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

• Published in: Journal of pharmaceutical policy and practice Vol. 16; no. 1; p. 122
• Main Authors: Chang, Chee Tao, Chan, Huan Keat, Cheah, Wee Kooi, Tan, Maw Pin, Ch'ng, Alan Swee Hock, Thiam, Chiann Ni, Abu Bakar, Nor Azlina, Yau, Weng Keong, Abu Hassan, Muhammad Radzi, Rajan, Philip, Tan, Kar Choon, Ambigapathy, Subashini, Vengadasalam, Paranthaman, Zaman Huri, Surina, Arvinder-Singh, H S, Thum, Chern Choong, Chung, Wai Mun, Ooi, Jun How, Sabki, Noor Hamizah, Lee, Hooi Peng, Mohd Shariff, Siti Mallissa, Azman, Muhammad Azuan, Teoh, Siew Li, Lee, Shaun Wen Huey
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 19.10.2023; BioMed Central
• Subjects: Aged; Antacids; Antihistamines; Complications and side effects; Decision-making; Delphi method; Drug therapy; Drug use; Drugs; Emergency medical care; Feedback; Geriatrics; Gerontology; Hydrochlorothiazide; Levetiracetam; Medical personnel; Older people; Otolaryngology; Pantoprazole; Pharmacovigilance; Polypharmacy; Population; Prescription writing; Questionnaires; Systematic review; Malaysia; Medication review; Prescribing omission; Polypharmacy; Older adults; Potentially inappropriate medications
• ISSN: 2052-3211; 2052-3211
• DOI: 10.1186/s40545-023-00630-4

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