Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 28;20(3):2327.
doi: 10.3390/ijerph20032327.

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

Tobias Dreischulte  1 , Linda Sanftenberg  1 , Philipp Hennigs  1 , Isabel Zöllinger  1 , Rita Schwaiger  1 , Caroline Floto  2 , Maria Sebastiao  2 , Thomas Kühlein  2 , Dagmar Hindenburg  3 , Ildikó Gagyor  3 , Domenika Wildgruber  4 , Anita Hausen  4 , Christian Janke  5 , Michael Hölscher  5 , Daniel Teupser  6 , Jochen Gensichen  1 , On Behalf Of The Bacom Study Group
Affiliations

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

Tobias Dreischulte et al. Int J Environ Res Public Health. .

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: adverse drug reaction; inappropriate medication; nursing home residents; polypharmacy; prescribing omission.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Venn diagrams of unique and overlapping detection of PIMs (a) and PPOs (b) by different tools. The numbers represent the quantities of PIMs/PPOs in that respective area (e.g., STOPP uniquely identified 104 PIMs, but 55 PIMs that STOPP detected were also detected by FORTA). Blank areas without numbers are to be interpreted as zero.
Figure 2
Figure 2
Pareto chart showing the number of distinct PIMs detected by PIM instruments in descending order of PIM prevalence, and the cumulative sensitivity of PIM detection achieved by adding distinct items from each instrument. Panel (a) shows the effects on the cumulative sensitivity of adding all distinct items from each instrument. Panel (b) shows the effects on the cumulative sensitivity of adding to FORTA C/D and STOPP the most prevalent PIMs from other tools.
See this image and copyright information in PMC

References

    1. Mangoni A.A., Jackson S.H. Age-related changes in pharmacokinetics and pharmacodynamics: Basic principles and practical applications. Br. J. Clin. Pharmacol. 2004;57:6–14. doi: 10.1046/j.1365-2125.2003.02007.x. - DOI - PMC - PubMed
    1. Endres H.G., Kaufmann-Kolle P., Steeb V., Bauer E., Böttner C., Thürmann P. Association between Potentially Inappropriate Medication (PIM) Use and Risk of Hospitalization in Older Adults: An Observational Study Based on Routine Data Comparing PIM Use with Use of PIM Alternatives. PLoS ONE. 2016;11:e0146811. doi: 10.1371/journal.pone.0146811. - DOI - PMC - PubMed
    1. Mair A., Wilson M., Dreischulte T. Addressing the Challenge of Polypharmacy. Annu. Rev. Pharmacol. Toxicol. 2020;60:661–681. doi: 10.1146/annurev-pharmtox-010919-023508. - DOI - PubMed
    1. Taché S.V., Sönnichsen A., Ashcroft D.M. Prevalence of Adverse Drug Events in Ambulatory Care: A Systematic Review. Ann. Pharmacother. 2011;45:977–989. doi: 10.1345/aph.1P627. - DOI - PubMed
    1. Barnett K., Mercer S.W., Norbury M., Watt G., Wyke S., Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study. Lancet. 2012;380:37–43. doi: 10.1016/S0140-6736(12)60240-2. - DOI - PubMed

Publication types

LinkOut - more resources