Conceptualizing and measuring potentially inappropriate drug therapy

Abstract

Summary What is known and objective Elderly people are the principal consumers of prescription drugs. The more the medication used by the patient, the greater the likelihood there is of the patient being subjected to potentially inappropriate drug therapy (PIDT). PIDT has been measured in the literature with both implicit and explicit tools. The purpose of this review was to assess the use of tools to detect PIDT in various studies and to determine which terms are used to refer to PIDT in practice. Methods A systematic review was conducted according to the following steps: the first was identification. In this step, studies were selected from different combinations of the descriptors ‘aged’, ‘elderly’, ‘inappropriate prescribing’ and ‘drug utilization’ in three different languages, using the Embase, Medline, Scielo, Scopus and Web of Science databases. Second, the papers that satisfied the inclusion criteria for data extraction were carefully examined by three evaluators to determine the tools used and terms that referred to PIDT. Results and discussion From the combinations of keywords, 8610 articles were found. At the end of the selection process, 119 of the articles complied with the specified criteria. The degree of agreement among evaluators was moderate for the study titles (κ1 = 0·479) and substantial for abstracts (κ2 = 0·647). With respect to the PIDT evaluation criteria used by the studies, 27·7% used two criteria. Of the 27 evaluation criteria identified, the Beers criteria were used by 82·3% of the studies. More than 50 different terms to identify PIDT were found in the literature. What is new and conclusion This review is the first study to conceptualize and discuss terms that refer to PIDT. At present, there is no consensus regarding terms used to refer to PIDT, with over 50 different terms currently in use. This review shows an increase in the number of articles aimed at evaluating PIDT using implicit and explicit tools.

Evaluation of pharmacotherapy complexity in residents of long-term care facilities: a cross-sectional descriptive study

“…For this, further studies should be conducted on the effects of pharmaceutical interventions in order to support this analysis. Another alternative would be to provide a list of inappropriate medications to prescribers delivering positive potential in terms of patient safety [41, 42]. …”

Potentially inappropriate psychotropic prescription at discharge is associated with lower functioning in the elderly psychiatric inpatients. A cross-sectional study

“…Potentially inappropriate psychotropic (PIP) prescription in the elderly patients (≥65 years) has become an important concern in developed countries (Nishtala et al 2014;Santos et al 2015a). With the global increase of medication prescription, the increase of life expectancy and the improvement of screening strategies, the global medication rate has increased in the elderly (Santos et al 2015b). This population has a higher prevalence of chronic illnesses, comorbidities, and is more likely to be on medication than young patients (Gallagher et al 2008;Cooper et al 2015).…”

Evaluation of the heterogeneity of studies estimating the association between risk factors and the use of potentially inappropriate drug therapy for the elderly: a systematic review with meta-analysis

“…Prevention of ADEs among older adults is crucial for the public health of this vulnerable population [3]. One of the causes of ADE is the prescription of potentially inappropriate drug therapy for the elderly (PIDT), which may be defined as the use of a drug therapy of in a manner that poses more risk than benefit, particularly where safer alternatives exist [4][5][6].…”