Validation of the LESS-CHRON criteria: reliability study of a tool for deprescribing in patients with multimorbidity

Abstract

Objective The 'LESS-CHRON criteria' (List of Evidence-Based Deprescribing for Chronic Patients criteria) is a newly created tool with 27 criteria to guide deprescribing. It was developed using a Delphi methodology. Each criterion consists of drugs and their indications, conditions under which deprescribing would be considered, a health variable to be monitored after deprescribing and a follow-up period. The aim of our study was to evaluate the reliability of the LESS-CHRON criteria in a population of patients with multimorbidity to determine the possible usefulness of this tool in clinical practice. Methods We selected chronic patients with multimorbidity from an internal medicine unit who were older than 80 years old and were alive at the time of the study. To determine interobserver reliability, each professional (internist or hospital pharmacy specialist) applied the questionnaire under the same conditions and with the same resources. To determine intraobserver reliability, each health professional applied the tool at baseline and 2 months later. We measured interobserver and intraobserver reliability using the kappa coefficient. The proportion of overall agreement was also determined. results We obtained a moderate overall kappa (ĸ=0.46, 95% CI 0.36 to 0.55) for interobserver reliability, and good (ĸ=0.65, 95% CI 0.57 to 0.78) and moderate (ĸ=0.59, 95% CI 0.49 to 0.74) values for intraobserver reliability for the internist and pharmacist, respectively. The proportion of overall agreement was very high: 92% (range: 62%-100%) for the interobserver, and 94% (80%-100%) and 93% (63%-100%) for the internist and pharmacist, respectively. Conclusions The LESS-CHRON criteria shows early promise as a reliable method to help guide deprescribing in patients with multimorbidity. Further, more complete testing with a larger sample of prescribers is needed.

A Personalized Ontology-Based Decision Support System for Complex Chronic Patients: Retrospective Observational Study

“…This document analyzes different pharmacological characteristics, including the indications for which the drug is prescribed, conditions that recommend deprescribing the drug, health variables to monitor the behavior of the drug, and the time that should elapse between different follow-ups. Based on these characteristics, a list of 27 criteria has been compiled [ 29 ].…”

Chronic-pharma: New Platform for Chronic Patients Pharmacotherapy Optimization

“…ABC includes previously published and validated scales identified in a systematic review [ 9 ]. LESS-CHRON and final TRIGGER-CHRON are in the process of validation in patients, which is the most expected study for a tool of this category; however, both has been applied in a theorical way, validating its utility [ 18 , 23 ]. In relation to the complexity when adapting the tools to web format, it should be noted that ABC differs from the LESS-CHRON and TRIGGER-CHRON tools in the modus operandi it requires, as well as in the expression of the results.…”

“…The LESS-CHRON criteria (List of Evidence baSed depreScribing for CHRONic patients) are a comprehensive and standardized methodology to identify clinical situations for deprescribing drugs in chronic patients with multimorbidity, considering life prognosis and providing health variables to value the safety of the process. They were translated into English using a transcultural methodology [ 17 ], and validated by a reliability study [ 18 ].…”

Identification and characterisation of deprescribing tools for older patients: A scoping review

“…Concerning their potential clinical applicability, three tools were designed to focus on institutionalised patients [28,29,33]. Two other tools were aimed at all healthcare settings [6,31]; although, in a reliability study, one of them was applied to hospitalised patients [32] and the other to outpatients [30]. The application of the latter in primary care and nursing homes has yet to be studied.…”