The EURO-FORTA (Fit fOR The Aged) List Version 2: Consensus Validation of a Clinical Tool for Improved Pharmacotherapy in Older Adults

Abstract

Background The aging of our societies leads to a higher prevalence of multimorbidity and therefore polypharmacy, which often results in inappropriate drug treatment. To address this issue, numerous listing approaches, such as the Fit fOR The Aged (FORTA) list have been developed. FORTA’s positive impact on the quality of medications and relevant clinical outcomes has been shown. Based on new emerging evidence and experiences with the existing FORTA lists, we aimed to update the FORTA lists in several European countries/regions. Methods Two-step Delphi consensus procedures were conducted in Poland, UK/Ireland, Italy, Spain, the Nordic countries, The Netherlands and France. The existing European FORTA lists served as survey proposals. Results Thirty-two experts agreed to take part in this study (return rate: 96.9%). The country/region-specific overall consensus for all items and participants after the first round was > 90%. FORTA lists from six participating countries, plus the FORTA list for the German-speaking countries, were collated into the new EURO-FORTA List, which now contains 267 items aligned to 27 indications. Three items were added to the EURO-FORTA List, and no drugs were deleted. Eight FORTA items were relabeled, and 96.9% of the labels remained unchanged. Conclusion In this study, seven new country/region specific FORTA lists, as well as a new overarching EURO-FORTA List, were developed. An overall increase in the mean consensus coefficient and increases for all disease-specific mean consensus coefficients show a wider consensus among participants. The new lists have the potential to improve drug therapy in older people internationally. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-023-01024-6.

Deprescribing of antidepressants: development of indicators of high-risk and overprescribing using the RAND/UCLA Appropriateness Method

“…To the best of our knowledge, this is the first consensus study focused on identifying indicators for high-risk and overprescribing of antidepressants. Compared to more generic lists of potentially inappropriate medications [ 23 , 39 ], our focus on a specific class of drugs allowed for the development of a comprehensive set of indicators specifically related to antidepressants. For example, STOPP (Screening Tool of Older Person’s Prescriptions/START (Screening Tool to Alert doctors to Right Treatment) version 3 includes 10 indicators related to antidepressants (7.5%) [ 23 ], while FORTA (Fit fOR The Aged) identifies individual antidepressants for 6 indications [ 39 ].…”

“…Compared to more generic lists of potentially inappropriate medications [ 23 , 39 ], our focus on a specific class of drugs allowed for the development of a comprehensive set of indicators specifically related to antidepressants. For example, STOPP (Screening Tool of Older Person’s Prescriptions/START (Screening Tool to Alert doctors to Right Treatment) version 3 includes 10 indicators related to antidepressants (7.5%) [ 23 ], while FORTA (Fit fOR The Aged) identifies individual antidepressants for 6 indications [ 39 ]. In comparison, this study identified 37 high-risk prescribing indicators related to a broad spectrum of adverse outcomes.…”

“…Clinical practice guidelines typically focus on the appropriate use of antidepressants but do not explicitly state when their use may require caution or review with a view to deprescribing. This set of indicators may therefore complement such guidelines and could be used in conjunction with other established PIM lists [ 23 , 39 , 44 ]. Decision aids, ideally implemented in practice management systems, can trigger a process of shared decision-making, thereby strengthening the physician–patient interaction, ensuring desired effects, and preventing adverse effects of antidepressants before they occur.…”

A newly developed algorithm for switching outpatient medications to medications listed in the hospital formulary: a prospective real-word evaluation in patients admitted electively to hospital

“…As part of this, drug-related problems were analyzed (e.g., drug-drug interactions, appropriateness of medication [ 18 , 19 ]). For the latter, the PRISCUS [ 20 ] and FORTA list [ 21 ] were used to assess patient-related information.…”