Farhad Pazan1, Yana Gercke1, Christel Weiss2, Martin Wehling3. 1. Institute for Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Germany. 2. Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty of the University of Heidelberg in Mannheim, Germany. 3. Institute for Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Germany. Electronic address: martin.wehling@medma.uni-heidelberg.de.
Abstract
BACKGROUND/ OBJECTIVES: Polypharmacy and multimorbidity is a threat to older people; hence, listing approaches should support physicians to optimize medication. The FORTA (Fit fOR The Aged) classification of drug appropriateness for older people provides positive or negative labels: A (A-bsolutely), B (B-eneficial), C (C-areful), and D (D-on't). Based on these categories, FORTA-labeled drug lists were developed in 7 European countries or regions; the same approach was used to develop a U.S.-FORTA List reflecting the country-specific availability and usage of drugs. DESIGN/ SETTING: A 2-step Delphi-type approach was employed to add, remove, or relabel drugs from the listing proposal and to add or remove new indications. The proposal utilized the European (EURO)-FORTA list as template. PARTICIPANTS: Eight US-based geriatricians/pharmacists served as raters. MEASUREMENTS: Raters gave recommendations and comments on the list items. RESULTS: The first U.S.-FORTA List contains 273 items aligned to 27 main indication groups; 30 drugs and drug groups were added, and 23 removed as being unavailable in the United States. The highest percentage of changes in FORTA labels as compared to the EURO-FORTA List occurred for sleep disorders associated with dementia (40%). In 8 indications, the labels for 11 items were different from the proposal. Thus, for the majority of the items (n = 232, 95.5%), the proposals were accepted by the US raters. Only 16 (6.6%) of the proposed items (n = 243) had to be re-evaluated in the second round as a result of inconsistent rating in the first round. CONCLUSIONS AND IMPLICATIONS: The U.S.-FORTA List addresses the appropriateness of drugs for older people in the United States reflecting country-specific availability, usage, and expert rating. As shown for the FORTA list in Europe, this listing approach is among the few that are clinically validated and improve well-being and geriatric outcomes. The U.S.-FORTA List now largely enhances the global availability of this approach.
BACKGROUND/ OBJECTIVES: Polypharmacy and multimorbidity is a threat to older people; hence, listing approaches should support physicians to optimize medication. The FORTA (Fit fOR The Aged) classification of drug appropriateness for older people provides positive or negative labels: A (A-bsolutely), B (B-eneficial), C (C-areful), and D (D-on't). Based on these categories, FORTA-labeled drug lists were developed in 7 European countries or regions; the same approach was used to develop a U.S.-FORTA List reflecting the country-specific availability and usage of drugs. DESIGN/ SETTING: A 2-step Delphi-type approach was employed to add, remove, or relabel drugs from the listing proposal and to add or remove new indications. The proposal utilized the European (EURO)-FORTA list as template. PARTICIPANTS: Eight US-based geriatricians/pharmacists served as raters. MEASUREMENTS: Raters gave recommendations and comments on the list items. RESULTS: The first U.S.-FORTA List contains 273 items aligned to 27 main indication groups; 30 drugs and drug groups were added, and 23 removed as being unavailable in the United States. The highest percentage of changes in FORTA labels as compared to the EURO-FORTA List occurred for sleep disorders associated with dementia (40%). In 8 indications, the labels for 11 items were different from the proposal. Thus, for the majority of the items (n = 232, 95.5%), the proposals were accepted by the US raters. Only 16 (6.6%) of the proposed items (n = 243) had to be re-evaluated in the second round as a result of inconsistent rating in the first round. CONCLUSIONS AND IMPLICATIONS: The U.S.-FORTA List addresses the appropriateness of drugs for older people in the United States reflecting country-specific availability, usage, and expert rating. As shown for the FORTA list in Europe, this listing approach is among the few that are clinically validated and improve well-being and geriatric outcomes. The U.S.-FORTA List now largely enhances the global availability of this approach.
Authors: Farhad Pazan; Ronan Collins; Victor M Gil; Olivier Hanon; Roland Hardt; Martin Hoffmeister; Pedro Monteiro; Terence J Quinn; Dieter Ropers; Giuseppe Sergi; Freek W A Verheugt; Martin Wehling Journal: Drugs Aging Date: 2020-07 Impact factor: 3.923
Authors: Thomas R Radomski; Alison Decker; Dmitry Khodyakov; Carolyn T Thorpe; Joseph T Hanlon; Mark S Roberts; Michael J Fine; Walid F Gellad Journal: JAMA Netw Open Date: 2022-02-01
Authors: Martin Schulze Westhoff; Adrian Groh; Sebastian Schröder; Phileas Johannes Proskynitopoulos; Kirsten Jahn; Martin Klietz; Benjamin Krichevsky; Dirk O Stichtenoth; Felix Wedegärtner; Stefan Bleich; Helge Frieling; Johannes Heck Journal: J Neural Transm (Vienna) Date: 2022-09-02 Impact factor: 3.850