UMMS Affiliation

Department of Quantitative Health Sciences

Date

3-15-2016

Document Type

Article

Disciplines

Clinical Epidemiology | Epidemiology | Geriatrics | Health Services Administration | Pharmacy and Pharmaceutical Sciences

Abstract

BACKGROUND: Frameworks exist to evaluate the appropriateness of medication regimens for older patients with multiple medical conditions (MCCs). Less is known about how to translate the concepts of the frameworks into specific strategies to identify and remediate inappropriate regimens.

METHODS: Modified Delphi method involving iterative rounds of input from panel members. Panelists (n = 9) represented the disciplines of nursing, medicine and pharmacy. Included among the physicians were two geriatricians, one general internist, one family practitioner, one cardiologist and two nephrologists. They participated in 3 rounds of web-based anonymous surveys.

RESULTS: The panel reached consensus on a set of markers to identify problems with medication regimens, including patient/caregiver report of non-adherence, medication complexity, cognitive impairment, medications identified by expert opinion as inappropriate for older persons, excessively tight blood sugar and blood pressure control among persons with diabetes mellitus, patient/caregiver report of adverse medication effects or medications not achieving desired outcomes, and total number of medications. The panel also reached consensus on approaches to address these problems, including endorsement of strategies to discontinue medications with known benefit if necessary because of problems with feasibility or lack of alignment with patient goals.

CONCLUSIONS: The results of the Delphi process provide the basis for an algorithm to improve medication regimens among older persons with MCCs. The algorithm will require assessment not only of medications and diagnoses but also cognition and social support, and it will support discontinuation of medications both when risks outweigh benefits and when regimens are not feasible or do not align with goals.

Rights and Permissions

Citation: BMC Geriatr. 2016 Mar 15;16:67. doi: 10.1186/s12877-016-0240-3. Link to article on publisher's site

DOI of Published Version

10.1186/s12877-016-0240-3

Related Resources

Link to Article in PubMed

Keywords

Chronic conditions, Medications, Polypharmacy

Journal Title

BMC geriatrics

PubMed ID

26979576

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

 
 

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