https://orcid.org/0000-0002-9263-446X
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Abstract
Introduction
Polypharmacy and potentially inappropriate medications (PIM) are common among older adults. To guide appropriate prescribing, healthcare professionals often rely on explicit criteria to identify and deprescribe inappropriate medications, or to start medications due to prescribing omission. However, most explicit PIM criteria were developed with inadequate guidance from quality metrics or integrating real-world data, which are rich and valuable data source.
Aim
To develop a list of medications to facilitate appropriate prescribing among older adults.
Methods
A preliminary list of PIM and potential prescribing omission (PPO) were generated from systematic review, supplemented with local pharmacovigilance data of adverse reaction incidents among older people. Twenty-one experts from nine specialties participated in two Delphi to determine the list of PIM and PPO in February and March 2023. Items that did not reach consensus after the second Delphi round were adjudicated by six geriatricians.
Results
The preliminary list included 406 potential candidates, categorised into three sections: PIM independent of diseases, disease dependent PIM and omitted drugs that could be restarted. At the end of Delphi, 92 items were decided as PIM, including medication classes, such as antacids, laxatives, antithrombotics, antihypertensives, hormones, analgesics, antipsychotics, antidepressants, and antihistamines. Forty-two disease-specific PIM criteria were included, covering circulatory system, nervous system, gastrointestinal system, genitourinary system, and respiratory system. Consensus to start potentially omitted treatment was achieved in 35 statements across nine domains.
Conclusions
The newly developed PIM criteria can serve as a useful tool to guide clinicians and pharmacists in identifying PIMs and PPOs during medication review and facilitating informed decision-making for appropriate prescribing.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s40545-023-00630-4.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s40545-023-00630-4.
Acknowledgements
We would like to thank the Director General of Health Malaysia for his permission to publish this article. We would like to thank the Pharmacovigilance Section, Centre for Compliance and Quality Control, National Pharmaceutical Regulatory Agency (NPRA) for their invaluable contribution in providing the adverse drug events safety data used in this study. We would like to thank Mr. Jason Lee Choong Yin, Perak Pharmaceutical Services Division for assisting in the tabulation, visualization of NPRA pharmacovigilance data and developing the MALPIP website portal. We would like to thank Mr. Khoo Tatt Ee, Hospital Raja Permaisuri Bainun for assisting in development of the MALPIP Android application.
Author contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by CCT. All authors were involved in investigation during the Delphi rounds. HKC, WKC, YWK, MRAH, SWHL provided study-related resources. TCN, KCT, SA were involved in curating the pharmacovigilance data. CCT, MPT, ASHC, NAAB, PR, PV, SZH involved in checking and validating the accuracy of the drugs and drug classes in the first draft and the final MALPIP list. TCC involved in visualisation of the data into figures and tables. ASHS, WMC, JHO, NHS were involved in validating the analyses of secondary data. The first draft of the manuscript was written by CCT and all authors reviewed the manuscript critically and commented on the draft versions of the manuscript. All authors read and approved the final manuscript, and agrees to be accountable for its content.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Availability of data and materials
All data to reproduce the tables and figures in the manuscript and Additional Information can be obtained with reasonable request from the corresponding author.
Declarations
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Competing interests
The authors declare no conflict of interests.
Supplementary Information
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