Barbara Roux1,2, Julie Berthou-Contreras3, Jean-Baptiste Beuscart4, Marion Charenton-Blavignac5, Jean Doucet6, Jean-Pascal Fournier7, Blandine de la Gastine8, Sophie Gautier9, Régis Gonthier10, Valérie Gras11, Muriel Grau12, Pernelle Noize13,14, Elisabeth Polard15, Karen Rudelle16, Marie-Blanche Valnet-Rabier17, Thomas Tannou18, Marie-Laure Laroche12,19,20. 1. Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France. rouxbarbara91@gmail.com. 2. INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France. rouxbarbara91@gmail.com. 3. Department of Pharmacy, Clinical Pharmacy Unit, University Hospital of Besançon, Besançon, France. 4. Univ. Lille, CHU Lille, ULR 2694 - METRICS: Evaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France. 5. Department of Geriatric Medicine, Hospital Center of La Rochelle-Ré-Aunis, La Rochelle, France. 6. Department of Internal Medicine, Geriatrics and Therapeutics, Saint Julien Hospital, Rouen University Hospital, 76031, Rouen Cedex, France. 7. Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France. 8. Geriatric Department, Institut du Vieillissement, Hospices Civils de Lyon, Hôpital Pierre Garraud, Lyon, France. 9. Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Medical Pharmacology, University Hospital of Lille, Lille, France. 10. Département de Gérontologie Clinique, CHU de Saint Etienne, Hôpital de La Charité, 44 rue Pointe Cadet, 42000, Saint-Etienne, France. 11. Centre of Pharmacovigilance, Department of Clinical Pharmacology, University Hospital of Amiens, Amiens, France. 12. Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France. 13. Department of Clinical Pharmacology, University Hospital of Bordeaux, Bordeaux, France. 14. Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France. 15. Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Medical Pharmacology, University Hospital of Rennes, Rennes, France. 16. University Department of General Medicine, Faculty of Medicine, Limoges, France. 17. Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Medical Pharmacology, University Hospital of Besançon, Besançon, France. 18. Geriatric Departement, University Hospital of Besançon, Besançon, France. 19. INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France. 20. Laboratoire Vie-Santé (Vieillissement Fragilité Prévention, E-Santé), IFR GEIST, Université de Limoges, Limoges, France.
Abstract
PURPOSE: To establish a consensus on both explicit and implicit criteria in order to identify potentially inappropriate prescribing (PIP) in French older people aged 75 years and over or 65 years and over with multimorbidity. METHODS: Fifteen experts in geriatrics, general practice, pharmacy, and clinical pharmacology were involved in a two-round Delphi survey to assess preliminary explicit and implicit criteria based on an extensive literature review and up-to-date evidence data. Experts were asked to rate their level of agreement using a 5-level Likert scale for inclusion of criteria and also for rationale and therapeutic alternatives. A consensus was considered as reached if at least 75% of the experts rated criteria as "strongly agreed" or "agreed." RESULTS: The new tool included a seven-step algorithm (implicit criteria) encompassing the three main domains that define PIP (i.e. overprescribing, underprescribing, and misprescribing) and 104 explicit criteria. Explicit criteria were divided into 6 tables related to inappropriate drug duplications (n = 7 criteria), omissions of medications and/or medication associations (n = 16), medications with an unfavourable benefit/risk ratio and/or a questionable efficacy (n = 39), medications with an unsuitable dose (n = 4) or duration (n = 6), drug-disease (n = 13), and drug-drug interactions (n = 19). CONCLUSION: The REMEDI[e]S tool (REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors) is an original mixed tool, adapted to French medical practices, aimed at preventing PIP both at the individual level in clinical practice and the population level in large-scale studies. Therefore, its use could contribute to an improvement in healthcare professionals' prescribing practices and safer care in older adults.
PURPOSE: To establish a consensus on both explicit and implicit criteria in order to identify potentially inappropriate prescribing (PIP) in French older people aged 75 years and over or 65 years and over with multimorbidity. METHODS: Fifteen experts in geriatrics, general practice, pharmacy, and clinical pharmacology were involved in a two-round Delphi survey to assess preliminary explicit and implicit criteria based on an extensive literature review and up-to-date evidence data. Experts were asked to rate their level of agreement using a 5-level Likert scale for inclusion of criteria and also for rationale and therapeutic alternatives. A consensus was considered as reached if at least 75% of the experts rated criteria as "strongly agreed" or "agreed." RESULTS: The new tool included a seven-step algorithm (implicit criteria) encompassing the three main domains that define PIP (i.e. overprescribing, underprescribing, and misprescribing) and 104 explicit criteria. Explicit criteria were divided into 6 tables related to inappropriate drug duplications (n = 7 criteria), omissions of medications and/or medication associations (n = 16), medications with an unfavourable benefit/risk ratio and/or a questionable efficacy (n = 39), medications with an unsuitable dose (n = 4) or duration (n = 6), drug-disease (n = 13), and drug-drug interactions (n = 19). CONCLUSION: The REMEDI[e]S tool (REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors) is an original mixed tool, adapted to French medical practices, aimed at preventing PIP both at the individual level in clinical practice and the population level in large-scale studies. Therefore, its use could contribute to an improvement in healthcare professionals' prescribing practices and safer care in older adults.
Authors: Maarit S Dimitrow; Marja S A Airaksinen; Sirkka-Liisa Kivelä; Alan Lyles; Saija N S Leikola Journal: J Am Geriatr Soc Date: 2011-07-28 Impact factor: 5.562
Authors: Arjun Poudel; Anna Ballokova; Ruth E Hubbard; Leonard C Gray; Charles A Mitchell; Lisa M Nissen; Ian A Scott Journal: Geriatr Gerontol Int Date: 2015-09-03 Impact factor: 2.730