Explicit criteria as clinical tools to minimize inappropriate medication use and its consequences

Abstract

Polypharmacy and prescribing of potentially inappropriate medications (PIMs) are the key elements of inappropriate medication use (IMU) in older multimorbid people. IMU is associated with a range of negative healthcare consequences including adverse drug events and unplanned hospitalizations. Furthermore, prescribing guidelines are commonly derived from randomized controlled clinical trials which have specifically excluded older adults with multimorbidity. Consequently, indiscriminate application of single disease pharmacotherapy guidelines to older multimorbid patients can lead to increased risk of drug–drug interactions, drug–disease interactions and poor drug adherence. Both polypharmacy and PIMs are highly prevalent in older people and strategies to improve the quality and safety of prescribing, largely through avoidance of IMU, are needed. In the last 30 years, numerous explicit PIM criteria-based tools have been developed to assist physicians with medication management in clinically complex multimorbid older people. Very few of these PIM criteria sets have been tested as an intervention compared with standard pharmaceutical care in well-designed clinical trials. In this review, we describe the most widely used sets of explicit PIM criteria to address inappropriate polypharmacy with particular focus on STOPP/START criteria and FORTA criteria which have been associated with positive patient-related outcomes when used as interventions in recent randomized controlled trials.

Potentially inappropriate medication and attitudes of older adults towards deprescribing

“…To the best of our knowledge, we were the first to investigate the relation between medication appropriateness and patients’ willingness to deprescribe using validated tools. The Beers criteria is the most widely used tool for medication appropriateness and has proven to be accurate in the assessment of PIM [ 42 , 43 ]. The Beers 2019 version is updated according to the latest evidence and includes drug-drug interactions when assessing PIMs.…”

“…For the assessment of medication appropriateness, a selection of the AGS Beers 2019 criteria was used [ 42 ]. The AGS Beers list is the most commonly used tool for assessment of PIMs worldwide [ 43 ]. Since data on medical conditions was limited in this study, we used only the criteria that were applicable without clinical information (52 of 97 criteria).…”

Evaluation of clarity of the STOPP/START criteria for clinical applicability in prescribing for older people: a quality appraisal study

“…Clinicians with high affinity for geriatric medicine may not need explicit treatment recommendation to provide best patient care, whereas some clinicians—such as surgical specialists—who treat older people but may be less experienced with (in)appropriate prescribing in older people, probably require more clear guidance. Clear recommendations are therefore important to reach all prescribers, because the success of STOPP/START criteria as an intervention depends on its integration and implementation in clinical practice 23. Some recommendations may be best applied by physicians with a certain expertise, such as to start an ‘acetylcholinesterase inhibitor for mild-to-moderate Alzheimer’s dementia or Lewy body dementia (START C3)’.…”

Optimierung der Psychopharmakotherapie im Alter

“…Sie enthält somit eine Positiv-Negativ-Bewertung von Arzneimitteln zur Behandlung älterer Patienten und ist keine reine Negativliste [59,60]. Die FORTA-Liste hat in randomisierten klinischen Studien bereits positive Effekte bei Anwendung gezeigt [55,61]. Unter anderem können Über-und Unterbehandlungen anhand der Liste detektiert werden [62].…”