The PROMPT criteria: Development and validation of prescribing indicators in middle-aged adults

Transcription

1 The PROMPT criteria: Development and validation of prescribing indicators in middle-aged adults Dr. Janine Cooper, Professor Carmel Hughes, Dr. Cristín Ryan, Professor Susan Smith, Dr. Emma Wallace, Dr. Kathleen Bennett, Dr. Caitriona Cahir, Professor David Williams, Professor Tom Fahey

2 Background - Multimorbidity Defined as the presence of two or more long-term conditions Prevalence increases with increasing age 64.9% of people over 65 years are multimorbid [1] 30.4% of middle-aged people (45 and 64 years) are multimorbid [1]

3 Background - Polypharmacy Challenge for healthcare professionals, particularly prescribers, as polypharmacy has a range of definitions that refer to the use of multiple medication regimens, but no standard definition is used consistently Common definition the ingestion of four or more medications [2] Polypharmacy can also have a dual meaning of too many drugs or many drugs [3]

4 Screening tools Screening tools have been shown to be beneficial in highlighting the level of potentially inappropriate prescribing These tools have been aimed at older age groups e.g. Beers, PRISCUS list, STOPP/START A new screening tool for use without clinical indication is being developed for middle-aged people

5 Most commonly dispensed drugs in Northern Ireland and the Republic of Ireland in 2010 in middle-aged adults Northern Ireland Republic of Ireland (BSO data) (PCRS data) 1 st Proton pump inhibitor Statin 2 nd Statin Proton pump inhibitor 3 rd Selective serotonin reuptake inhibitor Aspirin 75mg 4 th Analgesics containing codeine Inhaled salbutamol 5 th Angiotensin-converting-enzyme inhibitor Levothyroxine 6 th Aspirin 75mg Selective serotonin reuptake inhibitor 7 th Levothyroxine Oral antidiabetics drugs 8 th Infections Beta-blocker 9 th Anxiolytics Non benzodiazepine hypnotics 10 th Nonsteroidal anti-inflammatory drugs Angiotensin-converting-enzyme inhibitor

6 The PROMPT criteria PRescribing Optimally in Middle-aged People s Treatments Aims To develop an explicit list of prescribing indicators for appropriate prescribing in middle aged adults without clinical information To validate these explicit criteria for use using a Delphi validation technique To promote appropriate prescribing in middle aged adults in the UK and the ROI

7 Methods - Development of criteria The PROMPT Steering Group are responsible for overseeing the development and validation of the PROMPT criteria The PROMPT Steering Group Dr. Janine Cooper Professor Carmel Hughes Dr. Cristín Ryan Professor Susan Smith Dr. Emma Wallace Dr. Kathleen Bennett Dr. Caitriona Cahir Professor David Williams Professor Tom Fahey 1. Compiling a comprehensive list of prescribing indicators Explicit criteria for older people published to date e.g. Beers, PRISCUS list, STOPP/START Literature search Indicators informed by relevance to clinical practice

8 Methods - Development of criteria 2. Inviting participants for a Delphi panel Consensus opinion on a complex topic through resolving disagreements in a group of expert individuals Two-round process Anonymous questionnaire via a web-link

9 Methods Data collection Statement and Rationale Additional comments Level of agreement

10 Results - Round 1 Example Esomeprazole or omeprazole should not be used in combination with clopidogrel Rationale: Esomeprazole and omeprazole reduce the anti-platelet effect of clopidogrel, therefore concomitant use should be avoided

11 Results Level of agreement Median response and interquartile range for each criterion Overall group opinion reported as a statistical measure Level of agreement and additional comments considered by the Steering Group

12 On-going work In criteria where a consensus is reached, these will be accepted or rejected If a consensus is not reached, these criteria will be rated again as part of round 2 (October 2013) If no consensus is reached after second round, the criteria will be rejected The final PROMPT criteria will be applied to data without clinical information to determine the prevalence of potentially inappropriate prescribing

13 QUESTIONS The PROMPT team Dr. Janine Cooper, Professor Carmel Hughes, Dr. Cristín Ryan, Professor Susan Smith, Dr. Emma Wallace, Dr. Kathleen Bennett, Dr. Caitriona Cahir, Professor David Williams, Professor Tom Fahey References [1] Barnett K et al., (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a crosssectional study. Lancet 380(9836):37-43 [2 ] Rollason V, Vogt N. Reduction of polypharmacy in the elderly. A systematic review of the role of the pharmacist. Drugs and Aging 2003;20(11): [3] Aronson JK. In defense of polypharmacy. Br J Clin Pharmacol 2004; 57: