Salas Roxana De Las, Eslava-Schmalbach Javier, Vaca-González Claudia, Rodríguez Dolores, Figueras Albert
BSN, MSc. Department of Pharmacy, Faculty of Sciences, National University of Colombia. Bogotá (Colombia).
MD, MSc, PhD. Professor. Department of Public Health, Faculty of Medicine, National University of Colombia. Bogotá (Colombia).
Pharm Pract (Granada). 2020 Oct-Dec;18(4):2033. doi: 10.18549/PharmPract.2020.4.2033. Epub 2020 Dec 4.
The aim of this study was to develop and validate a stepwise tool to aid primary health care professionals in the process of deprescribing potentially inappropriate medication in older persons.
We carried out a systematic review to identify previously published tools. A composite proposal of algorithm was made by following the steps from clinical experience to deprescribe medications. A 2-round electronic Delphi method was conducted to establish consensus. Eighteen experts from different countries (Colombia, Spain and Argentina) accepted to be part of the panel representing geriatricians, internists, endocrinologist, general practitioners, pharmacologists, clinical pharmacists, family physicians and nurses. Panel members were asked to mark a Likert Scale from 1 to 9 points (1= strongly disagree, 9= strongly agree). The content validity ratio, item-level content validity, and Fleiss' Kappa statistics was measured to establish reliability. The same voting method was used for round 2.
A 7-question algorithm was proposed. Each question was part of a domain and conduct into a decision. In round 1, a consensus was not reached but statements were grouped and organized. In round 2, the tool met consensus. The inter-rater reliability was between substantial and almost perfect for questions with Kappa=0.77 (95% CI 0.60-0.93), for domains with Kappa= 0.73 (95%CI 0.60-0.86) and for decisions with Kappa= 0.97 (95%CI 0.90-1.00).
This is a novel tool that captures and supports healthcare professionals in clinical decision-making for deprescribing potentially inappropriate medication. This includes patient's and caregiver's preferences about medication. This tool will help to standardize care and provide guidance on the prescribing/deprescribing process of older persons' medications. Also, it provides a holistic way to reduce polypharmacy and inappropriate medications in clinical practice.
本研究旨在开发并验证一种逐步工具，以协助初级卫生保健专业人员在老年人中停用潜在不适当药物的过程。
我们进行了系统综述以识别先前发表的工具。通过遵循从临床经验到停用药物的步骤，提出了算法的综合建议。采用两轮电子德尔菲法达成共识。来自不同国家（哥伦比亚、西班牙和阿根廷）的18名专家接受成为代表老年病学家、内科医生、内分泌学家、全科医生、药理学家、临床药剂师、家庭医生和护士的小组成员。要求小组成员在1至9分的李克特量表上打分（1 = 强烈不同意，9 = 强烈同意）。测量内容效度比、项目级内容效度和Fleiss' Kappa统计量以确定可靠性。第二轮采用相同的投票方法。
提出了一个包含7个问题的算法。每个问题都是一个领域的一部分并进行决策。在第一轮中，未达成共识，但陈述被分组和整理。在第二轮中，该工具达成了共识。对于问题，评分者间信度在实质性和几乎完美之间，Kappa = 0.77（95%CI 0.60 - 0.93）；对于领域，Kappa = 0.73（95%CI 0.60 - 0.86）；对于决策，Kappa = 0.97（95%CI 0.90 - 1.00）。
这是一种新颖的工具，可在临床决策中捕捉并支持医疗保健专业人员停用潜在不适当药物。这包括患者和护理人员对药物的偏好。该工具将有助于规范护理，并为老年人药物的处方/停用过程提供指导。此外，它提供了一种整体方法，以减少临床实践中的多重用药和不适当用药。
