Computer Algorithm May Be Able to Detect Potentially Inappropriate Prescribing

The findings come from an algorithm that was based on 4 criteria-based tools, including 2 widely-used measures designed to ferret out inappropriate medication prescribing in older adults.

A group of researchers have created an algorithm they say may be able to identify potentially inappropriate medication prescribing (PIP), based on their validation of the algorithm among a cohort of older patients.

The findings come from an algorithm constructed based on 4 criteria-based tools, including the European list of potentially inappropriate medications (EU(7)-PIM) and the Screening Tool of Older People’s Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) v2 criteria.

Tested among more than 1500 patients aged 70 years and older included in the 3-year, multicenter Multidomain Alzheimer Preventive Trial (MAPT) study, the algorithm found that approximately half of medications prescribed to older patients with Alzheimer disease are potentially inappropriate, with a PIP prevalence of 59% based on EU(7)-PIM, 43.2% based on STOPP criteria, and 51.3% based on START criteria.

The researchers underscored that the prevalence of PIP identified in the study should be not “considered as a reliable indicator of the clinical relevance of prescriptions” and that the only intention of the results is to confirm the validity of the algorithm.

Multivariate analysis results showed that older age, polypharmacy, and a high comorbidity index were associated with PIP. Importantly, these results are consistent with previous findings, said the researchers.

“The finding of the association between PIP and age, polypharmacy, and morbidity established in multivariate analyses is widely consistent with other published studies, that enforce the construct validity of the computer algorithm,” wrote the researchers. “According to the review by Tommelein et al., all of the publications analyzed (27/27) show an association between PIP and polypharmacy, more than half (6/10) between PIP and comorbidities, and nearly half (12/25) between PIP and advanced age. This is linked to the fact that age and comorbidity score in- crease polypharmacy, and therefore, the likelihood of having an inappropriate medication. Likewise, the number of comorbidities also increases with age.”

The researchers highlighted the strengths of their algorithm, noting that their algorithm used 4 explicit criteria-based tools and major drug interactions, while previous studies have used just 1 or 2 explicit criteria-based tools. They add that in addition to being consistent with the existing literature, their algorithm’s coding of criteria was defined based on consensus between pharmacists and was double checked.

Reference

Pagès A, Rouch L, Costa N, et al. Potentially inappropriate medication prescribing detected by computer algorithm among older patients: Results from the MAPT study. Pharmacy. 2021;9(4):189. doi: 10.3390/pharmacy9040189