Study questions criteria for assessing drug treatment quality among older people
Researchers at the University of Gothenburg show that criteria used to assess drug treatment quality among older people do not provide clinically relevant results. In the study, the researchers urge caution when interpreting results based on such criteria.
This research concerns criteria for identifying PIMs (potentially inappropriate medications) and PPOs (potential prescribing omissions). Such criteria have been developed both to measure the quality of older people’s medications and to support physicians treating older patients. They include the National Board of Health and Welfare’s indicators for appropriate drug treatment among older people. The criteria are based on expert panel opinions and have come to be used primarily to assess the quality of drug treatment, both in research and in benchmarking of healthcare provided. Parts of the Swedish National Board of Health and Welfare’s criteria have previously also been used in allocating resources to healthcare centers.
Reviewed medical records
In a recent study, researchers at Sahlgrenska Academy at the University of Gothenburg show that the clinical relevance of the criteria can be questioned. For the study, two specialists in family medicine reviewed the medical records of 302 older patients at two healthcare centers in Region Västra Götaland and assessed their drug treatment.
“First, we identified those who had ‘potentially inappropriate medications’ (PIMs) and ‘potential prescribing omissions’ (PPOs) using three criteria lists designed to reflect the quality of the treatment, including that of the National Board of Health and Welfare. Then we assessed whether these PIMs and PPOs were clinically relevant to the individual patient from a medical perspective,” says Naldy Parodi López, a doctoral student at Sahlgrenska Academy and one of the general practitioners who conducted the assessments in the study.
Rarely clinically relevant
The study shows that only one in seven PIMs/PPOs identified with the criteria was clinically relevant for the specific patient. And for every second of these, no action before the next regular visit was medically prioritized.
“Since few of the ‘potentially inappropriate’ or ‘omitted’ medicines identified with the criteria were actually judged to be clinically relevant, and even fewer merited action, they do not really reflect the quality of older people’s drug treatment,” says Parodi López. “This is interesting because these lists are used to measure such quality in Sweden and many other countries.”
From an educational perspective, however, it is instructive to use the criteria, so Parodi López believes that they could be valuable as learning tools.
Title: Clinical relevance of potentially inappropriate medications and potential prescribing omissions according to explicit criteria-a validation study; https://doi.org/10.1007/s00228-022-03337-8
BY: ELIN LINDSTRÖM