A Delphi process to address medication appropriateness for older persons with multiple chronic conditions
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2016-03-15Keywords
Chronic conditionsMedications
Polypharmacy
Clinical Epidemiology
Epidemiology
Geriatrics
Health Services Administration
Pharmacy and Pharmaceutical Sciences
Metadata
Show full item recordAbstract
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.Source
BMC Geriatr. 2016 Mar 15;16:67. doi: 10.1186/s12877-016-0240-3. Link to article on publisher's siteDOI
10.1186/s12877-016-0240-3Permanent Link to this Item
http://hdl.handle.net/20.500.14038/40078PubMed ID
26979576Related Resources
Link to Article in PubMedDistribution License
http://creativecommons.org/licenses/by/4.0/ae974a485f413a2113503eed53cd6c53
10.1186/s12877-016-0240-3
Scopus Count
Collections
Except where otherwise noted, this item's license is described as http://creativecommons.org/licenses/by/4.0/