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BMC Geriatrics
Published in: BMC Geriatrics 1/2016

Open Access 01-12-2016 | Research article

A Delphi process to address medication appropriateness for older persons with multiple chronic conditions

Authors: Terri R. Fried, Kristina Niehoff, Jennifer Tjia, Nancy Redeker, Mary K. Goldstein

Published in: BMC Geriatrics | Issue 1/2016

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Abstract

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.
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Metadata
Title
A Delphi process to address medication appropriateness for older persons with multiple chronic conditions
Authors
Terri R. Fried
Kristina Niehoff
Jennifer Tjia
Nancy Redeker
Mary K. Goldstein
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2016
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-016-0240-3

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