Potentially inappropriate (risky) drugs at geriatric patients Expert consensus for the Czech Republic 2012
Authors:
E. Topinková 1,3; D. Fialová 1,3; H. Matějovská Kubešová 2,3
Authors place of work:
1. lékařská fakulta UK a Všeobecná fakultní nemocnice, Praha, Geriatrická klinika, Přednostka: prof. MUDr. Eva Topinková, CSc.
1; Lékařská fakulta Masarykovy univerzity, Brno, Klinika interní, geriatrie a všeobecného praktického lékařství, Přednostka: prof. MUDr. Hana Matějovská Kubešová, CSc.
2; Expertní panel:
Koordinátoři: prof. MUDr. Eva Topinková, CSc., PharmDr. Daniela Fialová, PhD.
prof. MUDr. Štefan Alušík, CSc., prim. MUDr. Ivo Bureš, MUDr. Tomáš Doležal, PhD.
prim. MUDr. Ivana Doleželová, MUDr. Božena Jurašková, PhD., MUDr. Jaroslava La
3
Published in the journal:
Prakt. Lék. 2012; 92(1): 11-22
Category:
Reviews
Summary
Demographic population ageing and “geriatrization of medicine” contribute to steadily increasing drug consumption. Therefore, rational prescribing is needed for maximizing of the treatment benefit for the patient and to minimize the risk of adverse drug reactions. Age-related physiological changes and multiple comorbid conditions typical for geriatric patients influence the therapeutic value of many drugs and change their risk/benefit ratio. Medication for which there is pharmacological evidence of increased risk of adverse drug events in frail elderly patients or for which evidence of sufficient benefit is lacking are understood as “potentially inappropriate (risky) medication”. The most widely known are ”Beers’ criteria” from US but also other national criteria of inapproprite medictions for older persons reflecting availability of drugs and specific clinical approaches in individual countries.
In the Czech Republic several pharmacoepidemiologic studies using american and irish criteria reported high prevalence of prescribing errors in senior population, the most prevalent were omission of potentially beneficial drugs and high potentially inappropriate drugs prescribing. Due to differences in availability of potentially inappropriate drugs at the Czech pharmaceutical market and in the spectrum of prescribed inappropriate medications we recommended to develop Czech national criteria of inappropriate prescription in older patients for the use in clinical practice.
In the article we describe the modified Delphi method used for the development of the Czech national criteria based on the consensus of the multidisciplinary expert panel representing
- geriatric medicine,
- internal medicine,
- general practice,
- clinical pharmacy, and
- clinical pharmacology.
Overall, 71 individual medications fulfilled these criteria and were included into final list of the “Czech national criteria for inappropriate medication in older patients”. Medications are listed based on their pharmacological groups:
- central nervous system drugs,
- cardiovascular drugs,
- muscle relaxing and spasmolytic drugs,
- antiemetics and antivertiginous drugs,
- analgesics,
- gastrointestinal tract drugs, and
- other drugs.
However, the newly developed criteria do not represent absolute contraindications for the prescribing of included drugs. The list should alert the prescribing physician not to prescribe these drugs as the first line pharmacotherapy and to limit their prescripton in older patients when possible. When prescribed, patients should be carefully monitored for drug effect and potential adverese events and higher risk acknowledged by the physician. Implementation of the newly developed national criteria may help in decreasing potentially risky prescriptions in geriatric patients and to prevent their negative health and economical consequences.
Key words:
geriatric pharmacotherapy, potentially inappropriate drugs, risk.
Zdroje
1. Fialová, D. Specifické rysy geriatrické farmakoterapie. I – Změna terapeutické hodnoty léku ve stáří. Praha: Karolinum, 2007, 90 s.
2. Fialová, D., Onder, G. Medication errors in elderly people: Contributing factors and future perspectives. Br. J. Clin. Pharmacol. 2009; 67(6), p. 641-645.
3. O’Mahony, D., Gallagher, P.F. Inappropriate prescribing in the older population: need for new criteria. Age Ageing 2008, 37(2), p. 138-141.
4. Beers, M.H., Ouslander, Rollingher, I. Explicit criteria for determining inapproprite medication use in nursing home residents. Arch. Intern. Med. 1991, 151(9), p. 1825-1832.
5. Beers, M.H. Explicit criteria for determining potentially innapropriate medication use by the elderly: an update. Arch. Int. Med. 1997, 157(14), p. 1531-1536.
6. Fick, D.M., Cooper, J.W., Wade, W.E. et al. Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch. Intern. Med. 2003, 163(22), p. 2716-2724.
7. Fialová, D., Topinková, E. Koncept léčiv nevhodných ve stáří-farmakologické a farmakoepidemiologické aspekty. Remedia 2005, 15(4-5), s. 410-417.
8. Fialová, D., Topinková, E., Gambassi, G. et al. Potentially innapropriate medication use among home care elderly patiens in Europe. JAMA 2005, 293(11), p. 1348-1358.
9. Vinšová, J., Fialová, D., Topinková, E. a kol. Prevalence a vývojové trendy v preskripci léčiv potenciálně nevhodných ve stáří v České republice. Prakt. Lék. 2006, 86(12), s. 722-728.
10. Passarelli, M.C.G., Jacob, W., Figueras, A. Adverse drug reactions in an elderly hospitalized population: inappropriate prescription is a leading cause. Drugs Aging 2005, 22(9), p. 767-777.
11. Page, R.L. II., Linnebur, S.A., Bryant, L.L., Ruscin. J.M. Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions. Clin. Interv. Aging 2010, 5, p. 75-87.
12. Spinewine, A., Schmader, K.E., Barber, N. et al. Appropriate prescribing in elderly people: how well can it be measured and optimised. Lancet 2007, 370(9582), p. 173-184.
13. Fialová, D., Příhodová, V., Topinková, E. Explicitní kritéria hodnocení kvality lékové preskripce ve stáří. Geriatria 2010,16(3),p. 104-117.
14. Hanlon, J.T., Schmader, K.E., Samsa, G.P. et al. A method for assessing drug therapy appropriateness. J. Clin. Epidemiol. 1992, 45(10), p. 1045-1051.
15. Chang, C.B., Chan, D.C. Comparison of published explicit criteria for potentially inappropriate medications in older adults. Drugs Aging 2010, 27(12), p. 947-957.
16. Kaur, S., Mitchell, G., Vitetta, L. et al. Interventions that can reduce inappropriate prescribing in the elderly: a systematic review. Drugs Aging 2009, 26(12), p. 1013-1028.
17. Gallagher, P., Ryan, C., Byrne, S. et al. STOPP (Screening Tool of Older Persons Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment). Int. J. Clin. Pharmacol. Ther. 2008, 46(2), p. 72-82.
18. Topinková, E., Mádlová, P., Fialová, D., Klán, J. Nová evidence-based kritéria pro posouzení vhodnosti lékového režimu u seniorů: Kritéria STOPP (Screening Tool of Older Persons Prescriptions) a START (Screening Tool to Alert Doctors to Right Treatment). Vnitř. lék. 2008, 54(12), s. 1161-1169.
19. Topinkova, E., Madlova, P., Weber, P. et al. Inappropriate prescribing in geriatric patients at hospital admission as determined by STOPP/START criteria. Eur. Ger. Med. 2010, 1, Suppl 1, S 79.
20. Gallagher, P., Lang, P.O., Cherubini, A. et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur. J. Clin. Pharmacol. 2011, 67(11), p. 1175-1188.
21. Gallagher. P., Baeyens, J.P., Topinkova, E. et al. Inter-rater reliability of STOPP (Screening Tool of older Person´s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria amongst physicians in six European countries. Age Ageing 2009, 38(5), p. 603-606.
22. Winit-Watjana W, Sakulrat P, Kespichayawattana J. Criteria for high-risk medication use in Thai older patients. Arch. Gerontol. Geriatr. 2008, 47(1), p. 35-51.
23. McLeod, P.J., Huang, A.R., Tamblyn, R.M., Gayton, D.C. Defining inapproriate practices in prescribing for elderly people: a national consensus panel. CMAJ 1997, 156(3), p. 385-391.
24. Rancourt, C., Moisan, J., Baillargeon, L. et al. Potentially inappropriate prescriptions for older patients in long-term care. BMC Geriatr. 2004, 4, p. 9. Published online 2004 October 15. doi: 10.1186/1471-2318-4-9. Dostupné též na http://www.ncbi.nlm. nih.gov/pmc/articles/PMC529256/.
25. Laroche, M.L., Charmes, J.P., Merle, L. Potentially innapropriate medications in the elderly: a French consensus panel list. Eur. J. Clin. Pharmacol. 2007, 63(8), p. 725-731.
26. Rognstad, S., Brekke, M., Fetveit, A. et al. The Norvegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients: a modified Delphi study. Scand. J. Prim. Health. Care 2009, 27(3), p. 153-159.
27. van Spall, H.G., Toren, A., Kiss, A., Fowler, R.A. Eligibility criteria of randomized controlled trials published in high-impact general medical journals: a systematic sampling review. JAMA 2007, 297, p. 1233-1240.
28. Tamblyn, R., Huang, A., Perreault, R. et al. The medical office of the 21st century (MOXXI): Effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ 2003, 169, p. 549-556.
29. Terrell, K.M., Perkins, A.J., Dexter, P.R. et al. Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: a randomized, controlled trial. J. Am. Geriatr. Soc. 2009, 57, p.1388–1394.
30. Mattison, M.L., Afonso, K.A., Ngo, L.H., Mukamal, K.J. Preventing potentially inappropriate medication use in hospitalized older patients with a computerized provider order entry warning system. Arch. Intern. Med. 2010, 170, p. 1331-1336.
31. Arora, V.M., Johnson, M., Olson, J. Using assesing care of vulnerable elders quality indicators to measure quality of hospital care for vulnerable elders. J. Am. Geriatr. Soc. 2007, 55(11), p. 1705-1711.
Štítky
General practitioner for children and adolescents General practitioner for adultsČlánok vyšiel v časopise
General Practitioner
2012 Číslo 1
- Memantine Eases Daily Life for Patients and Caregivers
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole vs. Tramadol in Postoperative Analgesia
- Advances in the Treatment of Myasthenia Gravis on the Horizon
- What Effect Can Be Expected from Limosilactobacillus reuteri in Mucositis and Peri-Implantitis?
Najčítanejšie v tomto čísle
- Current role of endoscopic ultrasound investigation in the diagnosis of pancreatic diseases – our experiences
- Psychoactive substances abuse and diabetes mellitus
- Potentially inappropriate (risky) drugs at geriatric patients Expert consensus for the Czech Republic 2012
- A survey of motivational factors in non-medical health professionals