(106) Performance of Three Sets of Criteria for Potentially Inappropriate Prescribing as Diagnostic Tools to Identify Inadequate Drug Treatment

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 780

Presenting Author(s)

Susanna M. Wallerstedt
– University of Gothenburg, Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, G�teborg, V�stra G�talands l�n, Sweden

Co-Author(s)

Johan Lonnbro, PhD, MD
– Consultant physician, University of Gothenburg, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Staffan A. Svensson, MD, PhD
– University of Gothenburg, Dept of Pharmacology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
Fredrik Hieronymus
– PhD/MD, Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Sweden, Sweden
Johan Fastbom
– Professor/MD, Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden, Sweden
Mikael Hoffmann, MD, PhD, MPH
– PhD/MD, The NEPI Foundation – Swedish Network for Pharmacoepidemiology, Linköping University, Sweden, Linköping, Sweden
Naldy Parodi L�pez
– University of Gothenburg, Gothenburg, Sweden

Background: Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) have been suggested for inclusion in core outcome sets for evaluation of interventions for improved prescribing in older patients.

Objectives: To evaluate the performance of three sets of PIM/PPO criteria as diagnostic tools to identify inadequate drug treatment in older patients.

Methods: In this validation study, the drug treatment of 302 consecutive primary care patients was analysed (65-99 years; 59% female; treated with 0–20 (median: 6) drugs). PIMs/PPOs concordantly identified by two specialist physicians, in retrospect after a planned physician visit, using three European PIM/PPO criteria sets, were included. As gold standard, the physicians in consensus categorised the drug treatment as adequate or inadequate, the latter implying that additional action related to the medication could be medically justified prior to the next regular visit. Areas under the receiver operating characteristic (ROC) curve for PIMs/PPOs according to the three criteria sets to identify inadequate drug treatment were calculated, as well as sensitivity/specificity.

Results: According to the STOPP/START criteria, the EU(7)-PIM list, and the Swedish indicators of prescribing quality, 0–8, 0–6, and 0–12 PIMs/PPOs per patient, respectively, were identified. In all, the drug treatment of 98 (32%) patients was categorised as inadequate, most often due to a need for more medical information to enable decision making about initiation/withdrawal of a specific drug. The areas under the ROC curve for the three criteria sets were 0.60 (95% confidence interval: 0.53–0.66), 0.69 (0.63–0.75), and 0.73 (0.67–0.80), respectively. The sensitivities/specificities for ≥1 PIMs/PPOs to reflect adequacy of drug treatment were 0.79/0.33, 0.79/0.54, and 0.79/0.61, respectively. Using the number of drugs in the medication list for comparison, the area under the ROC curve was 0.71 (0.65–0.78) and the sensitivity/specificity, using the median as cut-off (≥6 drugs), 0.77/0.56.

Conclusions: The evaluated PIM/PPO sets had poor to fair performance as diagnostics to identify inadequate drug treatment, comparable with a simple count of the number of drugs in the medication list. The value of PIMs/PPOs as indicators of drug treatment quality thus seems questionable.