Wiener klinische Wochenschrift

, Volume 124, Issue 5–6, pp 160–169 | Cite as

Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list

  • Eva Mann
  • Birgit Böhmdorfer
  • Thomas Frühwald
  • Regina E. Roller-Wirnsberger
  • Peter Dovjak
  • Christine Dückelmann-Hofer
  • Peter Fischer
  • Susanne Rabady
  • Bernhard Iglseder
Original article

Summary

BACKGROUND: The practice of inappropriate medication and drug prescription is a major risk factor for adverse drug reactions in geriatric patients and increases the individual, as well as overall, rates of hospital admissions, resulting in increased health care expenditures. A consensus-based list of drugs, generally to be avoided in geriatric patients, is a practical tool to possibly improve the quality of prescribing. OBJECTIVE: The aim was to develop a consensus-based list of potentially inappropriate medications (PIM) for geriatric patients in Austria. Local market characteristics and documented prescribing regimens were considered in detail. METHODS: A two-round Delphi process involving eight experts in the field of geriatric medicine was undertaken to create a list of potentially inappropriate medications. Using a 5-point Likert scale (from strong agreement to strong disagreement), mean ratings from the experts were evaluated for each drug selected in the first round. The participants were first asked to comment on the potential inappropriateness of a preliminary list of drugs, and to propose alternate substances missing in the previous questionnaire for a second rating process. All drugs whose upper limit of the 95% CI was less than 3.0 were classified as potentially inappropriate. Drugs with a 95% CI enclosing 3.0 entered a second rating by the experts, in addition to other substances suggested during the first questionnaire. Drugs in the second rating were evaluated in comparable fashion to the first one. The final list was synthesized from the results in both rounds. RESULTS: Out of a preliminary list of 102 drugs, 61 drugs (59.2%) were classified as potentially inappropriate for geriatric persons in the first Delphi- round. In the second rating, six drugs that were reevaluated, and six drugs proposed additionally, were rated as potentially inappropriate. The final list contains 73 drugs to be avoided in older patients because of an unfavorable benefit/risk profile and/or unproven effectiveness. The list also contains suggestions for therapeutic alternatives and information about pharmacological and pharmacokinetic characteristics of all drugs judged as potentially inappropriate. CONCLUSION: The current Austrian list of potentially inappropriate medications may be a helpful tool for clinicians to increase the quality of prescribing in older patients. Like all explicit lists previously published, its validity needs to be proven in validation studies.

Keywords

Pharmacotherapy Inappropriate prescribing Older patients Aged Delphi method Austria 

Potentiell inadäquate Medikation bei geriatrischen Patienten: Die Österreichische PIM-Liste

Zusammenfassung

HINTERGRUND: Bei geriatrischen Patienten stellen inadäquate Medikamentenverordnungen einen wichtigen Risikofaktor für unerwünschte Arzneimittelereignisse dar. Sie führen in diesem Zusammenhang zu einer Zunahme von Spitalszuweisungen, welche die Gesundheitskosten belasten. Die Entwicklung Konsensus-basierter Listen von Medikamenten, die bei geriatrischen Patienten im Allgemeinen vermieden werden sollten, wird als eine mögliche Strategie angesehen, um die Qualität der medikamentösen Behandlung zu steigern. ZIEL: Erstellung einer, den österreichischen Verschreibungsgewohnheiten und der Marktsituation angepassten, Konsensus-basierten Liste von Arzneimitteln, deren Verordnung potentiell inadäquat für geriatrische Patienten ist, und die deshalb vermieden werden sollten. METHODE: Als Evaluierungsmethode wurde ein zwei-stufiger Delphi Prozess gewählt, an dem acht Experten mit Erfahrung in der medikamentösen Therapie geriatrischer Patienten teilnahmen. In der ersten Runde bewerteten die Experten Medikamente einer vorgegebenen Liste anhand einer 5-stufigen Likert Skala von sicher potentiell unangemessen bis sicher nicht potentiell unangemessen. Alle Medikamente, für deren Bewertung die obere Grenze des 95 % Konfidenzintervalls unter 3,0 lag, wurden als potentiell unangemessen klassifiziert. Medikamente, deren 95 % KI den Wert 3,0 umschloss, wurden in der zweiten Runde wieder anhand einer 5-stufigen Likert Skala bewertet, ebenso wie die in der ersten Runde neu vorgeschlagenen Medikamente. Nach Analyse der Ergebnisse der zweiten Runde wurde die finale Liste erstellt. RESULTATE: Von den vorgegebenen 102 Medikamenten wurden 61 Medikamente (59,2 %) bereits in der ersten Runde als potentiell unangemessen für ältere Menschen eingestuft. Sechs Medikamente, die in der zweiten Runde erneut evaluiert wurden, und sechs in der ersten Runde neu vorgeschlagene Medikamente wurden in der zweiten Runde als potentiell inadäquat klassifiziert. Die finale Liste enthält 73 Arzneimittel, die aufgrund eines ungünstigen Nutzen/Risiko Profils oder aufgrund fraglicher Wirksamkeit bei geriatrischen Patienten nicht verordnet werden sollten. SCHLUSSFOLGERUNG: Die Österreichische PIM Liste kann für klinisch tätige Ärzte ein in der Praxis anwendbares Instrument darstellen, das zu einer Verbesserung der Qualität von Medikamentenverordnungen bei älteren Patienten beiträgt. Studien zur Validierung der PIM-Liste stehen in Österreich ebenso wie in anderen Ländern mit bereits veröffentlichten PIM-Listen noch aus.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Eva Mann
    • 1
  • Birgit Böhmdorfer
    • 2
  • Thomas Frühwald
    • 3
  • Regina E. Roller-Wirnsberger
    • 4
  • Peter Dovjak
    • 5
  • Christine Dückelmann-Hofer
    • 6
  • Peter Fischer
    • 7
  • Susanne Rabady
    • 8
  • Bernhard Iglseder
    • 9
  1. 1.Institute of General Medicine, Family Medicine and Preventive MedicineParacelsus Medical UniversitySalzburgAustria
  2. 2.Department of Pharmacy, Vienna Hospital AssociationKrankenhaus Hietzing mit neurologischem Zentrum RosenhügelViennaAustria
  3. 3.Department of Geriatric Acute Care, Vienna Hospital AssociationKrankenhaus Hietzing mit neurologischem Zentrum RosenhügelViennaAustria
  4. 4.Department of Internal Medicine/ GeriatricsMedical University of GrazGrazAustria
  5. 5.Department of GeriatricsLandeskrankenhaus GmundenGmundenAustria
  6. 6.Department of PharmacyGemeinnützige Salzburger Landeskliniken Betriebsgesellschaft mbH, LandeskrankenhausSalzburgAustria
  7. 7.Department of Psychiatry, Sozialmedizinisches Zentrum OstDonau SpitalViennaAustria
  8. 8.General practiceWindigsteigAustria
  9. 9.Department of Geriatric Medicine, Paracelsus Medical UniversityGemeinnützige Salzburger Landeskliniken Betriebsgesellschaft mbH, Christian-Doppler-KlinikSalzburgAustria

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