Detecting Medication Risks among People in Need of Care: Performance of Six Instruments

Tobias Dreischulte, Linda Sanftenberg (), Philipp Hennigs, Isabel Zöllinger, Rita Schwaiger, Caroline Floto, Maria Sebastiao, Thomas Kühlein, Dagmar Hindenburg, Ildikó Gagyor, Domenika Wildgruber, Anita Hausen, Christian Janke, Michael Hölscher, Daniel Teupser, Jochen Gensichen and on behalf of the BACOM Study Group
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Tobias Dreischulte: Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
Linda Sanftenberg: Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
Philipp Hennigs: Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
Isabel Zöllinger: Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
Rita Schwaiger: Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
Caroline Floto: Institute of General Practice, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany
Maria Sebastiao: Institute of General Practice, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany
Thomas Kühlein: Institute of General Practice, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany
Dagmar Hindenburg: Institute of General Practice, University Hospital of Julius-Maximilians-Universität Würzburg, 97070 Würzburg, Germany
Ildikó Gagyor: Institute of General Practice, University Hospital of Julius-Maximilians-Universität Würzburg, 97070 Würzburg, Germany
Domenika Wildgruber: Katholische Stiftungshochschule München/University of Applied Sciences, 81667 Munich, Germany
Anita Hausen: Katholische Stiftungshochschule München/University of Applied Sciences, 81667 Munich, Germany
Christian Janke: Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of LMU Munich, 80802 Munich, Germany
Michael Hölscher: Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of LMU Munich, 80802 Munich, Germany
Daniel Teupser: Institute of Laboratory Medicine, University Hospital of LMU Munich, 81377 Munich, Germany
Jochen Gensichen: Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
on behalf of the BACOM Study Group: BACOM Study Group are listed in acknowledgments.

IJERPH, 2023, vol. 20, issue 3, 1-15

Abstract: Introduction: 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. Objectives: This cross sectional study compares six validated tools in terms of PIM and PPO detection. Methods: 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. Results: 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. Conclusion: 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.

Keywords: inappropriate medication; prescribing omission; nursing home residents; polypharmacy; adverse drug reaction (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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