Pazan Farhad, Weiss Christel, Wehling Martin
Institute for Experimental and Clinical Pharmacology and Toxicology, Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Straße 13-17, 68167, Mannheim, Germany.
Drugs Aging. 2018 Jan;35(1):61-71. doi: 10.1007/s40266-017-0514-2.
Drug treatment of older people is still potentially inappropriate in many cases as multimorbidity and related polypharmacy are highly prevalent. To increase the quality of drug treatment in older people, the FORTA (Fit fOR The Aged) List (first version 2012) was developed in a Delphi consensus procedure and updated (FORTA2015) by 21 experts from Germany and Austria. It has been validated in a randomized, controlled, prospective trial demonstrating significant improvement in the quality of drug treatment and clinical endpoints (VALFORTA).
Based on these results, Delphi consensus validations (two rounds) of country/region-specific FORTA Lists were conducted in the UK/Ireland, France, Poland, Italy, Spain, the Nordic countries and The Netherlands. An algorithm based on geriatric/pharmacologic expertise, publications and professional position was used to find experts in the field.
Forty-seven experts agreed to participate in the Delphi process (return rate of 97.9%). For each country/region, the overall mean consensus coefficient (deviation from the initiator proposal) was > 0.9. FORTA Lists from six countries/regions with a minimum of four participating experts (excluding The Netherlands) plus the original FORTA List were collated into the EURO-FORTA List containing 264 items in 26 main indication groups. Two drugs had to be added to the proposed items, as proposed by at least four countries/regions; none had to be removed.
This project produced seven new country/region-specific FORTA Lists, as well as the overarching EURO-FORTA List showing a high consensual level based on a broader expert base. EURO-FORTA should help to spread the FORTA approach and improve geriatric pharmacotherapy internationally.
由于多种疾病共存及相关的多药合用情况极为普遍，老年人的药物治疗在很多情况下仍可能存在不合理之处。为提高老年人药物治疗质量，“适合老年人的药物（FORTA）清单”（2012年第一版）通过德尔菲共识程序制定，并由来自德国和奥地利的21位专家进行了更新（FORTA2015）。该清单已在一项随机、对照、前瞻性试验中得到验证，结果显示药物治疗质量和临床终点有显著改善（VALFORTA）。
基于这些结果，在英国/爱尔兰、法国、波兰、意大利、西班牙、北欧国家和荷兰对特定国家/地区的FORTA清单进行了两轮德尔菲共识验证。使用一种基于老年医学/药理学专业知识、出版物和专业地位的算法来寻找该领域的专家。
47位专家同意参与德尔菲过程（回复率为97.9%）。对于每个国家/地区，总体平均共识系数（与发起者提议的偏差）均>0.9。来自六个国家/地区（至少有四位参与专家，不包括荷兰）的FORTA清单加上原始的FORTA清单被整理成包含26个主要适应症组中的264项的欧洲FORTA清单。至少四个国家/地区提议的两种药物必须添加到提议项目中；没有药物需要删除。
该项目产生了七份新的特定国家/地区的FORTA清单，以及基于更广泛专家基础、具有高度共识水平的总体欧洲FORTA清单。欧洲FORTA清单应有助于推广FORTA方法并在国际上改善老年药物治疗。
