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 Oct 19;16(1):122.
doi: 10.1186/s40545-023-00630-4.

Development of a Malaysian potentially inappropriate prescribing screening tool in older adults (MALPIP): a Delphi study

Chee Tao Chang  1   2 , Huan Keat Chan  3   4 , Wee Kooi Cheah  5 , Maw Pin Tan  6   7 , Alan Swee Hock Ch'ng  8 , Chiann Ni Thiam  9 , Nor Azlina Abu Bakar  10 , Weng Keong Yau  11 , Muhammad Radzi Abu Hassan  3 , Philip Rajan  12 , Kar Choon Tan  13 , Subashini Ambigapathy  14 , Paranthaman Vengadasalam  15 , Surina Zaman Huri  16 , H S Arvinder-Singh  12   17 , Chern Choong Thum  18 , Wai Mun Chung  19 , Jun How Ooi  20 , Noor Hamizah Sabki  21 , Hooi Peng Lee  22 , Siti Mallissa Mohd Shariff  23 , Muhammad Azuan Azman  24 , Siew Li Teoh  25 , Shaun Wen Huey Lee  26
Affiliations

Development of a Malaysian potentially inappropriate prescribing screening tool in older adults (MALPIP): a Delphi study

Chee Tao Chang et al. J Pharm Policy Pract. .

Abstract

Introduction: Polypharmacy and potentially inappropriate medications (PIM) are common among older adults. To guide appropriate prescribing, healthcare professionals often rely on explicit criteria to identify and deprescribe inappropriate medications, or to start medications due to prescribing omission. However, most explicit PIM criteria were developed with inadequate guidance from quality metrics or integrating real-world data, which are rich and valuable data source.

Aim: To develop a list of medications to facilitate appropriate prescribing among older adults.

Methods: A preliminary list of PIM and potential prescribing omission (PPO) were generated from systematic review, supplemented with local pharmacovigilance data of adverse reaction incidents among older people. Twenty-one experts from nine specialties participated in two Delphi to determine the list of PIM and PPO in February and March 2023. Items that did not reach consensus after the second Delphi round were adjudicated by six geriatricians.

Results: The preliminary list included 406 potential candidates, categorised into three sections: PIM independent of diseases, disease dependent PIM and omitted drugs that could be restarted. At the end of Delphi, 92 items were decided as PIM, including medication classes, such as antacids, laxatives, antithrombotics, antihypertensives, hormones, analgesics, antipsychotics, antidepressants, and antihistamines. Forty-two disease-specific PIM criteria were included, covering circulatory system, nervous system, gastrointestinal system, genitourinary system, and respiratory system. Consensus to start potentially omitted treatment was achieved in 35 statements across nine domains.

Conclusions: The newly developed PIM criteria can serve as a useful tool to guide clinicians and pharmacists in identifying PIMs and PPOs during medication review and facilitating informed decision-making for appropriate prescribing.

Keywords: Medication review; Older adults; Polypharmacy; Potentially inappropriate medications; Prescribing omission.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interests.

Figures

Fig. 1
Fig. 1
Delphi process to identify independent PIM, disease-specific PIM and PPO
See this image and copyright information in PMC

References

    1. Ageing and health. World Health Organization Fact Sheet. 2022. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed 16 May 2023.
    1. Fan Z-Y, Yang Y, Zhang C-H, Yin R-Y, Tang L, Zhang F. Prevalence and patterns of comorbidity among middle-aged and elderly people in China: a cross-sectional study based on CHARLS data. Int J Gen Med. 2021;14:1449–1455. doi: 10.2147/IJGM.S309783. - DOI - PMC - PubMed
    1. Liew NY, Chong YY, Yeow SH, Kua KP, Saw PS, Lee SWH. Prevalence of potentially inappropriate medications among geriatric residents in nursing care homes in Malaysia: a cross-sectional study. Int J Clin Pharm. 2019;41:895–902. doi: 10.1007/s11096-019-00843-1. - DOI - PubMed
    1. Delara M, Murray L, Jafari B, Bahji A, Goodarzi Z, Kirkham J, et al. Prevalence and factors associated with polypharmacy: a systematic review and meta-analysis. BMC Geriatr. 2022;22:601. doi: 10.1186/s12877-022-03279-x. - DOI - PMC - PubMed
    1. Rodrigues DA, Plácido AI, Mateos-Campos R, Figueiras A, Herdeiro MT, Roque F. Effectiveness of interventions to reduce potentially inappropriate medication in older patients: a systematic review. Front Pharmacol. 2021;12:777655. doi: 10.3389/fphar.2021.777655. - DOI - PMC - PubMed