Nyborg Gunhild, Straand Jørund, Klovning Atle, Brekke Mette
Department of General Practice/Family Medicine, Institute of Health and Society, University of Oslo , Norway.
Scand J Prim Health Care. 2015 Jun;33(2):134-41. doi: 10.3109/02813432.2015.1041833. Epub 2015 Jun 23.
To develop a set of explicit criteria for pharmacologically inappropriate medication use in nursing homes.
In an expert panel, a three-round Delphi consensus process was conducted via survey software.
Norway.
Altogether 80 participants - specialists in geriatrics or clinical pharmacology, physicians in nursing homes and experienced pharmacists - agreed to participate in the survey. Of these, 62 completed the first round, and 49 panellists completed all three rounds (75.4% of those ultimately entering the survey).
The authors developed a list of 27 criteria based on the Norwegian General Practice (NORGEP) criteria, literature, and clinical experience. The main outcome measure was the panellists' evaluation of the clinical relevance of each suggested criterion on a digital Likert scale from 1 (no clinical relevance) to 10. In the first round panellists could also suggest new criteria to be included in the process. For each criterion, degree of consensus was based on the average Likert score and corresponding standard deviation (SD).
A list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed through a three-round web-based Delphi consensus process. Degree of consensus increased with each round. No criterion was voted out. Suggestions from the panel led to the inclusion of seven additional criteria in round two.
The NORGEP-NH list may serve as a tool in the prescribing process and in medication list reviews and may also be used in quality assessment and for research purposes.
制定一套养老院中药物使用不当的明确标准。
在一个专家小组中,通过调查软件进行三轮德尔菲共识达成过程。
挪威。
共有80名参与者——老年医学或临床药理学专家、养老院医生和经验丰富的药剂师——同意参与调查。其中,62人完成了第一轮,49名小组成员完成了所有三轮(占最终参与调查者的75.4%)。
作者基于挪威全科医疗(NORGEP)标准、文献和临床经验制定了一份包含27条标准的清单。主要观察指标是小组成员对每条建议标准的临床相关性在1(无临床相关性)至10的数字李克特量表上进行评估。在第一轮中,小组成员还可以提出纳入该过程的新标准。对于每条标准,共识程度基于平均李克特得分和相应的标准差(SD)。
通过三轮基于网络的德尔菲共识达成过程,制定了一份包含34条养老院潜在不当药物使用明确标准的清单。每一轮的共识程度都有所提高。没有标准被否决。小组的建议导致在第二轮中又纳入了七条标准。
NORGEP-NH清单可作为处方过程和药物清单审查的工具,也可用于质量评估和研究目的。