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Table 3 Table of included studies

From: Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study

Authors and year Country Setting Development of indicators Name of instrument Number of indicators Implicit only or mixed (explicit/implicit) indicators Example indicator
Basger et al., 2008 [18] Australia Primary care Literature review and expert discussions to develop indicators Australian prescribing indicators for commonly occurring conditions in patients aged > 65 years 48 Mixed Patient has no significant medication interactions (agreement between two medication interaction databases)
Basger et al., 2012 [19] Australia Primary care Literature review and expert discussions to develop indicators
RAND/UCLA Appropriateness Method to refine indicators
Validated prescribing appropriateness criteria for older Australians (≥ 65 years) for commonly used medications and medical condition 41 Mixed Patient has no clinically significant medication interactions (agreement between two medication interaction databases)
Bergman-Evans, 2006 [27] USA Not confined to one setting Literature review to develop indicators Medication Management Outcomes Monitor 18 Implicit Medications prescribed match established diagnosis
Buetow et al., 1996 [42] UK Primary care Nominal group technique to develop indicators
Indicators applied to studies located through systematic review
Dimensions and indicators of prescribing appropriateness 19 Implicit The formulation and route and method of delivery are designed to maximise compliance for an individual patient
Cantrill et al., 1998 [28] UK Primary care Nominal Group Technique to develop indicators
Delphi method to assess validity of indicators
Indicators of appropriateness of prescribing 9 Mixed If a potentially hazardous drug–drug combination is prescribed, the prescriber shows knowledge of the hazard
Caughey et al., 2014 [43] Australia Primary care Literature review and review of clinical indicators to identify existing indicators and develop new ones
Modified RAND appropriateness method to assess validity of indicators
Australian medication-related indicators of potentially preventable hospitalisations 29 Mixed Use of two or more agents with anticholinergic activity OR use of an agent with high anticholinergic activity
Drenth-van Maanen et al., 2009 [24] The Netherlands Primary care No detail on how indicators developed Prescribing Optimization Method 6 Implicit Which adverse effects are present?
Fried et al., 2016 [44] USA Not confined to one setting Literature review and expert discussions to develop indicators
Modified Delphi method to refine indicators
Strategies for addressing problems with medication regimens 10 Mixed It is reasonable to undertake dose reduction or discontinuation of medications associated with both benefits and side effects if the patient views the side effects as more important than the benefits
Gazarian et al., 2006 [45] Australia Not confined to one setting Expert working party using consensus-based approaches to develop decision algorithm Assessing appropriateness of off-label medicines use Not available – decision algorithm with accompanying explanatory notes Implicit Will this medicine be used according to a registered indication, age, dose and route?
Hamdy et al., 1995 [29] USA Care homes Literature review to develop indicators Criteria for medication profile review 5 Implicit Are any significant drug–drug or drug–disease interactions present?
Hanlon et al., 1992 [14] USA Internal medicine Literature review and expert discussions to develop indicators Medication Appropriateness Index 10 Implicit Is the dosage correct?
Hassan et al., 2010 [46] Malaysia Not confined to one setting Literature review and expert discussions to develop indicators
Modified Delphi method to assessing validity of indicators
Prescription Quality
Index
22 Implicit Is there unnecessary duplication with other drug(s)?
Johnson et al., 1995 [47] USA Pharmacy Literature review and expert discussions to develop indicators 10 Implicit Interaction: drug–drug
Lara et al., 2012 [26] Spain Not confined to one setting Literature review to identify indicators
Delphi method to refine indicators
12 Implicit Is there a lack of diagnoses or symptoms recorded in the medical history that do not have drug treatments but could have it?
Lenaerts et al., 2013 [25] Belgium Primary care No detail on how indicators developed Appropriate Medication for Older people-tool 8 Implicit Are dosage and dosage form adapted to the patient?
Newton et al., 1994 [31] USA Primary care Expert discussions to develop indicators The Geriatric Medication Evaluation Algorithm 10 Implicit Is the patient/caregiver unclear about the medication regimen?
O’Mahoney et al., 2014 [48] Europe Not confined to one setting Literature review and expert consultation to review existing indicators and propose new ones
Two-round Delphi method to refine and validate indicators
STOPP/START 114 (80 STOPP; 34 START) Mixed Any drug prescribed without an evidence-based clinical indication
Stange et al., 2010 [49] Germany Not confined to one setting Forward and backward translation of the English version of the MCRI Medication Regimen Complexity Index – German 1 Implicit Not available: three sections (Section A: dosage forms; Section B: dosage frequency; Section C: additional instructions) to compute a score indicating the complexity of a given pharmacotherapeutic regimen
Tommelein et al., 2015 [50] Belgium Primary care Literature review and two-round RAND/UCLA Appropriateness method to develop indicators Ghent Older People’s Prescriptions community Pharmacy Screening (GheOP3S) tool 83 Mixed Polypharmacy patients (chronically taking five or more drugs) were not questioned about whether a clear medication scheme was available to them
Tully et al., 2005 [30] UK Secondary care Literature review and expert discussions to develop indicators
Pre- and pilot-testing on patient records, and expert panel, to assess validity of indicators
Appropriateness of long-term prescribing commenced in hospital practice 14 Implicit Hazardous drug–drug combination
van Dijk et al., 2003 [51] The Netherlands Primary care Does not state how indicators developed Evaluation of drug use in nursing homes 6 Mixed More than one drug from same drug class
Winslade et al., 1997 [52] Canada Pharmacy Expert discussions and application in practice to revise two previous sets of indicators Pharmacist management of drug-related problems 8 Implicit The patient is taking/receiving a drug for which there is no valid indication