compared implementation models in six European countries.

Results: Two umbrella reviews and three systematic reviews were included, showing low risk of bias but predominantly low-quality primary evidence. SMRs reduced potentially inappropriate medication and missing indicated therapies, with small effects on adherence. No clear mortality reduction was found; results for hospitalisations and quality of life were mixed, with no relevant safety concerns.

Discussion: SMRs improve medication-related processes but show inconsistent effects on patient-relevant outcomes. Effects depend strongly on intervention intensity and implementation quality. Economic evidence remains limited and heterogeneous.

Conclusions: SMRs should primarily be considered a measure to enhance medication safety. Implementation should prioritise high-risk patients, standardised components, clear communication pathways, use of digital medication data, and accompanying health services research.