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Ben Schottker - One of the best experts on this subject based on the ideXlab platform.
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systematic review and meta analysis on the associations of polypharmacy and Potentially Inappropriate Medication with adverse outcomes in older cancer patients
Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2020Co-Authors: Liju Chen, Kira Trares, Dana Clarissa Laetsch, Thi Ngoc Mai Nguyen, Hermann Brenner, Ben SchottkerAbstract:BACKGROUND Both polypharmacy and Potentially Inappropriate Medication (PIM) intake are highly prevailing in older cancer patients. However, only studies on the association of polypharmacy and post-operative complications have been meta-analyzed previously. METHODS A systematic review and a meta-analysis of prospective/retrospective observational studies reporting associations of polypharmacy or PIM with at least 1 out of 5 pre-defined adverse health outcomes in a population of older cancer patients (≥ 60 years) were carried out. PubMed and Web of Science were used to search for relevant studies published between January 1991 and March 2020. Data were pooled by adopting a random-effects model. RESULTS Overall, 42 publications were included in the systematic review. Meta-analyses could be performed on 39 studies about polypharmacy and 13 studies about PIM. Polypharmacy was found to be statistically significantly associated with all-cause mortality (risk ratio [95% confidence interval]: 1.37 [1.25-1.50]), hospitalization (1.53 [1.37-1.71]), treatment-related toxicity (1.22 [1.01-1.47]), and postoperative complications (1.73 [1.36-2.20]). The association of polypharmacy with prolongation of hospitalization was not statistically significant at the p<0.05 significance level (1.62 [0.98-2.66]). With respect to PIM, a statistically significant association with all-cause mortality (1.43 [1.08-1.88]) was observed but not with other adverse outcomes. CONCLUSION Polypharmacy was found to be associated with several adverse outcomes and PIM use with all-cause mortality in older cancer patients. However, these results should be interpreted with caution because about three-quarters of the studies identified did not adjust for comorbidity and are prone to confounding by indication.
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the association of Potentially Inappropriate Medication at older age with cardiovascular events and overall mortality a systematic review and meta analysis of cohort studies
Journal of the American Medical Directors Association, 2017Co-Authors: Hermann Brenner, Ben Schottker, Dana Clarissa Muhlack, Liesa Katharina Hoppe, Janick WeberpalsAbstract:Abstract Objective The aim of this systematic review was to identify, evaluate, and meta-analyze cohort studies reporting the association of Potentially Inappropriate Medication (PIM) intake with mortality and cardiovascular events. Design A systematic review and meta-analysis of prospective and retrospective cohort studies were conducted. Study appraisal included a thorough risk of bias assessment. Data synthesis followed a random-effects model. Data sources The included studies were retrieved from the databases MEDLINE and ISI Web of Knowledge. Additionally, the authors checked the references of the included studies for further relevant literature. Eligibility criteria for selecting studies For inclusion in a study, the population needed to be older than 60 years of age and not restricted to having one specific disease. The outcome had to address all-cause mortality or cardiovascular events. Studies that examined polypharmacy or specific drugs were excluded. Results At first, 13 studies were included in a meta-analysis. The association of PIM with overall mortality was not statistically significant (risk ratio; 95% confidence interval, 1.13; 0.95–1.35). However, the majority of studies showed a high risk of specific forms of bias. These biases can be excluded by applying a new user design. It ascertains that adverse events occurring early in therapy are recorded. After restricting the meta-analysis to three studies with a new user design, the association of PIM use and mortality was statistically significant (risk ratio; 95% confidence interval, 1.59; 1.45–1.75). Only one study focused on cardiovascular events and found no statistically significant association. However, the study was not conducted with a new user design. Conclusion In studies with adequate methods (new user design), PIM use, defined by Beers criteria or the HEDIS-DAE list, was associated with a 1.6-fold increased mortality in older adults. Physicians should therefore avoid prescribing PIM for older adults whenever feasible. Further new user design studies are required for cardiovascular outcomes and to compare the predictive value of different PIM criteria for mortality.
Vittorio Maio - One of the best experts on this subject based on the ideXlab platform.
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hospitalization rates during Potentially Inappropriate Medication use in a large population based cohort of older adults
British Journal of Clinical Pharmacology, 2017Co-Authors: Stefan Varga, Matthew Alcusky, Scott W Keith, Sarah E Hegarty, Stefano Del Canale, M Lombardi, Vittorio MaioAbstract:Background and aims The temporal relationship between Potentially Inappropriate Medication (PIM) use and hospitalization remains uncertain. We examined whether current PIM use increases the rate of hospitalization and estimated the rate of hospitalization during exposure to individual PIMs. Methods A retrospective population-based cohort study of 1 480 137 older adults was conducted using the 2003–2013 Italian Emilia-Romagna Regional administrative healthcare database (~4.5 million residents), which includes demographic, hospital and outpatient prescription information. Each day of follow-up was defined as exposed/unexposed to PIMs that ‘should always be avoided’, according to the Maio criteria, an Italian modified version of the Beers criteria. The study outcome was all-cause hospitalizations. Crude PIM-related hospitalization rates were calculated for individual PIMs. Repeated-events Cox proportional hazards models with time-dependent covariates estimated adjusted hazard ratios for hospitalization during PIM exposure, as defined by three versions of the Maio criteria (v2007, v2011, v2014). Results During >10 million person-years of follow-up, 54.2% of individuals used ≥1 PIM and 10.9% of all person-time was exposed to v2014 PIMs. Among 1 604 901 hospitalizations, 15.6% occurred during v2014 PIM exposure. Crude hospitalization rates during v2014 PIM-exposed and unexposed person-time were 228.1 and 152.1 per 1000 person-years, respectively. The PIM with the highest rate of hospitalization was ketorolac, while nonsteroidal anti-inflammatory drugs had the most exposure time. The hazard of hospitalization was 16% greater (hazard ratio = 1.16; 95% confidence interval 1.14, 1.18) among patients exposed to v2014 PIMs. The v2007 and v2011 estimates were similar. Conclusions In this large population-based cohort of older adults, we found a 16% increased hospitalization risk associated with PIM exposure.
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Potentially Inappropriate Medication prescribing for elderly outpatients in emilia romagna italy a population based cohort study
Drugs & Aging, 2006Co-Authors: Vittorio Maio, Elaine J Yuen, Karen D Novielli, Kenneth D Smith, Daniel Z LouisAbstract:Background In the US, a growing body of epidemiological studies has documented widespread Potentially Inappropriate Medication prescribing among the elderly in outpatient settings. However, only limited information exists in Europe.
Hanshelmut Konig - One of the best experts on this subject based on the ideXlab platform.
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the impact of Potentially Inappropriate Medication on the development of health care costs and its moderation by the number of prescribed substances results of a retrospective matched cohort study
PLOS ONE, 2018Co-Authors: Dirk Heider, Herbert Matschinger, Andreas D Meid, Renate Quinzler, Jurgenbernhard Adler, Christian Gunster, Walter E Haefeli, Hanshelmut KonigAbstract:Background In the growing population of the elderly, drug-related problems are considered an important health care safety issue. One aspect of this is the prescription of Potentially Inappropriate Medication (PIM) which is considered to increase health care costs. Objective Using data from the Health Economics of Potentially Inappropriate Medication (HEPIME) study, we aimed to analyze how the number of prescribed substances moderates the association of PIM use as defined by the German PRISCUS list and health care costs applying a longitudinal perspective. Methods An initial number of 6,849,622 insurants aged 65+ of a large German health insurance company were included in a retrospective matched cohort study. Based on longitudinal claims data from the four separate quarters of a 12-month pre-period, 3,860,842 individuals with no exposure to PIM in 2011 were matched to 508,212 exposed individuals. Exposure effects of PIM use on health care costs and the number of prescribed substances were measured based on longitudinal claims data from the four separate quarters of the 12-month post-period. Results After successful balancing for the development of numerous matching variables during the four quarters of the pre-period, exposed individuals consumed 2.1 additional prescribed substances and had higher total health care costs of 1,237 € when compared to non-exposed individuals in the 1st quarter of the post-period. Controlling for the number of prescribed substances, the difference in total health care costs between both study groups was 401 €. The average effect of one additionally prescribed substance (other than PIM) on total health care costs was increased by an amount of 137 € for those being exposed to a PIM. In quarters 2-4 of the post-period, the differences between both study groups tended to decrease sequentially. Conclusions PIM use has an increasing effect on the development of health care costs. This cost-increasing effect of PIM use is moderated by the number of prescribed substances.
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Health Service Use, Costs, and Adverse Events Associated with Potentially Inappropriate Medication in Old Age in Germany: Retrospective Matched Cohort Study
Drugs & Aging, 2017Co-Authors: Dirk Heider, Herbert Matschinger, Andreas D Meid, Renate Quinzler, Jurgenbernhard Adler, Christian Gunster, Walter E Haefeli, Hanshelmut KonigAbstract:Background Drug-related problems are an important healthcare safety concern in the growing population of older people. Prescription of Potentially Inappropriate Medication (PIM) is one aspect of this concern that is considered to increase the risk of adverse health outcomes. Objective The aim of the Health Economics of Potentially Inappropriate Medication (HEPIME) study was to analyze the association between the prescription of PIMs according to the German PRISCUS list and healthcare utilization, healthcare costs, and the occurrence of adverse events in old age. Methods Insurants of a large German health insurance company aged 65+ years were included in a retrospective matched cohort study. A total of 3,953,423 individuals with no exposure to PIM in 2011 were matched to 521,644 exposed individuals and compared in terms of outpatient healthcare utilization, healthcare costs, and the occurrence of adverse events in outpatient, hospital, and rehabilitation sectors during a 12-month follow-up. Results On average, individuals in the exposed group had additional 143 [95% confidence interval (CI) 140–146] daily defined doses of pharmaceuticals and 4.5 (95% CI 4.4–4.6) days in hospital. Mean annual total healthcare costs per individual in the exposed group exceeded those in the non-exposed group by €2321 (95% CI 2269–2372), resulting mainly from differences in hospitalization costs of €1718 (95% CI 1678–1759). Odds ratios for the occurrence of adverse events in the exposed group were 1.32 (95% CI 1.32–1.34) in the outpatient sector, 1.76 (95% CI 1.73–1.79) in the hospital sector, and 1.82 (95% CI 1.76–1.89) in the rehabilitation sector. Conclusions Increased healthcare utilization and costs as well as an increased probability for adverse events in individuals exposed to PIM demonstrate the health economic relevance of PIM prescriptions. Whether avoiding PIM listed on the PRISCUS list may Potentially improve the quality and efficiency of healthcare is currently unknown.
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health service use costs and adverse events associated with Potentially Inappropriate Medication in old age in germany retrospective matched cohort study
Drugs & Aging, 2017Co-Authors: Dirk Heider, Herbert Matschinger, Andreas D Meid, Renate Quinzler, Jurgenbernhard Adler, Christian Gunster, Walter E Haefeli, Hanshelmut KonigAbstract:Background Drug-related problems are an important healthcare safety concern in the growing population of older people. Prescription of Potentially Inappropriate Medication (PIM) is one aspect of this concern that is considered to increase the risk of adverse health outcomes.
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Potentially Inappropriate Medication in elderly primary care patients a retrospective longitudinal analysis
Bundesgesundheitsblatt-gesundheitsforschung-gesundheitsschutz, 2013Co-Authors: T Zimmermann, Hanshelmut Konig, Hanna Kaduszkiewicz, Van Den Bussche H, Gerhard Schon, Christian Brettschneider, B Wiese, Horst Bickel, Edelgard Mosch, Melanie LuppaAbstract:BACKGROUND: Elderly people are often burdened by several diseases. This accounts for a higher Medication intake and increases the risk of adverse drug events. To minimize this risk, several lists (Beers, PRISCUS) have been published of drugs that elderly patients should not take. We present a longitudinal analysis of the use of Potentially Inappropriate Medication (PIM) over a period 4.5 years in a cohort of patients aged 75 years or more. METHODS: Data were collected from the prospective, multicenter, observational study "German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe)," initially enrolling 3,327 patients. We investigated the prevalence of PIM by checking Medications during visits to patients' homes. Furthermore, we analyzed the use of individual PIM agents over time. RESULTS: At baseline, we found a PIM prevalence of 29 % according to the PRISCUS list, which decreased to 25.0 % 4.5 years later (χ(2): 7.87, p = 0.004). The Beers list yielded a prevalence of 21 % at baseline, decreasing after 4.5 years to 17.1 % (χ(2): 10.77, p = 0.000). A time-dependent multilevel model confirmed these results. Older age, depression, and the use of numerous prescribed agents are independent risk factors for using a PRISCUS-PIM. CONCLUSION: Our results seem to support a trend toward a more rational drug therapy because fewer patients were prescribed PIM. Thus, for the individual patient, the risk of adverse effects and side effects is reduced as are the costs of these effects.
Kathrin Heser - One of the best experts on this subject based on the ideXlab platform.
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perspective of elderly patients on chronic use of Potentially Inappropriate Medication results of the qualitative cim triad study
PLOS ONE, 2018Co-Authors: Kathrin Heser, Nadine Janis Pohontsch, Antje Löffler, Tobias Luck, Debora Parker, Britta Haenisch, Martin Scherer, Steffi G Riedelheller, Wolfgang Maier, Frank JessenAbstract:: Although Potentially Inappropriate Medication (PIM) is associated with risk of harm due to adverse effects, it is frequently prescribed for elderly patients. The aim of this qualitative multi-center study was to gain insight into contextual factors that might lead to chronic PIM use. We conducted semi-structured interviews with elderly patients with or without chronic PIM use (patient interviews: n = 52). Patients were between 86 and 96 years old. The participants were recruited from the AgeCoDe study. Interviews were audiotaped and transcribed verbatim. The transcripts of the interviews were analysed using qualitative content analysis. Deductive and inductive categories were determined. We found contextual factors related to the patient and related to patient-general practitioner (GP) communication that might lead to chronic PIM use (i.e., positive features of PIM, maintaining characteristics of Medication intake, barriers to deprescribe PIM, external actors supporting PIM intake, system-related factors). Besides certain health-related behaviours (e.g., own obligation to report to GP) and Medication-related attitudes and knowledge (e.g., awareness of side effects and interaction of medicines), patient-GP-interactions that were characterised by mutual agreements on drugs (e.g., concerning dosage or discontinuation of a drug) might be advantageous to reduce the probability of chronic PIM use. The results might assist in the development of guidelines and educational programs aiming to reduce PIM use in the elderly.
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Informal caregivers' perspectives on health of and (Potentially Inappropriate) Medication for (relatively) independent oldest-old people - a qualitative interview study.
BMC Geriatrics, 2018Co-Authors: Nadine Janis Pohontsch, Antje Löffler, Tobias Luck, Kathrin Heser, Debora Parker, Britta Haenisch, Steffi G. Riedel-heller, Frank Jessen, Martin SchererAbstract:Oldest-old persons frequently receive Potentially Inappropriate Medication. Medication use takes place under the patients’ informal caregivers’ influence. We explored informal caregivers’ perspectives on Medication of (relatively) independent oldest-old persons to identify starting points for safer Medication prescription/handling. In this exploratory qualitative interview study we interviewed 45 informal caregivers of 45 oldest-old persons (23 with Potentially Inappropriate Medication/22 without Potentially Inappropriate Medication). Interviews were recorded, transcribed and content analyzed (deductive/inductive coding). Interviewees had little knowledge about/influence on oldest-old persons’ Medication, but declared to monitor oldest-old persons’ needs for assistance. They were unaware of the concept of Potentially Inappropriate Medication but sometimes sensitive to substance dependency. Most informal caregivers were satisfied with the oldest-old persons’ Medication and viewed Medication as increasing the patients’ quality of life. Inadequate communication was found between informal caregivers and general practitioners. Influence of informal caregivers on (relatively) independent oldest-old persons’ Medication seems low. Stakeholders need to be aware that there is a transitional period where independency of oldest-old persons decreases and support needs increase which may be missed by (in-)formal caregivers or concealed by oldest-old persons. Monitoring patients’ Medication competencies; measures supporting communication between informal caregivers and health care professionals; provision of educational and support resources for informal caregivers and the acceptance of oldest-old persons’ increasing assistance needs may increase Medication safety.
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Potentially Inappropriate Medication association between the use of antidepressant drugs and the subsequent risk for dementia
Journal of Affective Disorders, 2018Co-Authors: Kathrin Heser, Tobias Luck, Hanna Kaduszkiewicz, Horst Bickel, Edelgard Mosch, Susanne Rohr, Birgitt Wiese, Siegfried Weyerer, Jochen Werle, Christian BrettschneiderAbstract:Abstract Background Potentially Inappropriate Medication (PIM) is associated with an increased risk for detrimental health outcomes in elderly patients. Some antidepressant drugs are considered as PIM, but previous research on the association between antidepressants and subsequent dementia has been inconclusive. Therefore, we investigated whether the intake of antidepressants, particularly of those considered as PIM according to the Priscus list, would predict incident dementia. Methods We used data of a prospective cohort study of non-demented primary care patients (n = 3239, mean age = 79.62) to compute Cox proportional hazards models. The risk for subsequent dementia was estimated over eight follow-ups up to 12 years depending on antidepressant intake and covariates. Results The intake of antidepressants was associated with an increased risk for subsequent dementia (HR = 1.53, 95% CI: 1.16–2.02, p = .003; age-, sex-, education-adjusted). PIM antidepressants (HR = 1.49, 95% CI: 1.06–2.10, p = .021), but not other antidepressants (HR = 1.04, 95% CI: 0.66–1.66, p = .863), were associated with an increased risk for subsequent dementia (in age-, sex-, education-, and depressive symptoms adjusted models). Significant associations disappeared after global cognition at baseline was controlled for. Limitations Methodological limitations such as selection biases and self-reported drug assessments might have influenced the results. Conclusions Only antidepressants considered as PIM were associated with an increased subsequent dementia risk. Anticholinergic effects might explain this relationship. The association disappeared after the statistical control for global cognition at baseline. Nonetheless, physicians should avoid the prescription of PIM antidepressants in elderly patients whenever possible.
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general practitioners views on long term prescription and use of problematic and Potentially Inappropriate Medication for oldest old patients a qualitative interview study with gps cim triad study
BMC Family Practice, 2017Co-Authors: Nadine Janis Pohontsch, Antje Löffler, Tobias Luck, Kathrin Heser, Debora Parker, Britta Haenisch, Frank Jessen, Steffi G Riedelheller, Wolfgang Maier, Martin SchererAbstract:Abstract Background Potentially Inappropriate Medication (PIM) is defined as Medication with uncertain therapeutic effects and/or potential adverse drug reactions outweighing the clinical benefits. The prescription rate of PIM for oldest-old patients is high despite the existence of lists of PIM (e.g. the PRISCUS list) and efforts to raise awareness. This study aims at identifying general practitioners’ views on PIM and aspects affecting the (long-term) use of PIM. Methods As part of the CIM-TRIAD study, we conducted semi-structured, qualitative interviews with 47 general practitioners, discussing 25 patients with and 22 without PIM (according to the PRISCUS list). The interview guideline included generic and patient-specific questions. Interviews were digitally recorded and transcribed verbatim. We content analyzed the interviews using deductive and inductive category development. Results The majority of the general practitioners were not aware of the PRISCUS list. Agents deemed Potentially Inappropriate from the general practitioners’ point of view and the PRISCUS list are not completely superimposable. General practitioners named their criteria to identify appropriate Medication for elderly patients (e.g. renal function, cognitive state) and emphasized the importance of monitoring. We identified prescription- (e.g. benzodiazepines on alternative private prescription), Medication- (e.g. subjective perception that PIM has no alternative), general practitioner- (e.g. general practitioner relies on specialists), patient- (e.g. “demanding high-user”, positive subjective benefit-risk-ratio) and system-related aspects (e.g. specialists lacking holistic view, interface problems) related to the (long term) use of PIM. Conclusions While the PRISCUS list does not seem to play a decisive role in general practice, general practitioners are well aware of risks associated with PIM. Our study identifies some starting points for a safer handling of PIM, e.g. stronger dissemination of the PRISCUS list, better compensation of Medication reviews, “positive lists”, adequate patient information, multifaceted interventions and improved communication between general practitioners and specialists.
Frank Jessen - One of the best experts on this subject based on the ideXlab platform.
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perspective of elderly patients on chronic use of Potentially Inappropriate Medication results of the qualitative cim triad study
PLOS ONE, 2018Co-Authors: Kathrin Heser, Nadine Janis Pohontsch, Antje Löffler, Tobias Luck, Debora Parker, Britta Haenisch, Martin Scherer, Steffi G Riedelheller, Wolfgang Maier, Frank JessenAbstract:: Although Potentially Inappropriate Medication (PIM) is associated with risk of harm due to adverse effects, it is frequently prescribed for elderly patients. The aim of this qualitative multi-center study was to gain insight into contextual factors that might lead to chronic PIM use. We conducted semi-structured interviews with elderly patients with or without chronic PIM use (patient interviews: n = 52). Patients were between 86 and 96 years old. The participants were recruited from the AgeCoDe study. Interviews were audiotaped and transcribed verbatim. The transcripts of the interviews were analysed using qualitative content analysis. Deductive and inductive categories were determined. We found contextual factors related to the patient and related to patient-general practitioner (GP) communication that might lead to chronic PIM use (i.e., positive features of PIM, maintaining characteristics of Medication intake, barriers to deprescribe PIM, external actors supporting PIM intake, system-related factors). Besides certain health-related behaviours (e.g., own obligation to report to GP) and Medication-related attitudes and knowledge (e.g., awareness of side effects and interaction of medicines), patient-GP-interactions that were characterised by mutual agreements on drugs (e.g., concerning dosage or discontinuation of a drug) might be advantageous to reduce the probability of chronic PIM use. The results might assist in the development of guidelines and educational programs aiming to reduce PIM use in the elderly.
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Informal caregivers' perspectives on health of and (Potentially Inappropriate) Medication for (relatively) independent oldest-old people - a qualitative interview study.
BMC Geriatrics, 2018Co-Authors: Nadine Janis Pohontsch, Antje Löffler, Tobias Luck, Kathrin Heser, Debora Parker, Britta Haenisch, Steffi G. Riedel-heller, Frank Jessen, Martin SchererAbstract:Oldest-old persons frequently receive Potentially Inappropriate Medication. Medication use takes place under the patients’ informal caregivers’ influence. We explored informal caregivers’ perspectives on Medication of (relatively) independent oldest-old persons to identify starting points for safer Medication prescription/handling. In this exploratory qualitative interview study we interviewed 45 informal caregivers of 45 oldest-old persons (23 with Potentially Inappropriate Medication/22 without Potentially Inappropriate Medication). Interviews were recorded, transcribed and content analyzed (deductive/inductive coding). Interviewees had little knowledge about/influence on oldest-old persons’ Medication, but declared to monitor oldest-old persons’ needs for assistance. They were unaware of the concept of Potentially Inappropriate Medication but sometimes sensitive to substance dependency. Most informal caregivers were satisfied with the oldest-old persons’ Medication and viewed Medication as increasing the patients’ quality of life. Inadequate communication was found between informal caregivers and general practitioners. Influence of informal caregivers on (relatively) independent oldest-old persons’ Medication seems low. Stakeholders need to be aware that there is a transitional period where independency of oldest-old persons decreases and support needs increase which may be missed by (in-)formal caregivers or concealed by oldest-old persons. Monitoring patients’ Medication competencies; measures supporting communication between informal caregivers and health care professionals; provision of educational and support resources for informal caregivers and the acceptance of oldest-old persons’ increasing assistance needs may increase Medication safety.
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general practitioners views on long term prescription and use of problematic and Potentially Inappropriate Medication for oldest old patients a qualitative interview study with gps cim triad study
BMC Family Practice, 2017Co-Authors: Nadine Janis Pohontsch, Antje Löffler, Tobias Luck, Kathrin Heser, Debora Parker, Britta Haenisch, Frank Jessen, Steffi G Riedelheller, Wolfgang Maier, Martin SchererAbstract:Abstract Background Potentially Inappropriate Medication (PIM) is defined as Medication with uncertain therapeutic effects and/or potential adverse drug reactions outweighing the clinical benefits. The prescription rate of PIM for oldest-old patients is high despite the existence of lists of PIM (e.g. the PRISCUS list) and efforts to raise awareness. This study aims at identifying general practitioners’ views on PIM and aspects affecting the (long-term) use of PIM. Methods As part of the CIM-TRIAD study, we conducted semi-structured, qualitative interviews with 47 general practitioners, discussing 25 patients with and 22 without PIM (according to the PRISCUS list). The interview guideline included generic and patient-specific questions. Interviews were digitally recorded and transcribed verbatim. We content analyzed the interviews using deductive and inductive category development. Results The majority of the general practitioners were not aware of the PRISCUS list. Agents deemed Potentially Inappropriate from the general practitioners’ point of view and the PRISCUS list are not completely superimposable. General practitioners named their criteria to identify appropriate Medication for elderly patients (e.g. renal function, cognitive state) and emphasized the importance of monitoring. We identified prescription- (e.g. benzodiazepines on alternative private prescription), Medication- (e.g. subjective perception that PIM has no alternative), general practitioner- (e.g. general practitioner relies on specialists), patient- (e.g. “demanding high-user”, positive subjective benefit-risk-ratio) and system-related aspects (e.g. specialists lacking holistic view, interface problems) related to the (long term) use of PIM. Conclusions While the PRISCUS list does not seem to play a decisive role in general practice, general practitioners are well aware of risks associated with PIM. Our study identifies some starting points for a safer handling of PIM, e.g. stronger dissemination of the PRISCUS list, better compensation of Medication reviews, “positive lists”, adequate patient information, multifaceted interventions and improved communication between general practitioners and specialists.
