Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany.
Institute of General Practice, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany.
Int J Environ Res Public Health. 2023 Jan 28;20(3):2327. doi: 10.3390/ijerph20032327.
Numerous tools exist to detect potentially inappropriate medication (PIM) and potential prescribing omissions (PPO) in older people, but it remains unclear which tools may be most relevant in which setting.
This cross sectional study compares six validated tools in terms of PIM and PPO detection.
We examined the PIM/PPO prevalence for all tools combined and the sensitivity of each tool. The pairwise agreement between tools was determined using Cohen's Kappa.
We included 226 patients in need of care (median (IQR age 84 (80-89)). The overall PIM prevalence was 91.6 (95% CI, 87.2-94.9)% and the overall PPO prevalence was 63.7 (57.1-69.9%)%. The detected PIM prevalence ranged from 76.5%, for FORTA-C/D, to 6.6% for anticholinergic drugs (German-ACB). The PPO prevalences for START (63.7%) and FORTA-A (62.8%) were similar. The pairwise agreement between tools was poor to moderate. The sensitivity of PIM detection was highest for FORTA-C/D (55.1%), and increased to 79.2% when distinct items from STOPP were added.
Using a single screening tool may not have sufficient sensitivity to detect PIMs and PPOs. Further research is required to optimize the composition of PIM and PPO tools in different settings.
有许多工具可用于检测老年人潜在不适当的药物（PIM）和潜在的处方遗漏（PPO），但仍不清楚哪些工具在哪些环境下可能最相关。
本横断面研究比较了六种经过验证的工具在检测 PIM 和 PPO 方面的性能。
我们综合考察了所有工具的 PIM/PPO 检出率和每种工具的灵敏度。使用 Cohen's Kappa 来确定工具之间的两两一致性。
我们纳入了 226 名需要护理的患者（中位数（IQR 年龄）为 84（80-89）岁）。总的 PIM 检出率为 91.6%（95%CI，87.2-94.9）%，总的 PPO 检出率为 63.7%（57.1-69.9）%。检测到的 PIM 检出率范围从 FORTA-C/D 的 76.5%到抗胆碱能药物（德国-ACB）的 6.6%。START（63.7%）和 FORTA-A（62.8%）的 PPO 检出率相似。工具之间的两两一致性为差到中度。PIM 检测的灵敏度最高的是 FORTA-C/D（55.1%），当加入 STOPP 的不同项目时，灵敏度增加到 79.2%。
使用单一的筛选工具可能不足以检测 PIM 和 PPO。需要进一步研究以优化不同环境下 PIM 和 PPO 工具的组成。
