The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries

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Abstract

Purpose

The aim of the study was to develop a European list of potentially inappropriate medications (PIM) for older people, which can be used for the analysis and comparison of prescribing patterns across European countries and for clinical practice.

Methods

A preliminary PIM list was developed, based on the German PRISCUS list of potentially inappropriate medications and other PIM lists from the USA, Canada and France. Thirty experts on geriatric prescribing from Estonia, Finland, France, the Netherlands, Spain and Sweden participated; eight experts performed a structured expansion of the list, suggesting further medications; twenty-seven experts participated in a two-round Delphi survey assessing the appropriateness of drugs and suggesting dose adjustments and therapeutic alternatives. Finally, twelve experts completed a brief final survey to decide upon issues requiring further consensus.

Results

Experts reached a consensus that 282 chemical substances or drug classes from 34 therapeutic groups are PIM for older people; some PIM are restricted to a certain dose or duration of use. The PIM list contains suggestions for dose adjustments and therapeutic alternatives.

Conclusions

The European Union (EU)(7)-PIM list is a screening tool, developed with participation of experts from seven European countries, that allows identification and comparison of PIM prescribing patterns for older people across European countries. It can also be used as a guide in clinical practice, although it does not substitute the decision-making process of individualised prescribing for older people. Further research is needed to investigate the feasibility and applicability and, finally, the clinical benefits of the newly developed list.

Electronic supplementary material

The online version of this article (doi:10.1007/s00228-015-1860-9) contains supplementary material, which is available to authorized users.

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Most cited references 38

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STOPP/START criteria for potentially inappropriate prescribing in older people: version 2

Denis O’Mahony, David O'Sullivan, Stephen Byrne … (2014)

Purpose: screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required. Methods: we reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology. Results: the expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines. Conclusion: STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts.

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Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.

Donna M Fick, James W. Cooper, William Wade … (2003)

Medication toxic effects and drug-related problems can have profound medical and safety consequences for older adults and economically affect the health care system. The purpose of this initiative was to revise and update the Beers criteria for potentially inappropriate medication use in adults 65 years and older in the United States. This study used a modified Delphi method, a set of procedures and methods for formulating a group judgment for a subject matter in which precise information is lacking. The criteria reviewed covered 2 types of statements: (1) medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available and (2) medications that should not be used in older persons known to have specific medical conditions. This study identified 48 individual medications or classes of medications to avoid in older adults and their potential concerns and 20 diseases/conditions and medications to be avoided in older adults with these conditions. Of these potentially inappropriate drugs, 66 were considered by the panel to have adverse outcomes of high severity. This study is an important update of previously established criteria that have been widely used and cited. The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug-related problems.

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Appropriate prescribing in elderly people: how well can it be measured and optimised?

Anne Spinewine, Kenneth Schmader, Nick Barber … (2007)

Prescription of medicines is a fundamental component of the care of elderly people, and optimisation of drug prescribing for this group of patients has become an important public-health issue worldwide. Several characteristics of ageing and geriatric medicine affect medication prescribing for elderly people and render the selection of appropriate pharmacotherapy a challenging and complex process. In the first paper in this series we aim to define and categorise appropriate prescribing in elderly people, critically review the instruments that are available to measure it and discuss their predictive validity, critically review recent randomised controlled intervention studies that assessed the effect of optimisation strategies on the appropriateness of prescribing in elderly people, and suggest directions for future research and practice.

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Author and article information

Contributors

Anna Renom-Guiteras: +49 (0) 2302 926749 , anna.renom@uni-wh.de

Journal

Journal ID (nlm-ta): Eur J Clin Pharmacol

Journal ID (iso-abbrev): Eur. J. Clin. Pharmacol

Title: European Journal of Clinical Pharmacology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0031-6970

ISSN (Electronic): 1432-1041

Publication date (Electronic): 14 May 2015

Publication date PMC-release: 14 May 2015

Publication date (Print): 2015

Volume: 71

Issue: 7

Pages: 861-875

Affiliations

[ ]Institute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany

[ ]Universitat Autònoma de Barcelona, Barcelona, Spain

[ ]Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany

[ ]School of Nursing Science, Faculty of Health, University of Witten/Herdecke, Witten, Germany

[ ]Clinical Pharmacology, Faculty of Health, University of Witten/Herdecke, Witten, Germany

[ ]Philipp Klee-Institute of Clinical Pharmacology, HELIOS Klinikum Wuppertal, Heusnerstraße 40, 42283 Wuppertal, Germany

Article

Publisher ID: 1860

DOI: 10.1007/s00228-015-1860-9

PMC ID: 4464049

PubMed ID: 25967540

SO-VID: 61d8758c-771b-44ae-855b-bb2db7d76ddf

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 20 February 2015

Date accepted : 29 April 2015

Custom metadata

ScienceOpen disciplines: Pharmacology & Pharmaceutical medicine

Keywords: potentially inappropriate medication,inappropriate prescribing [mesh term],aged [mesh term],screening,europe [mesh term]

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ScienceOpen disciplines: Pharmacology & Pharmaceutical medicine

Keywords: potentially inappropriate medication, inappropriate prescribing [mesh term], aged [mesh term], screening, europe [mesh term]

The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries

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Abstract

Purpose

Methods

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Conclusions

Electronic supplementary material

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Drug Repurposing

Most cited references 38

STOPP/START criteria for potentially inappropriate prescribing in older people: version 2

Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.

Appropriate prescribing in elderly people: how well can it be measured and optimised?

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