Department of Nursing, Km5 Via Puerto Colombia, Universidad del Norte, Barranquilla, Colombia.
Faculty of Science, Department of Pharmacy, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Bogota, Colombia.
BMC Geriatr. 2023 Oct 20;23(1):682. doi: 10.1186/s12877-023-04271-9.
Potentially inappropriate medication use is prevalent among older adults in primary care, leading to increased morbidity, adverse drug reactions, hospitalizations, and mortality. This study aimed to develop and validate a tool for identifying PIMs in older adults within the primary care setting. The tool is composed of a list of criteria and was created based on consensus among experts from three Spanish-speaking countries, including two from Latin America.
A literature review was conducted to identify existing tools, and prescription patterns were evaluated in a cohort of 36,111 older adults. An electronic Delphi method, consisting of two rounds, was used to reach a formal expert consensus. The panel included 18 experts from Spain, Colombia, and Argentina. The content validity index, validity of each content item, and Kappa Fleiss statistical measure were used to establish reliability.
Round one did not yield a consensus, but a definitive consensus was reached in round two. The resulting tool consisted of a list of 5 general recommendations per disease, along with 33 criteria related to potential problems, recommendations, and alternative therapeutic options. The overall content validity of the tool was 0.87, with a Kappa value of 0.69 (95% CI 0.64-0.73; Substantial).
The developed criteria provide a novel list that allows for a comprehensive approach to pharmacotherapy in older adults, intending to reduce inappropriate medication use, ineffective treatments, prophylactic therapies, and treatments with an unfavorable risk-benefit ratio for the given condition. Further studies are necessary to evaluate the impact of these criteria on health outcomes.
在初级保健中，老年人中普遍存在潜在不适当的药物使用，导致发病率、药物不良反应、住院和死亡率增加。本研究旨在开发和验证一种用于识别初级保健环境中老年人潜在不适当药物的工具。该工具由一系列标准组成，是根据来自三个西班牙语国家的专家（其中两个来自拉丁美洲）的共识创建的。
进行了文献回顾以确定现有的工具，并在 36111 名老年人的队列中评估了处方模式。采用两轮电子 Delphi 法达成正式专家共识。该小组包括来自西班牙、哥伦比亚和阿根廷的 18 名专家。内容有效性指数、每个内容项目的有效性和 Kappa Fleiss 统计测量用于建立可靠性。
第一轮没有达成共识，但在第二轮达成了明确的共识。由此产生的工具包括每个疾病的 5 条一般建议列表，以及 33 条与潜在问题、建议和替代治疗选择相关的标准。该工具的总体内容有效性为 0.87，Kappa 值为 0.69（95%CI 0.64-0.73；中度）。
开发的标准提供了一个新的清单，允许对老年人进行全面的药物治疗，旨在减少不适当的药物使用、无效治疗、预防性治疗以及给定情况下不利风险-效益比的治疗。需要进一步研究来评估这些标准对健康结果的影响。
