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. 2016 Mar 15:16:67.
doi: 10.1186/s12877-016-0240-3.

A Delphi process to address medication appropriateness for older persons with multiple chronic conditions

Terri R Fried  1   2 , Kristina Niehoff  3 , Jennifer Tjia  4 , Nancy Redeker  5 , Mary K Goldstein  6   7
Affiliations

A Delphi process to address medication appropriateness for older persons with multiple chronic conditions

Terri R Fried et al. BMC Geriatr. .

Erratum in

Abstract

Background: Frameworks exist to evaluate the appropriateness of medication regimens for older patients with multiple medical conditions (MCCs). Less is known about how to translate the concepts of the frameworks into specific strategies to identify and remediate inappropriate regimens.

Methods: Modified Delphi method involving iterative rounds of input from panel members. Panelists (n = 9) represented the disciplines of nursing, medicine and pharmacy. Included among the physicians were two geriatricians, one general internist, one family practitioner, one cardiologist and two nephrologists. They participated in 3 rounds of web-based anonymous surveys.

Results: The panel reached consensus on a set of markers to identify problems with medication regimens, including patient/caregiver report of non-adherence, medication complexity, cognitive impairment, medications identified by expert opinion as inappropriate for older persons, excessively tight blood sugar and blood pressure control among persons with diabetes mellitus, patient/caregiver report of adverse medication effects or medications not achieving desired outcomes, and total number of medications. The panel also reached consensus on approaches to address these problems, including endorsement of strategies to discontinue medications with known benefit if necessary because of problems with feasibility or lack of alignment with patient goals.

Conclusions: The results of the Delphi process provide the basis for an algorithm to improve medication regimens among older persons with MCCs. The algorithm will require assessment not only of medications and diagnoses but also cognition and social support, and it will support discontinuation of medications both when risks outweigh benefits and when regimens are not feasible or do not align with goals.

Keywords: Chronic conditions; Medications; Polypharmacy.

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Figures

Fig. 1
Fig. 1
Clinical strategies to improve medication regimens among older persons and corresponding tasks for Delphi panel
Fig. 2
Fig. 2
Problems with medications and their corresponding markers
See this image and copyright information in PMC

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