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Development and Application of the GheOP3S-Tool Addendum on Potentially Inappropriate Prescribing (PIP) of Renally Excreted Active Drugs (READs) in Older Adults with Polypharmacy

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Abstract

Background

Renal function progressively worsens with age. Potentially inappropriate prescribing (PIP) of renally excreted active drugs (READs) is common in older adults, leading to an increased rate of iatrogenic illness. The Ghent Older People’s Prescription community Pharmacy Screening (GheOP3S-) tool is an effective, explicit instrument that was developed for community pharmacists (CPs) to detect PIP. So far, this tool does not assess PIP of the frequently used READs in older patients with renal impairment.

Objectives

This study aimed to expand the GheOP3S-tool with the first addendum to screen for PIP of frequently used READs, and to perform a cross-sectional analysis using the addendum and the medication history of a group of older adults with polypharmacy.

Methods

The addendum was developed in three steps: (1) collection of individual and combined READs, (2) collection of dose-adjustment recommendations, and (3) expert panel evaluation. Consequently, the addendum was applied retrospectively on the medication list of 60 older adults with polypharmacy and with four renal function-estimating equations.

Results

The addendum includes 61 READs recommendations for dose/drug-adjustment alternatives, laboratory test follow-ups, and patients’ referral to specialists’ care. In the cross-sectional analysis, 35–78% of patients were diagnosed with renal impairment, depending on the equations used for renal function estimation. Among patients with renal impairment, 21–46% of the prescribed READs were deemed potentially inappropriate by the GheOP3S-tool addendum.

Conclusion

The GheOP3S-tool was expanded with an addendum on PIP of READs in renal impairment for older patients. The cross-sectional analysis using the addendum suggests that PIP of READs is common in older patients with polypharmacy and renal impairment. Using this addendum, CPs might contribute to diminishing PIP of READs.

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Authors and Affiliations

  1. Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Gent, Belgium

    Abdul Aziz Al Wazzan, Eline Tommelein, Katrien Foubert, Annemie Somers & Koen Boussery

  2. Department of Internal medicine (Geriatrics), Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Gent, Belgium

    Mirko Petrovic

  3. Department of Pharmacy, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium

    Annemie Somers

  4. Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy

    Abdul Aziz Al Wazzan & Stefano Bonassi

  5. Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy

    Stefano Bonassi

  6. Department of Geriatrics, Centro Medicina dell’Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy

    Abdul Aziz Al Wazzan & Graziano Onder

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  1. Abdul Aziz Al Wazzan
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Correspondence to Abdul Aziz Al Wazzan.

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No sources of funding were used to assist in the conduct of this study or the preparation of this article.

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Abdul Aziz Al Wazzan, Eline Tommelein, Katrien Foubert, Stefano Bonassi, Graziano Onder, Annemie Somers, Mirko Petrovic and Koen Boussery declare that they have no conflicts of interest relevant to the content of this review.

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Wazzan, A.A.A., Tommelein, E., Foubert, K. et al. Development and Application of the GheOP3S-Tool Addendum on Potentially Inappropriate Prescribing (PIP) of Renally Excreted Active Drugs (READs) in Older Adults with Polypharmacy. Drugs Aging 35, 343–364 (2018). https://doi.org/10.1007/s40266-018-0530-x

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