Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA.
Department of Pharmacy, University of Washington, Seattle, WA, USA.
J Am Geriatr Soc. 2024 Jan;72(1):126-138. doi: 10.1111/jgs.18681. Epub 2023 Dec 20.
Potentially inappropriate medications (PIMs) in older adults are medications in which risks often outweigh benefits and are suggested to be avoided. Worldwide, many distinct guidelines and tools classify PIMs in older adults. Collating these guidelines and tools, mapping them to a medication classification system, and creating a crosswalk will enhance the utility of PIM guidance for research and clinical practice.
We used the Anatomical Therapeutic Chemical (ATC) Classification System, a hierarchical classification system, to map PIMs from eight distinct guidelines and tools (2019 Beers Criteria, Screening Tool for Older Person's Appropriate Prescriptions [STOPP], STOPP-Japan, German PRISCUS, European Union-7 Potentially Inappropriate Medication [PIM] list, Centers for Medicare & Medicaid Services [CMS] High-Risk Medication, Anticholinergic Burden Scale, and Drug Burden Index). Each PIM was mapped to ATC Level 5 (drug) and to ATC Level 4 (drug class). We then used the crosswalk (1) to compare PIMs and PIM drug classes across guidelines and tools to determine the number of PIMs that were index (drug-induced adverse event) or marker (treatment of drug-induced adverse event) drug of prescribing cascades, and (2) estimate the prevalence of PIM use in older adults continuously enrolled with fee-for-service Medicare in 2018 as use cases. Data visualization and descriptive statistics were used to assess guidelines and tools for both use cases.
Out of 480 unique PIMs identified, only three medications-amitriptyline, clomipramine, and imipramine and two drug classes-N06AA (tricyclic antidepressants) and N06AB (selective serotonin reuptake inhibitors), were noted in all eight guidelines and tools. Using the crosswalk, 50% of classes of index drugs and 47% of classes of marker drugs of known prescribing cascades were PIMs. Additionally, 88% of Medicare beneficiaries were dispensed ≥1 PIM across the eight guidelines and tools.
We created a crosswalk of eight PIM guidelines and tools to the ATC classification system and created two use cases. Our findings could be used to expand the ease of PIM identification and harmonization for research and clinical practice purposes.
老年人潜在不适当药物（PIMs）是指风险通常大于益处的药物，建议避免使用。在全球范围内，许多不同的指南和工具将老年人的 PIMs 进行了分类。整理这些指南和工具，将其映射到药物分类系统，并创建一个交叉参考，将提高 PIM 指导在研究和临床实践中的实用性。
我们使用解剖治疗化学（ATC）分类系统，这是一个分层分类系统，将来自八个不同指南和工具（2019 年 Beers 标准、老年人适宜处方筛选工具 [STOPP]、STOPP-Japan、德国 PRISCUS、欧盟 7 种潜在不适当药物 [PIM]清单、医疗保险和医疗补助服务中心 [CMS]高风险药物、抗胆碱能负担量表和药物负担指数）的 PIM 进行映射。每个 PIM 都映射到 ATC 第 5 级（药物）和 ATC 第 4 级（药物类别）。然后，我们使用交叉参考（1）比较指南和工具之间的 PIM 和 PIM 药物类别，以确定索引（药物引起的不良事件）或标记（药物引起的不良事件的治疗）药物处方级联的 PIM 数量，（2）估计 2018 年在接受按服务收费的医疗保险连续参保的老年人中 PIM 使用的流行率作为使用案例。使用数据可视化和描述性统计对这两个使用案例进行了指南和工具的评估。
在确定的 480 种独特的 PIM 中，只有三种药物-阿米替林、氯米帕明和丙咪嗪以及两种药物类别-N06AA（三环抗抑郁药）和 N06AB（选择性 5-羟色胺再摄取抑制剂）在所有八个指南和工具中都有记录。使用交叉参考，已知处方级联的索引药物的 50%的药物类别和标记药物的 47%的药物类别都是 PIM。此外，在这八个指南和工具中，88%的医疗保险受益人开出了≥1 种 PIM。
我们创建了一个将八个 PIM 指南和工具与 ATC 分类系统进行交叉参考的交叉参考，并创建了两个使用案例。我们的研究结果可用于扩展 PIM 识别和协调，以满足研究和临床实践的目的。
