TY - JOUR
T1 - Development of a Malaysian potentially inappropriate prescribing screening tool in older adults (MALPIP)
T2 - a Delphi study
AU - Chang, Chee Tao
AU - Chan, Huan Keat
AU - Cheah, Wee Kooi
AU - Tan, Maw Pin
AU - Ch’ng, Alan Swee Hock
AU - Thiam, Chiann Ni
AU - Abu Bakar, Nor Azlina
AU - Yau, Weng Keong
AU - Abu Hassan, Muhammad Radzi
AU - Rajan, Philip
AU - Tan, Kar Choon
AU - Ambigapathy, Subashini
AU - Vengadasalam, Paranthaman
AU - Zaman Huri, Surina
AU - Arvinder-Singh, Hs
AU - Thum, Chern Choong
AU - Chung, Wai Mun
AU - Ooi, Jun How
AU - Sabki, Noor Hamizah
AU - Lee, Hooi Peng
AU - Mohd Shariff, Siti Mallissa
AU - Azman, Muhammad Azuan
AU - Teoh, Siew Li
AU - Lee, Shaun Wen Huey
N1 - Funding Information:
We would like to thank the Director General of Health Malaysia for his permission to publish this article. We would like to thank the Pharmacovigilance Section, Centre for Compliance and Quality Control, National Pharmaceutical Regulatory Agency (NPRA) for their invaluable contribution in providing the adverse drug events safety data used in this study. We would like to thank Mr. Jason Lee Choong Yin, Perak Pharmaceutical Services Division for assisting in the tabulation, visualization of NPRA pharmacovigilance data and developing the MALPIP website portal. We would like to thank Mr. Khoo Tatt Ee, Hospital Raja Permaisuri Bainun for assisting in development of the MALPIP Android application.
Publisher Copyright:
© 2023, Dr. Zaheer-Ud-Din Babar and Auckland UniServices Ltd.
PY - 2023/12
Y1 - 2023/12
N2 - Introduction: Polypharmacy and potentially inappropriate medications (PIM) are common among older adults. To guide appropriate prescribing, healthcare professionals often rely on explicit criteria to identify and deprescribe inappropriate medications, or to start medications due to prescribing omission. However, most explicit PIM criteria were developed with inadequate guidance from quality metrics or integrating real-world data, which are rich and valuable data source. Aim: To develop a list of medications to facilitate appropriate prescribing among older adults. Methods: A preliminary list of PIM and potential prescribing omission (PPO) were generated from systematic review, supplemented with local pharmacovigilance data of adverse reaction incidents among older people. Twenty-one experts from nine specialties participated in two Delphi to determine the list of PIM and PPO in February and March 2023. Items that did not reach consensus after the second Delphi round were adjudicated by six geriatricians. Results: The preliminary list included 406 potential candidates, categorised into three sections: PIM independent of diseases, disease dependent PIM and omitted drugs that could be restarted. At the end of Delphi, 92 items were decided as PIM, including medication classes, such as antacids, laxatives, antithrombotics, antihypertensives, hormones, analgesics, antipsychotics, antidepressants, and antihistamines. Forty-two disease-specific PIM criteria were included, covering circulatory system, nervous system, gastrointestinal system, genitourinary system, and respiratory system. Consensus to start potentially omitted treatment was achieved in 35 statements across nine domains. Conclusions: The newly developed PIM criteria can serve as a useful tool to guide clinicians and pharmacists in identifying PIMs and PPOs during medication review and facilitating informed decision-making for appropriate prescribing.
AB - Introduction: Polypharmacy and potentially inappropriate medications (PIM) are common among older adults. To guide appropriate prescribing, healthcare professionals often rely on explicit criteria to identify and deprescribe inappropriate medications, or to start medications due to prescribing omission. However, most explicit PIM criteria were developed with inadequate guidance from quality metrics or integrating real-world data, which are rich and valuable data source. Aim: To develop a list of medications to facilitate appropriate prescribing among older adults. Methods: A preliminary list of PIM and potential prescribing omission (PPO) were generated from systematic review, supplemented with local pharmacovigilance data of adverse reaction incidents among older people. Twenty-one experts from nine specialties participated in two Delphi to determine the list of PIM and PPO in February and March 2023. Items that did not reach consensus after the second Delphi round were adjudicated by six geriatricians. Results: The preliminary list included 406 potential candidates, categorised into three sections: PIM independent of diseases, disease dependent PIM and omitted drugs that could be restarted. At the end of Delphi, 92 items were decided as PIM, including medication classes, such as antacids, laxatives, antithrombotics, antihypertensives, hormones, analgesics, antipsychotics, antidepressants, and antihistamines. Forty-two disease-specific PIM criteria were included, covering circulatory system, nervous system, gastrointestinal system, genitourinary system, and respiratory system. Consensus to start potentially omitted treatment was achieved in 35 statements across nine domains. Conclusions: The newly developed PIM criteria can serve as a useful tool to guide clinicians and pharmacists in identifying PIMs and PPOs during medication review and facilitating informed decision-making for appropriate prescribing.
KW - Medication review
KW - Older adults
KW - Polypharmacy
KW - Potentially inappropriate medications
KW - Prescribing omission
UR - http://www.scopus.com/inward/record.url?scp=85174513632&partnerID=8YFLogxK
U2 - 10.1186/s40545-023-00630-4
DO - 10.1186/s40545-023-00630-4
M3 - Article
AN - SCOPUS:85174513632
SN - 2052-3211
VL - 16
JO - Journal of Pharmaceutical Policy and Practice
JF - Journal of Pharmaceutical Policy and Practice
IS - 1
M1 - 122
ER -
