Applicability of EU(7)-PIM criteria in cross-national studies in European countries

Abstract

Background: The European Union (EU)(7)-PIM (potentially inappropriate medication) list presents the most comprehensive and up-to-date tool for evaluation of PIM prescribing in Europe; however, several country-specific studies have documented lower specificity of this list on pharmaceutical markets of some countries. The aim of our study was to describe approval rates and marketing of PIMs stated by EU(7)-PIM criteria in six EU countries [in comparison with the American Geriatric Society (AGS) Beers 2015 criteria]. Methods: Research teams of six EU countries (Czech Republic, Spain, Portugal, Serbia, Hungary and Turkey) participated in this study conducted by WG1b EU COST Action IS1402 group in the period October 2015–November 2018. Data on approval rates of PIMs and their availability on pharmaceutical markets have been obtained from databases of national drug-regulatory institutes and up-to-date drug compendia. The EU(7)-PIM list and AGS Beers 2015 Criteria (Section 1) were applied. Results: PIMs from EU(7)-PIM list were approved for clinical use more often than those from the AGS Beers 2015 criteria (Section 1). Approval rates for EU(7)-PIMs ranged from 42.8% in Serbia to 71.4% in Spain (for AGS criteria only from 36.4% to 65.1%, respectively). Higher percentages of approved PIMs were documented in Spain (71.4%), Portugal (67.1%) and Turkey (67.5%), lower in Hungary (55.5%), Czech Republic (50.2%) and Serbia (42.8%). The majority of approved PIMs were also currently marketed in all countries except in Turkey (19.8–21.7% not marketed PIMs) and less than 20% of PIMs were available as over-the-counter medications (except in Turkey, 46.4–48.1%). Conclusions: The EU(7)-PIM list was created for utilization in European studies; however, applicability of this list is still limited in some countries, particularly in Eastern and Central Europe. The EU project EUROAGEISM H2020 (2017–2021) that focuses on PIM prescribing and regulatory measures in Central and Eastern European countries must consider these limits.

Towards Safe Medication Use Among Geriatric Patients: A Combined Tool For Identification of Potential Drug-Related Problems

“…Thus, (1) two PIMs are used only with other pharmaceuticals in combined medicinal products (dextromethorphan, magnesium hydroxide), (2) aloe is not registered as a medication; it is a food supplement with no clear indication and relevant patient information provided by the manufacturer, (3) ginkgo folium, magnesium hydroxide and senna glucosides are licensed as OTC medications, but also marketed as food supplements where data about dosing and indication remains unclear, ( 4) niacin (nicotinic acid) is available only in an injection pharmaceutical dosage form, and ( 5) viscous para n is used exceptionally as an external product in Estonia, and the information provided by the EU( 7)-PIM list is not relevant (Appendix 1). The study results suggest a need to further explore the problem of combined medicinal products and other discrepancies mentioned above before the combined PIM tool becomes a widely available instrument for clinical use, and this suggestion is corroborated by the implications discussed in other studies [12,16,25].…”

Clinical characteristics and outcomes of polypharmacy in chronic obstructive pulmonary disease patients: A cross‐sectional study from Crete, Greece

“…Nevertheless, screening for polypharmacy-related risks is time consuming and may depend on physician's level of knowledge and workload. This study implies that reliable and comprehensive screening tools already developed by researchers and EU initiatives for PIMs (i.e., the EU(7) list 39 ) could support the physician if incorporated into the policy of medical care, enabling the physician to appraise patient's drug prescription in the context of his/her concurrent conditions and age. Usage of such tools in daily practice of COPD management deserves more attention in guideline recommendations.…”

“…Another explanation may be that American Beer's criteria for potentially inappropriate medication in older adult were used by most of these general population studies in Europe, while evidence suggests that such criteria cannot be easily applied to elderly in European countries. 39 Similarly, this issue applies for the EU(7)-PIM list, where applicability of these criteria in many EU countries is still limited because different PIMs are available. 39 It is worth noting that in our study, 13 out of the 15 subjects that used PIMs used them in order to treat mental health conditions, mainly depression-anxiety, highlighting the burden of these comorbid conditions in COPD.…”

“…39 Similarly, this issue applies for the EU(7)-PIM list, where applicability of these criteria in many EU countries is still limited because different PIMs are available. 39 It is worth noting that in our study, 13 out of the 15 subjects that used PIMs used them in order to treat mental health conditions, mainly depression-anxiety, highlighting the burden of these comorbid conditions in COPD. 40,41 This finding is important as depression is one of the most common mental disorders being associated with PIMs prescription in elderly patients.…”

Operacionalização para Portugal da Lista EU(7)-PIM para Identificação de Medicamentos Potencialmente Inapropriados nos Idosos

“…Um estudo recente avaliou a disponibilidade de medicamentos incluídos como PIM na lista EU(7)-PIM e mostrou que o número de medicamentos com AIM, listados como PIM, é bastante diferente em cada país, variando entre 42,8% na Sérvia e 71,4% em Espanha. 28 Num estudo belga, 29 os autores mostraram que, das 275 substâncias ativas incluídas na lista original, apenas 157 estavam disponíveis no mercado. Dentro das sete classes de medicamentos, 21 substâncias ativas eram comercializadas naquele país.…”