Abstract
PurposeThe 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.MethodsA 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.ResultsExperts 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.ConclusionsThe 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 materialThe online version of this article (doi:10.1007/s00228-015-1860-9) contains supplementary material, which is available to authorized users.
Highlights
Appropriate prescribing for older people is a public health concern, and several assessment tools are available for its evaluation
Experts reached a consensus that 282 chemical substances or drug classes from 34 therapeutic groups are potentially inappropriate medications (PIM) for older people; some PIM are restricted to a certain dose or duration of use
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 be used as a guide in clinical practice, it does not substitute the decision-making process of individualised prescribing for older people
Summary
Appropriate prescribing for older people is a public health concern, and several assessment tools are available for its evaluation. The prevalence of inappropriate prescribing and/or use of PIM has been analysed by several authors and ranges from 20 to 79 % depending on the population studied, the setting or country, and the specific tool used [5,6,7,8,9,10]. A recently published systematic review identified 46 tools or criteria for assessing inappropriate prescribing [16]. Implicit criteria are based on the judgement of a professional and are person-specific [20], requiring individual patient data for application, they are timeconsuming and more dependent on the user [2]. No single ideal tool has been identified so far, but each tool seems to have its strengths and weaknesses, and the choice of a tool may depend on the purpose of use (i.e. daily practice, research) and availability of data [16]
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