Potentially Inappropriate Medication Prescribing Detected by Computer Algorithm among Older Patients: Results from the MAPT Study.

Arnaud Pagès,Philipe De Souto Barreto,Philippe Cestac,Yves Rolland,Blandine Juillard-Condat,Laurent Molinier,Bruno Vellas,Nadège Costa,Laure Rouch

doi:10.3390/pharmacy9040189

Abstract

(1) Background: Some medications may be dangerous for older patients. Potentially inappropriate medication prescribing (PIP) among older patients represents a significant cause of morbidity. The aim of this study was to create an algorithm to detect PIP in a geriatric database (Multidomain Alzheimer Preventive Trial (MAPT) study), and then to assess the algorithm construct validity by comparing the prevalence of PIP and associated factors with literature data. (2) Methods: An algorithm was constructed to detect PIP and was based on different explicit criteria among which the European list of potentially inappropriate medications (EU(7)-PIM), the STOPP and START version 2 tools. For construct validity assessment, logistic mixed-effects model repeated measures analyses were used to identify factors associated with PIP. (3) Results: Prevalence of PIP was 59.0% with the EU(7)-PIM list criteria, 43.2% with the STOPP criteria and 51.3% with the START criteria. Age, polypharmacy, and higher Charlson comorbidity index were associated with PIP. (4) Conclusions: Prevalence of PIP and associated factors are consistent with literature data, supporting the construct validity of our algorithm. This algorithm opens up interesting perspectives both in terms of analysis of very large databases and integration into e-prescribing or pharmaceutical validation software.

Highlights

Older patients, who often suffer from multiple comorbidities and take multiple medications, are at risk for potentially inappropriate use of medications, including overuse, underuse, and misuse
A recent meta-analysis showed an association between potentially inappropriate medication prescriptions (PIPs) and the risk of adverse effects and hospitalizations in older subjects [1]
We identified market withdrawals manually from the websites of the agencies concerned and identified contraindications by querying a medication database approved by the French National Authority for Health

Summary

Introduction

Older patients, who often suffer from multiple comorbidities and take multiple medications, are at risk for potentially inappropriate use of medications, including overuse, underuse, and misuse. Several tools have been developed to make PIPs identification easier, based on explicit or implicit approaches, or a combination of both. The explicit approach is based on criteria that are derived from expert consensus. These criteria are simple to use and can be applied in the same way in all patients, regardless of individual characteristics. A literature review identified 36 validated explicit criteria-based tools for identifying PIPs in older people [5]. These were simple lists of potentially inappropriate medications

Objectives

Methods

Results

Conclusion