PDF(Pubmed)
Abstract：
Potentially inappropriate medication use is prevalent among older adults in primary care, leading to increased morbidity, adverse drug reactions, hospitalizations, and mortality. This study aimed to develop and validate a tool for identifying PIMs in older adults within the primary care setting. The tool is composed of a list of criteria and was created based on consensus among experts from three Spanish-speaking countries, including two from Latin America.
A literature review was conducted to identify existing tools, and prescription patterns were evaluated in a cohort of 36,111 older adults. An electronic Delphi method, consisting of two rounds, was used to reach a formal expert consensus. The panel included 18 experts from Spain, Colombia, and Argentina. The content validity index, validity of each content item, and Kappa Fleiss statistical measure were used to establish reliability.
Round one did not yield a consensus, but a definitive consensus was reached in round two. The resulting tool consisted of a list of 5 general recommendations per disease, along with 33 criteria related to potential problems, recommendations, and alternative therapeutic options. The overall content validity of the tool was 0.87, with a Kappa value of 0.69 (95% CI 0.64-0.73; Substantial).
The developed criteria provide a novel list that allows for a comprehensive approach to pharmacotherapy in older adults, intending to reduce inappropriate medication use, ineffective treatments, prophylactic therapies, and treatments with an unfavorable risk-benefit ratio for the given condition. Further studies are necessary to evaluate the impact of these criteria on health outcomes.
A literature review was conducted to identify existing tools, and prescription patterns were evaluated in a cohort of 36,111 older adults. An electronic Delphi method, consisting of two rounds, was used to reach a formal expert consensus. The panel included 18 experts from Spain, Colombia, and Argentina. The content validity index, validity of each content item, and Kappa Fleiss statistical measure were used to establish reliability.
Round one did not yield a consensus, but a definitive consensus was reached in round two. The resulting tool consisted of a list of 5 general recommendations per disease, along with 33 criteria related to potential problems, recommendations, and alternative therapeutic options. The overall content validity of the tool was 0.87, with a Kappa value of 0.69 (95% CI 0.64-0.73; Substantial).
The developed criteria provide a novel list that allows for a comprehensive approach to pharmacotherapy in older adults, intending to reduce inappropriate medication use, ineffective treatments, prophylactic therapies, and treatments with an unfavorable risk-benefit ratio for the given condition. Further studies are necessary to evaluate the impact of these criteria on health outcomes.
摘要：
背景：在初级保健中，老年人可能普遍存在不适当的药物使用，导致发病率增加，药物不良反应,住院治疗,和死亡率。这项研究旨在开发和验证一种在初级保健环境中识别老年人PIM的工具。该工具由一系列标准组成，是根据来自三个西班牙语国家的专家的共识创建的，包括两个来自拉丁美洲。
方法：进行了文献综述，以确定现有的工具，和处方模式在36,111名老年人队列中进行了评估。一种电子德尔菲法，由两轮组成，被用来达成正式的专家共识。该小组包括来自西班牙的18名专家，哥伦比亚,和阿根廷。内容效度指数，每个内容项的有效性，和KappaFleiss统计测量用于建立可靠性。
结果：第一轮没有达成共识，但是在第二轮中达成了明确的共识。由此产生的工具包括每个疾病的5个一般建议的列表，连同与潜在问题相关的33项标准，recommendations,和替代治疗选择。该工具的总体内容效度为0.87，Kappa值为0.69（95％CI0.64-0.73；实质）。
结论：制定的标准提供了一个新的清单，可以为老年人提供全面的药物治疗方法，打算减少不适当的药物使用，无效的治疗,预防性治疗,以及在给定条件下具有不利风险收益比的治疗。需要进一步的研究来评估这些标准对健康结果的影响。
方法：进行了文献综述，以确定现有的工具，和处方模式在36,111名老年人队列中进行了评估。一种电子德尔菲法，由两轮组成，被用来达成正式的专家共识。该小组包括来自西班牙的18名专家，哥伦比亚,和阿根廷。内容效度指数，每个内容项的有效性，和KappaFleiss统计测量用于建立可靠性。
结果：第一轮没有达成共识，但是在第二轮中达成了明确的共识。由此产生的工具包括每个疾病的5个一般建议的列表，连同与潜在问题相关的33项标准，recommendations,和替代治疗选择。该工具的总体内容效度为0.87，Kappa值为0.69（95％CI0.64-0.73；实质）。
结论：制定的标准提供了一个新的清单，可以为老年人提供全面的药物治疗方法，打算减少不适当的药物使用，无效的治疗,预防性治疗,以及在给定条件下具有不利风险收益比的治疗。需要进一步的研究来评估这些标准对健康结果的影响。
