Comparison of FORTA, PRISCUS and EU(7)-PIM lists on identifying potentially inappropriate medication and its impact on cognitive function in multimorbid elderly German people in primary care: a multicentre observational study
ObjectivesOur study aimed to assess the frequency of potentially inappropriate medication (PIM) use (according to three PIM lists) and to examine the association between PIM use and cognitive function among participants in the MultiCare cohort.DesignMultiCare is conducted as a longitudinal, multicen...
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| Published in: | BMJ open Vol. 11; no. 9; p. e050344 |
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| Main Authors: | , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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British Medical Journal Publishing Group
17-09-2021
BMJ Publishing Group LTD BMJ Publishing Group |
| Series: | Original research |
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| Abstract | ObjectivesOur study aimed to assess the frequency of potentially inappropriate medication (PIM) use (according to three PIM lists) and to examine the association between PIM use and cognitive function among participants in the MultiCare cohort.DesignMultiCare is conducted as a longitudinal, multicentre, observational cohort study.SettingThe MultiCare study is located in eight different study centres in Germany.Participants3189 patients (59.3% female).Primary and secondary outcome measuresThe study had a cross-sectional design using baseline data from the German MultiCare study. Prescribed and over-the-counter drugs were classified using FORTA (Fit fOR The Aged), PRISCUS (Latin for ‘time-honoured’) and EU(7)-PIM lists. A mixed-effect multivariate linear regression was performed to calculate the association between PIM use patients’ cognitive function (measured with (LDST)).ResultsPatients (3189) used 2152 FORTA PIM (mean 0.9±1.03 per patient), 936 PRISCUS PIM (0.3±0.58) and 4311 EU(7)-PIM (1.4±1.29). The most common FORTA PIM was phenprocoumon (13.8%); the most prevalent PRISCUS PIM was amitriptyline (2.8%); the most common EU(7)-PIM was omeprazole (14.0%). The lists rate PIM differently, with an overall overlap of 6.6%. Increasing use of PIM is significantly associated with reduced cognitive function that was detected with a correlation coefficient of −0.60 for FORTA PIM (p=0.002), −0.72 for PRISCUS PIM (p=0.025) and −0.44 for EU(7)-PIM (p=0.005).ConclusionWe identified PIM using FORTA, PRISCUS and EU(7)-PIM lists differently and found that PIM use is associated with cognitive impairment according to LDST, whereby the FORTA list best explained cognitive decline for the German population. These findings are consistent with a negative impact of PIM use on multimorbid elderly patient outcomes.Trial registration numberISRCTN89818205. |
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| AbstractList | OBJECTIVESOur study aimed to assess the frequency of potentially inappropriate medication (PIM) use (according to three PIM lists) and to examine the association between PIM use and cognitive function among participants in the MultiCare cohort. DESIGNMultiCare is conducted as a longitudinal, multicentre, observational cohort study. SETTINGThe MultiCare study is located in eight different study centres in Germany. PARTICIPANTS3189 patients (59.3% female). PRIMARY AND SECONDARY OUTCOME MEASURESThe study had a cross-sectional design using baseline data from the German MultiCare study. Prescribed and over-the-counter drugs were classified using FORTA (Fit fOR The Aged), PRISCUS (Latin for 'time-honoured') and EU(7)-PIM lists. A mixed-effect multivariate linear regression was performed to calculate the association between PIM use patients' cognitive function (measured with (LDST)). RESULTSPatients (3189) used 2152 FORTA PIM (mean 0.9±1.03 per patient), 936 PRISCUS PIM (0.3±0.58) and 4311 EU(7)-PIM (1.4±1.29). The most common FORTA PIM was phenprocoumon (13.8%); the most prevalent PRISCUS PIM was amitriptyline (2.8%); the most common EU(7)-PIM was omeprazole (14.0%). The lists rate PIM differently, with an overall overlap of 6.6%. Increasing use of PIM is significantly associated with reduced cognitive function that was detected with a correlation coefficient of -0.60 for FORTA PIM (p=0.002), -0.72 for PRISCUS PIM (p=0.025) and -0.44 for EU(7)-PIM (p=0.005). CONCLUSIONWe identified PIM using FORTA, PRISCUS and EU(7)-PIM lists differently and found that PIM use is associated with cognitive impairment according to LDST, whereby the FORTA list best explained cognitive decline for the German population. These findings are consistent with a negative impact of PIM use on multimorbid elderly patient outcomes. TRIAL REGISTRATION NUMBERISRCTN89818205. ObjectivesOur study aimed to assess the frequency of potentially inappropriate medication (PIM) use (according to three PIM lists) and to examine the association between PIM use and cognitive function among participants in the MultiCare cohort.DesignMultiCare is conducted as a longitudinal, multicentre, observational cohort study.SettingThe MultiCare study is located in eight different study centres in Germany.Participants3189 patients (59.3% female).Primary and secondary outcome measuresThe study had a cross-sectional design using baseline data from the German MultiCare study. Prescribed and over-the-counter drugs were classified using FORTA (Fit fOR The Aged), PRISCUS (Latin for ‘time-honoured’) and EU(7)-PIM lists. A mixed-effect multivariate linear regression was performed to calculate the association between PIM use patients’ cognitive function (measured with (LDST)).ResultsPatients (3189) used 2152 FORTA PIM (mean 0.9±1.03 per patient), 936 PRISCUS PIM (0.3±0.58) and 4311 EU(7)-PIM (1.4±1.29). The most common FORTA PIM was phenprocoumon (13.8%); the most prevalent PRISCUS PIM was amitriptyline (2.8%); the most common EU(7)-PIM was omeprazole (14.0%). The lists rate PIM differently, with an overall overlap of 6.6%. Increasing use of PIM is significantly associated with reduced cognitive function that was detected with a correlation coefficient of −0.60 for FORTA PIM (p=0.002), −0.72 for PRISCUS PIM (p=0.025) and −0.44 for EU(7)-PIM (p=0.005).ConclusionWe identified PIM using FORTA, PRISCUS and EU(7)-PIM lists differently and found that PIM use is associated with cognitive impairment according to LDST, whereby the FORTA list best explained cognitive decline for the German population. These findings are consistent with a negative impact of PIM use on multimorbid elderly patient outcomes.Trial registration numberISRCTN89818205. Objectives Our study aimed to assess the frequency of potentially inappropriate medication (PIM) use (according to three PIM lists) and to examine the association between PIM use and cognitive function among participants in the MultiCare cohort.Design MultiCare is conducted as a longitudinal, multicentre, observational cohort study.Setting The MultiCare study is located in eight different study centres in Germany.Participants 3189 patients (59.3% female).Primary and secondary outcome measures The study had a cross-sectional design using baseline data from the German MultiCare study. Prescribed and over-the-counter drugs were classified using FORTA (Fit fOR The Aged), PRISCUS (Latin for ‘time-honoured’) and EU(7)-PIM lists. A mixed-effect multivariate linear regression was performed to calculate the association between PIM use patients’ cognitive function (measured with (LDST)).Results Patients (3189) used 2152 FORTA PIM (mean 0.9±1.03 per patient), 936 PRISCUS PIM (0.3±0.58) and 4311 EU(7)-PIM (1.4±1.29). The most common FORTA PIM was phenprocoumon (13.8%); the most prevalent PRISCUS PIM was amitriptyline (2.8%); the most common EU(7)-PIM was omeprazole (14.0%). The lists rate PIM differently, with an overall overlap of 6.6%. Increasing use of PIM is significantly associated with reduced cognitive function that was detected with a correlation coefficient of −0.60 for FORTA PIM (p=0.002), −0.72 for PRISCUS PIM (p=0.025) and −0.44 for EU(7)-PIM (p=0.005).Conclusion We identified PIM using FORTA, PRISCUS and EU(7)-PIM lists differently and found that PIM use is associated with cognitive impairment according to LDST, whereby the FORTA list best explained cognitive decline for the German population. These findings are consistent with a negative impact of PIM use on multimorbid elderly patient outcomes.Trial registration number ISRCTN89818205. |
| Author | Wiese, Birgitt Dreischulte, Tobias Riedel-Heller, Steffi G Langebrake, Claudia Schäfer, Ingmar Maier, Wolfgang König, Hans-Helmut Scherer, Martin Weyerer, Siegfried von Renteln-Kruse, Wolfgang van den Bussche, Hendrik Krüger, Caroline Bickel, Horst Mergenthal, Karola Fuchs, Angela Schön, Gerhard |
| AuthorAffiliation | 7 Department for Health Economics and Health Services Research , Universitatsklinikum Hamburg-Eppendorf , Hamburg , Germany 5 Institute of General Practice and Family Medicine , Ludwig-Maximilians-Universitat Munchen , Munchen , Germany 9 Institute of General Practice , Goethe University Frankfurt , Frankfurt am Main , Germany 4 Institute of General Practice , Friedrich-Schiller-Universität Jena , Jena , Germany 10 Institute for Social Medicine , Leipzig University , Leipzig , Germany 1 Hospital Pharmacy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany 12 Medical Faculty , Central Institute of Mental Health , Mannheim , Germany 3 Department of Psychiatry , Technical University of Munich , Munchen , Germany 15 Department of Stem Cell Transplantation , University Medical Center Hamburg-Eppendorf , Hamburg , Germany 6 Institute of General Practice , Heinrich-Heine-Universitat Dusseldorf , Dusseldorf , Germany 14 Research Department , Albertinen-Haus Zentrum für Geriatrie und Geront |
| AuthorAffiliation_xml | – name: 6 Institute of General Practice , Heinrich-Heine-Universitat Dusseldorf , Dusseldorf , Germany – name: 14 Research Department , Albertinen-Haus Zentrum für Geriatrie und Gerontologie Medizinisch-Geriatrische Klinik , Hamburg , Germany – name: 9 Institute of General Practice , Goethe University Frankfurt , Frankfurt am Main , Germany – name: 7 Department for Health Economics and Health Services Research , Universitatsklinikum Hamburg-Eppendorf , Hamburg , Germany – name: 11 Department of Medical Biometry and Epidemiology , University Medical Center Hamburg-Eppendorf , Hamburg , Germany – name: 2 Department of Primary Medical Care , University Medical Center Hamburg-Eppendorf , Hamburg , Germany – name: 12 Medical Faculty , Central Institute of Mental Health , Mannheim , Germany – name: 1 Hospital Pharmacy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany – name: 15 Department of Stem Cell Transplantation , University Medical Center Hamburg-Eppendorf , Hamburg , Germany – name: 10 Institute for Social Medicine , Leipzig University , Leipzig , Germany – name: 4 Institute of General Practice , Friedrich-Schiller-Universität Jena , Jena , Germany – name: 13 Institute for General Practice , Hannover Medical School , Hannover , Germany – name: 8 Department of Psychiatry and Psychotherapy , University of Bonn , Bonn , Germany – name: 5 Institute of General Practice and Family Medicine , Ludwig-Maximilians-Universitat Munchen , Munchen , Germany – name: 3 Department of Psychiatry , Technical University of Munich , Munchen , Germany |
| Author_xml | – sequence: 1 givenname: Caroline orcidid: 0000-0001-9080-1562 surname: Krüger fullname: Krüger, Caroline email: c.krueger@uke.de organization: Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany – sequence: 2 givenname: Ingmar orcidid: 0000-0002-1038-7478 surname: Schäfer fullname: Schäfer, Ingmar organization: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany – sequence: 3 givenname: Hendrik surname: van den Bussche fullname: van den Bussche, Hendrik organization: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany – sequence: 4 givenname: Horst surname: Bickel fullname: Bickel, Horst organization: Department of Psychiatry, Technical University of Munich, Munchen, Germany – sequence: 5 givenname: Tobias surname: Dreischulte fullname: Dreischulte, Tobias organization: Institute of General Practice and Family Medicine, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany – sequence: 6 givenname: Angela surname: Fuchs fullname: Fuchs, Angela organization: Institute of General Practice, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany – sequence: 7 givenname: Hans-Helmut surname: König fullname: König, Hans-Helmut organization: Department for Health Economics and Health Services Research, Universitatsklinikum Hamburg-Eppendorf, Hamburg, Germany – sequence: 8 givenname: Wolfgang surname: Maier fullname: Maier, Wolfgang organization: Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany – sequence: 9 givenname: Karola surname: Mergenthal fullname: Mergenthal, Karola organization: Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany – sequence: 10 givenname: Steffi G surname: Riedel-Heller fullname: Riedel-Heller, Steffi G organization: Institute for Social Medicine, Leipzig University, Leipzig, Germany – sequence: 11 givenname: Gerhard surname: Schön fullname: Schön, Gerhard organization: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany – sequence: 12 givenname: Siegfried surname: Weyerer fullname: Weyerer, Siegfried organization: Medical Faculty, Central Institute of Mental Health, Mannheim, Germany – sequence: 13 givenname: Birgitt surname: Wiese fullname: Wiese, Birgitt organization: Institute for General Practice, Hannover Medical School, Hannover, Germany – sequence: 14 givenname: Wolfgang surname: von Renteln-Kruse fullname: von Renteln-Kruse, Wolfgang organization: Research Department, Albertinen-Haus Zentrum für Geriatrie und Gerontologie Medizinisch-Geriatrische Klinik, Hamburg, Germany – sequence: 15 givenname: Claudia surname: Langebrake fullname: Langebrake, Claudia organization: Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany – sequence: 16 givenname: Martin surname: Scherer fullname: Scherer, Martin organization: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany |
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| Title | Comparison of FORTA, PRISCUS and EU(7)-PIM lists on identifying potentially inappropriate medication and its impact on cognitive function in multimorbid elderly German people in primary care: a multicentre observational study |
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