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REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors (REMEDI[e]S): French implicit and explicit criteria

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

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.

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Acknowledgements

We would like to acknowledge the assistance of Prof Louis Merle, professor emeritus of clinical pharmacology, Faculty of Medicine of Limoges, for his attentive and critical review of the manuscript.

Author information

Authors and Affiliations

  1. Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Pharmacology Toxicology and Centre of Pharmacovigilance, University Hospital of Limoges, Limoges, France

    Barbara Roux, Muriel Grau & Marie-Laure Laroche

  2. INSERM UMR 1248, Faculty of Medicine, University of Limoges, Limoges, France

    Barbara Roux & Marie-Laure Laroche

  3. Department of Pharmacy, Clinical Pharmacy Unit, University Hospital of Besançon, Besançon, France

    Julie Berthou-Contreras

  4. Univ. Lille, CHU Lille, ULR 2694 – METRICS: Evaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France

    Jean-Baptiste Beuscart

  5. Department of Geriatric Medicine, Hospital Center of La Rochelle-Ré-Aunis, La Rochelle, France

    Marion Charenton-Blavignac

  6. Department of Internal Medicine, Geriatrics and Therapeutics, Saint Julien Hospital, Rouen University Hospital, 76031, Rouen Cedex, France

    Jean Doucet

  7. Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France

    Jean-Pascal Fournier

  8. Geriatric Department, Institut du Vieillissement, Hospices Civils de Lyon, Hôpital Pierre Garraud, Lyon, France

    Blandine de la Gastine

  9. Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Medical Pharmacology, University Hospital of Lille, Lille, France

    Sophie Gautier

  10. Département de Gérontologie Clinique, CHU de Saint Etienne, Hôpital de La Charité, 44 rue Pointe Cadet, 42000, Saint-Etienne, France

    Régis Gonthier

  11. Centre of Pharmacovigilance, Department of Clinical Pharmacology, University Hospital of Amiens, Amiens, France

    Valérie Gras

  12. Department of Clinical Pharmacology, University Hospital of Bordeaux, Bordeaux, France

    Pernelle Noize

  13. Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France

    Pernelle Noize

  14. Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Medical Pharmacology, University Hospital of Rennes, Rennes, France

    Elisabeth Polard

  15. University Department of General Medicine, Faculty of Medicine, Limoges, France

    Karen Rudelle

  16. Centre of Pharmacovigilance and Pharmacoepidemiology, Department of Medical Pharmacology, University Hospital of Besançon, Besançon, France

    Marie-Blanche Valnet-Rabier

  17. Geriatric Departement, University Hospital of Besançon, Besançon, France

    Thomas Tannou

  18. Laboratoire Vie-Santé (Vieillissement Fragilité Prévention, E-Santé), IFR GEIST, Université de Limoges, Limoges, France

    Marie-Laure Laroche

Authors
  1. Barbara Roux
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  2. Julie Berthou-Contreras
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  3. Jean-Baptiste Beuscart
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  4. Marion Charenton-Blavignac
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  5. Jean Doucet
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  6. Jean-Pascal Fournier
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  7. Blandine de la Gastine
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  8. Sophie Gautier
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  9. Régis Gonthier
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  10. Valérie Gras
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  11. Muriel Grau
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  12. Pernelle Noize
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  13. Elisabeth Polard
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  14. Karen Rudelle
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  15. Marie-Blanche Valnet-Rabier
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  16. Thomas Tannou
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  17. Marie-Laure Laroche
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Contributions

BR and MLL conceived and designed the study; BR screened the literature; BR and MLL drafted preliminary criteria; BR conducted the Delphi survey; BR and MLL analyzed the data; JBC, JBB, MCB, JD, JPF, BG, SG, RG, VG, MG, PN, EP, KR, MBVR, and TT participated in the Delphi consensus as experts; BR and MLL interpreted the data. All authors revised the manuscript and approved the final version.

Corresponding author

Correspondence to Barbara Roux.

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Competing interests

The authors declare no competing interests.

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Roux, B., Berthou-Contreras, J., Beuscart, JB. et al. REview of potentially inappropriate MEDIcation pr[e]scribing in Seniors (REMEDI[e]S): French implicit and explicit criteria. Eur J Clin Pharmacol 77, 1713–1724 (2021). https://doi.org/10.1007/s00228-021-03145-6

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  • DOI: https://doi.org/10.1007/s00228-021-03145-6

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