Table 3 Table of included studies
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 |