Table 4 Experts’ valuation of patients’ drug regimens
Recommendations | Intervention group: n = 281 patients § | ||
|---|---|---|---|
|  | n drugs | % of total prescriptions (n = 2658) |  |
Total number of drugs valued as inappropriate | 419 | 15.8% | Â |
|  |  | Median (IQR) | min – max |
Number of inappropriate drugs per patient (n = 281) |  | 1 (1–2) | 0–6 |
Number of inappropriate drugs per GP (n = 22) |  | 20 (15–22) | 5–37 |
Frequency of inappropriate drugs per patient | n patients | % of participating patients (n = 281) | |
n patients with 0 inappropriate drugs | 66 | 23.5% | |
n patients with 1 inappropriate drug | 91 | 32.4% | |
n patients with 2 inappropriate drugs | 70 | 24.9% | |
n patients with 3 inappropriate drugs | 37 | 13.2% | |
n patients with ≥4 inappropriate drugs | 17 | 6.0% | |
TOTAL patients with ≥ 1 inappropriate drug | 215 | 76.5% | |
Frequency of inappropriate drugs per GP | n GPs | % of participating GPs (n = 22) | |
n GPs with 5–10 inappropriate drugs | 3 | 13.6% | |
n GPs with 11–20 inappropriate drugs | 10 | 45.5% | |
n GPs with > 20 inappropriate drugs | 9 | 40.9% | |
Drug classes rated as inappropriate | n drugs | % of prescribed drugs | % of inappropriate drugs (n = 419) |
Anxiolytics/hypnotics (Benzodiazepines, Zolpidem) | 73 | 92.4% (n = 79) | 17.4% |
Alpha-blockers | 15 | 65.2% (n = 23) | 3.6% |
Antiarrhythmics | 10 | 58.8% (n = 17) | 2.4% |
NSAIDs, COX-2-inhibitors (Coxibe) | 21 | 56.8% (n = 37) | 5.0% |
PPIs | 72 | 44.7% (n = 161) | 17.2% |
Antidepressants, antipsychotics | 34 | 29.1% (n = 117) | 8.1% |
Oral antidiabetic drugs | 22 | 25.9% (n = 85) | 5.3% |
Drugs for gout treatment (Allopurinol) | 9 | 21.4% (n = 42) | 2.2% |
Corticosteroids | 11 | 19.3% (n = 57) | 2.6% |
Beta-blockers | 29 | 18.2% (n = 159) | 6.9% |
Opioids | 10 | 14.7% (n = 68) | 2.4% |
Analgesics - Paracetamol | 9 | 13.8% (n = 65) | 2.2% |
Dietary supplements (predominantly Calcium) | 9 | 10.5% (n = 86) | 2.2% |
Vitamins (predominantly Vit. D) | 11 | 9.3% (n = 118) | 2.6% |
Oral anticoagulants | 9 | 9.0% (n = 100) | 2.2% |
Experts’ motivations for recommendation to stop | n drugs | % of inappropriate drugs (n = 419) | |
Lack of clear indication | 255 | 60.9% | |
Contraindicated in older-aged persons | 63 | 15.0% | |
Not first choice | 57 | 13.6% | |
Not indicated as long-term therapy | 27 | 6.4% | |
Disease-specific contraindication | 9 | 2.1% | |
High risk of ADEs | 3 | 0.7% | |
High risk of significant DDIs | 2 | 0.5% | |
Unfavourable risk-benefit assessment | 2 | 0.5% | |
Duplication of drugs | 1 | 0.2% | |
n drugs valued as inappropriate per expert | n drugs (% of total prescriptions) | Median (IQR) | min – max |
Expert of Evidence-based Medicine (EbM) | 441 (16.6%) | 1 (1–2) | 0–6 |
Clinical pharmacologist | 374 (14.1%) | 1 (0–2) | 0–6 |
Specialist of internal medicine | 361 (13.6%) | 1 (0–2) | 0–6 |
Most frequent inappropriate drug classes per expert | Clinical pharmacologist | Internist | EbM-expert |
Anxiolytics/hypnotics (Benzodiazepines, Zolpidem): n | 72 | 72 | 73 |
PPIs: n | 71 | 63 | 73 |
Beta-blockers: n | 21 | 20 | 38 |
Concordance between experts | Pharm – Int | Pharm – EbM | EbM – Int |
Patients where two experts fully agreed: n (%) | 187 (66.6%) | 224 (79.7%) | 207 (73.7%) |