Operacionalização para Portugal da Lista EU(7)-PIM para Identificação de Medicamentos Potencialmente Inapropriados nos Idosos

Abstract

Introduction: In 2015, the EU(7)-PIM List was published, which identifies potentially inappropriate medicines in older patients and resulted from a consensus of experts from seven European countries. Portugal was not part of this group, so it was not originally adapted to the Portuguese reality. With this work, we intend to elaborate a list of potentially inappropriate medicines adapted to the reality of medicines marketed in Portugal, through the operationalization of the EU(7)-PIM List for the national reality and to evaluate the adequacy of its use for clinical practice.Material and Methods: Search, in INFARMED’s Infomed database, of drugs that are included in the EU(7)-PIM List that have marketing authorization, and analysis of possible new drugs for inclusion in the list. The tool adapted to the Portuguese reality was applied to a sample of 1089 outpatient, polymedicated older patients from 38 primary care units in Central Portugal.Results: The final PIM list adapted to the Portuguese reality includes 184 potentially inappropriate medicines (from these, 178 are active substances, five are classes of drugs, and one corresponds to the sliding scale therapeutic scheme used in insulin therapy). Of 1089 polymedicated older patients, 83.7% took at least one drug included in the final potentially inappropriate medicines list or belonging to one of the groups included in the list, and, on average, each patient took 1.74 (IQR 1 – 2).Discussion: Even though the availability of drugs on the market is quite diverse, the EU(7)-PIM List has been used in several European countries. With this study, we operationalized the European list for the Portuguese reality, which will enable its application in clinical practice.Conclusion: The list drawn up is a useful tool for the identification of potentially inappropriate medicines, easy to use in clinical practice and research.

Tools and guidelines to assess the appropriateness of medication and aid deprescribing: An umbrella review

“…Lastly, they conducted systematic literature reviews of original articles to create entirely new tools 15,43,44,48,50,52,56–60,63–71,73,81–83,85,89,90,92,94–99,108,110,111,113–115,119,122–124,126,130,133,136,137,139,140,142,144,146–149,151,152 Adaptation from existing tools : We found 13 tools and guidelines following this approach, 80,84,88,100,102,103,106,109,127,131,141,145,153 which involved tailoring existing tools to specific contexts and patient groups. For instance, tools were adapted from criteria such as the Beers criteria, 106,109,141,145 STOPP‐START 84,88,131 and EU (7)‐PIM list, 127,153 for use in different countries, to suit frail elderly in nursing home settings or study purposes. Reclassification of existing tools : This approach involved rearranging or redefining criteria in pre‐existing tools to address medication appropriateness issues more effectively.…”

“… Adaptation from existing tools : We found 13 tools and guidelines following this approach, 80,84,88,100,102,103,106,109,127,131,141,145,153 which involved tailoring existing tools to specific contexts and patient groups. For instance, tools were adapted from criteria such as the Beers criteria, 106,109,141,145 STOPP‐START 84,88,131 and EU (7)‐PIM list, 127,153 for use in different countries, to suit frail elderly in nursing home settings or study purposes. Reclassification of existing tools : This approach involved rearranging or redefining criteria in pre‐existing tools to address medication appropriateness issues more effectively. For instance, the Fit fOR The Aged (FORTA) list was originally proposed as a reclassification of the Beers criteria, providing both positive and negative lists based on the indications to better suit the target population.…”

“…Adaptation from existing tools: We found 13 tools and guidelines following this approach, 80,84,88,100,102,103,106,109,127,131,141,145,153 which involved tailoring existing tools to specific contexts and patient groups. For instance, tools were adapted from criteria such as the Beers criteria, 106,109,141,145 STOPP-START 84,88,131 and EU (7)-PIM list, 127,153 for use in different countries, to suit frail elderly in nursing home settings or study purposes.…”

Potentially Inappropriate Medication at Admission and at Discharge: A Geriatric Study in an Internal Medicine Service in Portugal

“…The list comprises 275 active substances and 7 drug classes, belonging to 55 therapeutic classes and 34 pharmacotherapeutic groups [ 7 ]. In 2020, an operationalization of the EU(7)-PIM list was carried out for the Portuguese reality, which consists of 184 PIMs; 178 correspond to active substances, five are drug classes, and one corresponds to the sliding scale therapeutic scheme used in insulins [ 16 ].…”

Assessment of Potentially Inappropriate Medications Using the EU (7)-PIM List, in a Sample of Portuguese Older Adults’ Residents in Nursing Homes

“…17 This list has recently been adapted to the reality of medicines marketed in Portugal. 18 Considering that, the inner center region of Portugal is one of the most aged regions of the country and the scarcity of studies that evaluate the prevalence of PIM in Portuguese nursing home residents, we developed this work that aims to characterize the medication profile and assess the presence of PIM, using the EU (7)-PIM list in older adults' residents at nursing homes. This list has the advantage to be appropriate for pharmacoepidemiology applications using administrative databases or surveys without any clinical information because it is only necessary to know the mediation profile of the patients including the duration of treatment and dosage of some medicine.…”