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

Renom‐Guiteras, Anna; Meyer, Gabriele; Thürmann, Petra A.

doi:10.1007/s00228-015-1860-9

Cited by 367 publications

(445 citation statements)

References 40 publications

(86 reference statements)

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“…They were updated in 2015 to include drugs affecting or being affected by renal function, similar to this update of the AGS Beers Criteria . Similar tools have been developed in Europe . The current update of the AGS Beers Criteria confirms and extends this work with a rigorous independent evidence grading process, an open peer‐review comment period consistent with Institute of Medicine standards, and the addition of drug–drug interactions and renal dose adjustment.…”

Section: Discussionmentioning

confidence: 77%

American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Samuel¹

2015

J American Geriatrics Society

2,177

898

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The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual's kidney function and select drug-drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion. The process followed an evidence-based approach using Institute of Medicine standards. The 2015 AGS Beers Criteria are applicable to all older adults with the exclusion of those in palliative and hospice care. Careful application of the criteria by health professionals, consumers, payors, and health systems should lead to closer monitoring of drug use in older adults.

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Section: Discussionmentioning

confidence: 77%

American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Samuel¹

2015

J American Geriatrics Society

2,177

898

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“…The tool analyses the patientʼs diagnoses, current medication, symptoms, biometric measurements (e.g., body mass index, blood pressure) and laboratory values, performs an electronic comprehensive medication review, and returns recommendations for drug discontinuation or modification based on the following components:

Indication and contraindication check for all prescribed drugs according to the diagnoses provided and the officially approved indications by the European Medicines Agency (EMA)

Forty rules and recommendations based on systematic reviews of clinical trial and observational study evidence on usage of the most commonly prescribed drugs in older patients [30]

Ninety-five rules and recommendations taken from the Evidence-Based Medicine electronic Decision Support (EBMeDS) database (http://www.ebmeds.org/web/guest/home). These recommendations in turn are derived from the NICE-approved Evidence Based Medicine Guidelines (EBMG; http://www.duodecim.fi/web/duodecimpublications/ebmg) to assure regular updating

RENBASE renal dosing decision support software (http://www.medbase.fi/en/professionals/renbase)Swedish, Finnish, INteraction X-referencing (SFINX) interaction check decision support software (www.medbase.fi/en/professionals/sfinx) [31]PHARAO decision support software on adverse drug reactions (http://www.medbase.fi/en/professionals/pharao)Check of drugs listed in the European list of potentially inappropriate medication for older patients [32] …”

Section: Methodsmentioning

confidence: 99%

Polypharmacy in chronic diseases–Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support (PRIMA-eDS): study protocol for a randomized controlled trial

Sönnichsen

Trampisch

Rieckert

et al. 2016

Trials

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BackgroundMultimorbidity is increasing in aging populations with a corresponding increase in polypharmacy as well as inappropriate prescribing. Depending on definitions, 25-50 % of patients aged 75 years or older are exposed to at least five drugs. Evidence is increasing that polypharmacy, even when guidelines advise the prescribing of each drug individually, can potentially cause more harm than benefit to older patients, due to factors such as drug-drug and drug-disease interactions. Several approaches reducing polypharmacy and inappropriate prescribing have been proposed, but evidence showing a benefit of these measures regarding clinically relevant endpoints is scarce. There is an urgent need to implement more effective strategies. We therefore set out to develop an evidence-based electronic decision support (eDS) tool to aid physicians in reducing inappropriate prescribing and test its effectiveness in a large-scale cluster-randomized controlled trial.MethodsThe “Polypharmacy in chronic diseases–Reduction of Inappropriate Medication and Adverse drug events in older populations” (PRIMA)-eDS tool is a tool comprising an indication check and recommendations for the reduction of polypharmacy and inappropriate prescribing based on systematic reviews and guidelines, the European list of inappropriate medications for older people, the SFINX-database of interactions, the PHARAO-database on adverse effects, and the RENBASE-database on renal dosing. The tool will be evaluated in a cluster-randomized controlled trial involving 325 general practitioners (GPs) and around 3500 patients across five study centres in the United Kingdom, Germany, Austria and Italy. GP practices will be asked to recruit 11 patients aged 75 years or older who are taking at least eight medications and will be cluster-randomized after completion of patient recruitment. Intervention GPs will have access to the PRIMA-eDS tool, while control GPs will treat their patients according to current guidelines (usual care) without access to the PRIMA-eDS tool. After an observation time of 2 years, intervention and control groups will be compared regarding the primary composite endpoint of first non-elective hospitalization or death.DiscussionThe principal hypothesis is that reduction of polypharmacy and inappropriate prescribing can improve the clinical composite outcome of hospitalization or death. A positive result of the trial will contribute substantially to the improvement of care in multimorbidity. The trial is necessary to investigate not only whether the reduction of polypharmacy improves outcome, but also whether GPs and patients are willing to follow the recommendations of the PRIMA-eDS tool.Trial registrationThis trial has been registered with Current Controlled Trials Ltd. on 31 July 2014 (ISRCTN10137559).Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1177-8) contains supplementary material, which is available to authorized users.

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“…Similarly, a study conducted in New Zealand suggested that PIMs were utilized by 42.7% of the community-dwelling elderly patients 12. Thus, such practices may increase the risk of developing ADEs up to several folds 13. This problem has threatened the geriatric population all over the world.…”

Section: Introductionmentioning

confidence: 99%

Assessment of prescribing potentially inappropriate medications listed in Beers criteria and its association with the unplanned hospitalization: a cross-sectional study in Lahore, Pakistan

Sarwar¹,

Dar²,

Mahar³

et al. 2018

CIA

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Background and objectivesDue to physiological and pharmacological variations, geriatrics are at high risk of experiencing life-threatening outcomes related to the use of potentially inappropriate medications (PIMs). Thus, the present study aims to evaluate prescribing practices of PIMs among elderly patients who may lead to unplanned hospitalization and associated risk factors.MethodsA cross-sectional study was conducted in different hospitals of Lahore, Pakistan. The study population consisted of geriatric patients aged ≥65 years. Data were collected from the medical records of geriatric patients, who attended these selected hospitals between December 1, 2017, and February 28, 2018. Data were analyzed using SPSS (IBM SPSS Statistics for Windows, Version 21.0) and Microsoft Excel (MS Office 2010).ResultsThe records of 385 geriatric patients were investigated. More than half (60.8%) of the patients were subjected to polypharmacy, which can be defined as the utilization of 5–9 drugs by the patient at the same time, whereas 36.4% were prescribed with one PIM and 56.4% were hospitalized due to PIMs. Majority of them were prescribed with PIMs including N02BA01 (aspirin, 32.4%), A02BC01 (omeprazole, 23.6%), A10AB02 (insulin, 17.4%), A02BC05 (esomeprazole, 8.5%), C08CA01 (amlodipine, 8.3%), and R06AA02 (diphenhydramine, 5.9%). Results of regression analysis revealed that patients exposed to polypharmacy (OR=2.556, 95% CI=1.579–4.135, P-value≤0.001) and excessive polypharmacy (OR=37.828, 95% CI=4.754–300.9, P-value≤0.001) were significantly associated with unplanned hospitalization, whereas factors such as age 75–84 years (OR=0.343, 95% CI=0.156–0.756, P-value=0.008) and polypharmacy (OR=2.480, 95% CI=1.219–5.048, P-value=0.012) were significantly correlated with PIMs.ConclusionThe utilization of PIMs listed in Beers criteria among geriatric population can cause unplanned hospitalization. As the patients receiving polypharmacy are at high risk of unplanned hospitalization, so caution must be exercised in prescribing PIMs for elderly people.

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

Cited by 367 publications

References 40 publications

American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Polypharmacy in chronic diseases–Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support (PRIMA-eDS): study protocol for a randomized controlled trial

Assessment of prescribing potentially inappropriate medications listed in Beers criteria and its association with the unplanned hospitalization: a cross-sectional study in Lahore, Pakistan

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