UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
2016-03-15
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.
Keywords
Chronic conditions, Medications, Polypharmacy
DOI of Published Version
10.1186/s12877-016-0240-3
Source
BMC Geriatr. 2016 Mar 15;16:67. doi: 10.1186/s12877-016-0240-3. Link to article on publisher's site
Journal/Book/Conference Title
BMC geriatrics
Related Resources
PubMed ID
26979576
Repository Citation
Fried, Terri R.; Niehoff, Kristina; Tjia, Jennifer; Redeker, Nancy; and Goldstein, Mary K., "A Delphi process to address medication appropriateness for older persons with multiple chronic conditions" (2016). Open Access Articles. 2882.
https://escholarship.umassmed.edu/oapubs/2882
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Included in
Clinical Epidemiology Commons, Epidemiology Commons, Geriatrics Commons, Health Services Administration Commons, Pharmacy and Pharmaceutical Sciences Commons