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Potentially inappropriate medication (PIM) includes over-prescription, which refers to prescribing of medications without a valid indication or with a contraindication, mis-prescription which refers to occurrence of unwanted drug-drug or drug-disease interactions; or the incorrect prescribing of an indicated drug (such as duplicate prescribing, inappropriate follow-up, and incorrect medication dose or duration, etc.) and under-prescription which stands for failure to prescribe a clinically indicated drug. PIM is a well-known risk factor for adverse drug events, and is therefore a source of morbidities and sometimes mortality, imposing clinical and economic burdens on patients and healthcare systems. In the last two decades explicit criteria, such as STOPP-START or Beers’ criteria have been shown to reduce PIMs in geriatrics. Nevertheless, polymorbidity and polypharmacy are independent risk factors for the occurrence of PIM, while age is not, and these problems are frequent in internal medicine, even in middle-aged patients
Our objective was to develop a prescription-screening checklist for use with adults in general internal medicine.
We conducted a 4-step study involving literature review, 17 semi-structured interviews with 17 medical specialists, a 2-round web-based Delphi survey including a panel of 40 French-speaking internists and clinical pharmacists, from university and general hospitals from Belgium, France, Quebec, and Switzerland, and a forward/back-translation process to develop this tool.
PIM-Check includes 160 statements, divided in 17 domains (e.g., medical specialties and medical acts such as vaccinations and transplants) and 55 sub-domains (e.g., conditions, therapeutic classes, and medical procedures such as prevention/prophylaxis, analgesia). 75 statements are related to under-prescriptions, 36 to over-prescriptions, 16 to interactions, and 33 to other PIM (e.g., drug monitoring, dose adjustment, wrong choice of medication). They are classified according to a physiopathological-based system. It is available as an electronic application both in French and in English.
The English version was validated using a forward-translation and back-translation process. Briefly, PIM-check was first forward translated into English by a bilingual native-English-speaking physician from Elsevier Translation Service (www.webshop.elsevier.com) who was familiar with French-speaking culture and with the terminology of internal medicine. Second, a bilingual native-French-speaking internist back translated the checklist into French. Third, 3 members of the research group identified and resolved any instances of inadequate expression between the back translation and the original version. This pre-final version is still under testing. Please feel free to report any language issue at the following address: firstname.lastname@example.org
For further information on the methodology, you can read to the following document (in French language):
Elaboration d’un outil de détection des prescriptions inappropriées destiné aux adultes en médecine interne