Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, Brazil.
Australas J Ageing. 2022 Sep;41(3):357-382. doi: 10.1111/ajag.13046. Epub 2022 Feb 28.
To map explicit screening tools to identify potentially inappropriate medication (PIMs), and the characteristics and limitations of these tools. Including PIMs-interactions, therapeutic alternatives and the clinical management of PIMs.
A systematic scoping review was conducted in PubMed and Scopus (until May 2021). The number of PIMs listed as essential drugs was identified in Model List of Essential Medicines by the World Health Organization (WHO) and National List of Essential Medicines (Brazil). In addition to reporting the therapeutic alternatives and clinical management proposed by explicit screening tools to identify PIMs, we suggested our own alternatives for the PIMs most frequently reported.
Fifty-eight tools reported 614 PIMs and 747 PIMs-interactions. Limited overlap between the tools was observed: 123 (69.1%) of 178 therapeutic alternatives proposed by the tools were considered inappropriate by other tools, and 222 (36.1%) of the 614 PIMs identified were named as being inappropriate only once. Only 21 tools were developed by a Delphi panel technique associated with systematic review. The PIMs listed as essential medication in Brazil and by the WHO were 30.6% and 23.3% of the total reported, respectively. For the most-cited PIMs, such as non-steroidal anti-inflammatory drugs, tricyclic antidepressants and benzodiazepines, we suggested the use of non-opioid and opioid analgesics; agomelatine, bupropion or moclobemide; and melatonin, respectively.
The next stages in the development of explicit screening tools to identify PIMs include achieving more consensus between them and improving their applicability across countries. Further, it is recommended that tools include PIMs risks and advice on therapeutic alternatives.
绘制明确的筛选工具以识别潜在不适当的药物（PIMs），并描述这些工具的特点和局限性。包括 PIMs-相互作用、治疗替代品以及 PIMs 的临床管理。
在 PubMed 和 Scopus 中进行了系统的范围综述（截至 2021 年 5 月）。确定了世界卫生组织（WHO）基本药物示范清单和巴西国家基本药物清单中列出的 PIMs 数量。除了报告明确的筛选工具识别 PIMs 所提出的治疗替代品和临床管理建议外，我们还针对最常报告的 PIMs 提出了自己的替代品。
58 种工具报告了 614 种 PIMs 和 747 种 PIMs-相互作用。观察到工具之间的重叠有限：工具提出的 178 种治疗替代品中有 123 种（69.1%）被其他工具认为不合适，而 614 种 PIMs 中有 222 种（36.1%）仅被一次命名为不合适。只有 21 种工具是通过与系统评价相关的 Delphi 小组技术开发的。巴西和 WHO 列出的基本药物中的 PIMs 分别占总报告的 30.6%和 23.3%。对于非甾体抗炎药、三环抗抑郁药和苯二氮䓬类等最常被引用的 PIMs，我们建议使用非阿片类和阿片类镇痛药；阿戈美拉汀、安非他酮或吗氯贝胺；以及褪黑素。
明确的筛选工具识别 PIMs 的下一步发展包括在它们之间实现更多共识，并提高其在各国的适用性。此外，建议工具包括 PIMs 风险和治疗替代品建议。
