The development of the PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) criteria

BMC Health Services Research

Carmel M Hughes³  Tom Fahey³  Mary Teeling¹  David Williams⁴  Caitriona Cahir¹  Kathleen Bennett¹  Emma Wallace³  Susan M Smith³  Cristín Ryan²  Janine A Cooper³ 

[1] Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St James’s Hospital, Dublin 8, Ireland;Clinical and Practice Research Group, School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, UK;HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin 2, Ireland;Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin 2, Ireland

关键词: Multimorbidity;    Polypharmacy;    Middle-age;    Delphi technique;    Explicit criteria;    Potentially inappropriate prescribing;   

Others  :  1118170
DOI  :  10.1186/s12913-014-0484-6

 received in 2014-04-16, accepted in 2014-10-03,  发布年份 2014

【 摘 要 】

Background

Whilst multimorbidity is more prevalent with increasing age, approximately 30% of middle-aged adults (45–64 years) are also affected. Several prescribing criteria have been developed to optimise medication use in older people (≥65 years) with little focus on potentially inappropriate prescribing (PIP) in middle-aged adults. We have developed a set of explicit prescribing criteria called PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) which may be applied to prescribing datasets to determine the prevalence of PIP in this age-group.

Methods

A literature search was conducted to identify published prescribing criteria for all age groups, with the Project Steering Group (convened for this study) adding further criteria for consideration, all of which were reviewed for relevance to middle-aged adults. These criteria underwent a two-round Delphi process, using an expert panel consisting of general practitioners, pharmacists and clinical pharmacologists from the United Kingdom and Republic of Ireland. Using web-based questionnaires, 17 panellists were asked to indicate their level of agreement with each criterion via a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree) to assess the applicability to middle-aged adults in the absence of clinical information. Criteria were accepted/rejected/revised dependent on the panel’s level of agreement using the median response/interquartile range and additional comments.

Results

Thirty-four criteria were rated in the first round of this exercise and consensus was achieved on 17 criteria which were accepted into the PROMPT criteria. Consensus was not reached on the remaining 17, and six criteria were removed following a review of the additional comments. The second round of this exercise focused on the remaining 11 criteria, some of which were revised following the first exercise. Five criteria were accepted from the second round, providing a final list of 22 criteria [gastro-intestinal system (n = 3), cardiovascular system (n = 4), respiratory system (n = 4), central nervous system (n = 6), infections (n = 1), endocrine system (n = 1), musculoskeletal system (n = 2), duplicates (n = 1)].

Conclusions

PROMPT is the first set of prescribing criteria developed for use in middle-aged adults. The utility of these criteria will be tested in future studies using prescribing datasets.

【 授权许可】

   
2014 Cooper et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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