Pha macy2021,9,194.h ps://doi.o g/10.3390/pha macy9040194www.mdpi.com/jou nal/pha macy
A icle
P esc ibing‐Assessmen Tools o Long‐Te mCa e
Pha macyP ac ice:ReachingConsensus h ough
aModi iedRAND/UCLAApp op ia enessMe hod
JoãoR.Gonçal es
1,
*,Be syL.Slea h
2
,ManuelJ.Lopes
3
andA onsoM.Ca aco
1
1
iMed.ULisboa,SocialPha macyDepa men ,Facul yo Pha macy,Uni e si yo Lisbon,
1649‐003Lisboa,Po ugal;aca [email p o ec ed]boa.p
2
EshelmanSchoolo Pha macy,Uni e si yo No hCa olinaa ChapelHill,ChapelHill,NC27599,USA;
[email p o ec ed]
3
Collegeo Nu singS.JoãodeDeus,Uni e si yo É o a,7000‐811É o a,Po ugal;mjl@ue o a.p
*Co espondence:jgoncal es11@o ice365.ulisboa.p
Abs ac :Medicinesa e hemos usedheal h echnologyinLong‐Te mCa e.Thep e alenceo
po en iallyinapp op ia emedicinesamongs Long‐Te mCa epa ien sishigh.Pha macis s,as‐
sis edbyp esc ibing‐assessmen ools,canplayanimpo an oleinop imizingmedica ionusea
hisle elo ca e.Th oughamodi iedRAND/UCLAApp op ia enessMe hod,13long‐ e mca e
andhospi alpha macis sassessedas‘app op ia e’,‘unce ain’,o ‘inapp op ia e’acollec iono
commonlyusedp esc ibing‐assessmen oolsas oi ssui abili yinassis ingpha macyp ac icein
ins i u ionallong‐ e mca ese ings.Aquali a i eanalysiso w i eno ansc ibedcommen so
pa icipan swaspu sued oiden i y ele an cha ac e is icso p esc ibing‐assessmen oolsand
po en ialhinde sin hei use.F om24di e en ools,pha macis sclassi ied9as‘app op ia e’ o
pha macyp ac ice a ge ed olong‐ e mca epa ien s,while3we eclassi iedas‘inapp op ia e’.
The ools ea u emos app ecia edbys udypa icipan swas heindica iono al e na i es opo‐
en iallyinapp op ia emedica ion.Lacko imeand/o pha macis sandlimi edaccess oclinical
in o ma ionseems obe hemos ele an hinde s o p esc ibing‐assessmen oolsusedindaily
p ac ice.
Keywo ds:long‐ e mca e;po en iallyinapp op ia ep esc ibing;pha macis ;pha macyp ac ice;
consensus;RAND/UCLA;p esc ibing‐assessmen ools
1.In oduc ion
Long‐Te mCa e(LTC)encompassesa angeo heal hca e,pe sonalca e,ando he
suppo i ese ices a ge ed opa ien swhosecapaci y o sel ‐ca eislimi edo e an
ex endedpe iod[1,2].InPo ugal, heNa ionalNe wo k o Long‐Te mIn eg a edCa e
ep esen s hecoun y’s esponse o heg owingdemand o hisle elo ca e.S uc u ‐
ally, heNa ionalNe wo k o Long‐Te mIn eg a edCa e(NLTIC)comp ehendsHome
andCommuni y‐BasedSe ices(ou pa ien se ings)andSkilledNu singHomes(inpa‐
ien se ings).Pha macis s’in e en ioninNLTICou pa ien se ingsisabsen .Na ional
Ne wo k o Long‐Te mIn eg a edinpa ien se ingsisdi idedin o‘Con alescence
uni s’,‘MediumTe m&Rehabili a ionuni s’,and‘Long‐Te m&Main enanceuni s’[3].
Al houghno explici ly a ge ed oca e o agedpeople,LTCpopula ionsa eo enel‐
de lypa ien s.In2020,84%o NLTIC’spa ien swe eaged65o o e ,alignedwi h he
wo ldwidedemog aphicageing end[4].Asex ensi ely epo ed, heageingp ocessis
highlyassocia edwi hmul imo bidi yand,consequen ly,wi haugmen eduseo medi‐
ca ions[5–7].Olde popula ionsa emo esuscep ible oAd e seD ugE en s(ADEs)
gi en heage‐ ela edpha macokine icsandpha macodynamicschanges,adding o
Ci a ion:Goncal es,J.R.;Slea h,
B.L.;Lopes,M.J.;Ca aco,A.M.
P esc ibing‐Assessmen Tools o
Long‐Te mCa ePha macyP ac ice:
ReachingConsensusTh ougha
Modi iedRAND/UCLA
App op ia enessMe hod.
Pha macy2021,9,194.
h ps://doi.o g/10.3390/
pha macy9040194
AcademicEdi o :Bja keAb ahamsen
Recei ed:15No embe 2021
Accep ed:2Decembe 2021
Published:3Decembe 2021
Publishe ’sNo e:MDPIs aysneu‐
alwi h ega d oju isdic ional
claimsinpublishedmapsandins i u‐
ionala ilia ions.
Copy igh :©2021by heau ho s.Li‐
censeeMDPI,Basel,Swi ze land.
Thisa icleisanopenaccessa icle
dis ibu edunde he e msandcon‐
di ionso heC ea i eCommonsA ‐
ibu ion(CCBY)license(h p://c ea‐
i ecommons.o g/licenses/by/4.0/).
Pha macy2021,9,1942o 15
elde s’usualunde ‐ ep esen a ioninclinical ials.Allp e ious easonsmigh explain
hehighp e alenceo Po en iallyInapp op ia eMedica ion(PIM)inolde pa ien s[8,9].
A ecen sys ema ic e iewiden i iedap e alenceo inapp op ia emedica ionuse
among heelde ly anging om11.5% o62.5%[10].InLTC acili ies, hep e alenceo
inapp op ia emedica ionisalsohigh[11–13].Consequen ly, hequali yo p esc ibingin
LTCpopula ionsiso u mos impo ance,beingacomplexandchallengingp ocess.Po‐
en iallyInapp op ia eP esc ibing(PIP)hasbeenassocia edwi hnega i eheal hou ‐
comesandeconomiclosses[14,15].Po en iallyInapp op ia eP esc ibingconcep encom‐
passes he ollowingp ac ices:i)misp esc ibing,i.e., hep esc ip iono amedica ion ha
couldpo en iallylead oasigni ican isko ADEs,due oe oneousposologyo ou eo
adminis a iono due oinc eased isko d ug‐d ugo d ug‐diseasein e ac ion;ii)un‐
de p esc ibingo Po en ialP esc ibingOmission(PPO),i.e., heomissiono amedica ion
ha isclinicallyindica ed o disease ea men o p e en ion;iii)o e p esc ibing,i.e., he
p esc ip iono medica ions o whichnoclea clinicalindica ionexis s[16,17].Di e en
me hodsha ebeende elopedandimplemen ed ocusedoninapp op ia ep esc ibing
p e en ion,suchaseduca ion,medica ion econcilia ion,andp esc ibing‐assessmen
ools[18].O e helas h eedecades,se e alc i e iaandsc eening oolsha ebeende‐
eloped oassis cliniciansiniden i yingandp e en ingPIP.These oolscanbeexplici
(i.e.,c i e ia‐based)o implici (i.e.,judgemen ‐based)[19,20].Amongs heheal hca e
p o essionalscapableo usingsuchins umen sa epha macis s.Pha macis s’p ac ice
encompassesse e almedicine‐ ela edin e en ions, ommedicinesmanagemen oes‐
ablishing,assessing,o moni o ing ea men plans.Th oughase o clinicalandpa ien ‐
o ien edac i i iesandcollabo a ionwi ho he heal hca ep o essionals,pha macis scan
educePIPalsoinLTCse ings[21,22].
Long‐Te mCa econcep ualiza ionanddeli e y a y omcoun y ocoun y,ham‐
pe ingscien i ic epo ingands anda dizedu iliza iono Po en iallyInapp op ia eP e‐
sc ibing(PIP)assessmen ools[23,24].InPo ugal,nocommono gene allyaccep ed
guidelines ega ding he apyop imiza iona eknowninLTC.Theexis inghe e ogenei y
o medica ionp esc ibingp ac ices, hewide angeo suppo ingins umen sa ailable,
and heLTCpopula ionhe e ogeneousheal hs a us u nschallenging oiden i y he
mos sui ableP esc ibing‐Assessmen Tools(PATs).Thiss udyaimed oiden i y hemos
sui ableP esc ibing‐Assessmen Toolsuse ul o LTCpha macyp ac ice.Anaddi ional
goalwas omapkeycha ac e is icso P esc ibing‐Assessmen Tools om hepha macis ‐
use pe spec i eandpo en ialhinde s o hei use.
2.Ma e ialsandMe hods
Thiss udy ollowedaconsensus‐buildingme hodology oselec hemos app op i‐
a e ools o pha macyp ac iceinLTCse ings,adjus ed opa ien s’cha ac e is icsand
pha macis s’ac i i iesin hisle elo ca e.
Theme hodologicalapp oachissumma izedinFigu e1.
Pha macy2021,9,1943o 15
Figu e1.S udyme hodology lowcha .
Consensusme hodscanbede inedasase o acili a ion echniquesdesigned oex‐
plo e hele elo consensusamongag oupo expe sbysyn hesizingandcla i yingex‐
pe opinions.Inheal hca e esea ch, ou consensusme hodsa e equen lyused:Delphi,
NominalG oup echnique,ConsensusDe elopmen Con e ence,andRAND/UCLAAp‐
p op ia enessMe hod(RAM)[25,26].RAMisaccomplished omalis o p ede e mined
i ems[27].Fo his eason,RAMsui sou objec i esonceP esc ibing‐Assessmen Tools
a eal eadyde elopedandpublishedin hescien i icli e a u e.Gene ically,RAMme h‐
odologycanbedesc ibedin ou mains eps:i)li e a u e e iew;ii)panel a ing ound o
e iew hee idencega he ed omli e a u e(wi hou anyin e ac ionsbe weenpanelis s,
hesilen ound);iii) ace‐ o‐ acemee ingaimeda discussingg oup’s a ings, ollowed
byindi idualoppo uni ies o e‐ a ings;i ) inalclassi ica iono e idenceas“app op i‐
a e”,“unce ain”o “inapp op ia e”(acco ding opanelis smediansco es)anddiscus‐
sion[27].Apilo phasewasunde aken oan icipa epo en ialhinde sinapplying his
me hod,pa icula ly o hemee ings ep(e.g., imeando he cons ain s).A hispoin ,
aRAMmodi ica ionwasassumed os eng henaquali a i epe spec i eonPATsuse,
inspi edbyamixed‐me hodsapp oach.Ins eado asingle ound, wosilen oundswi h
allpanelis swe econduc ed oob ainPATsquan i a i eapp aisalbe o e he ace‐ o‐ ace
mee ing.
2.1.Li e a u eRe iewandP esc ibing‐Assessmen ToolsIden i ica ion
P esc ibing‐Assessmen Toolswe eiden i iedins udies epo ingpha macis ‐ledin‐
e en ionsinins i u ionalLTCse ings ompublishedp ima ysou cessumma izedin
a ecen sys ema ic e iew,publishedelsewhe e(Figu e1)[28].Addi ionally,amanual
sea cho ele an e e ences om he e ie edpape swasunde aken.
Pha macy2021,9,1944o 15
2.2.P esc ibing‐Assessmen ToolsIndependen Ra ing
Panelis s’en ollmen wasmade ollowingapu posi esampling echnique(Table1).
Panelis swe eLTCpha macis sexclusi elydedica ed oa leas oneo he h ee ypeso
RNCCIinpa ien se ings(‘Con alescenceuni s’,‘MediumTe m&Rehabili a ionuni s’,
and‘Long‐Te m&Main enanceuni s’)o hospi alpha macis s.Re e alo pa ien s o he
Na ionalNe wo k o Long‐Te mIn eg a edCa eismademainly h oughhospi alse ‐
ings; he e o e, hein e en iono hospi alpha macis sin he ansi iono pa ien s o
LTCoccu s.Communi ypha macis sa eno in ol edin he ansi iono ca e; hus, hey
we eno ec ui ed.The inalPATscollec ionwasmailed oins i u ionaladd esseso each
pha macis o judgmen andp i a e a ing,asdesc ibednex .
Table1.Panelis s’demog aphiccha ac e is ics.
Pa icipan Gende Se ingo P o essionalAc i i yYea so P ac ice
1FemaleLong‐Te mCa eFacili y10
2FemaleLong‐Te mCa eFacili y15
3FemaleLong‐Te mCa eFacili y5
4FemaleLong‐Te mCa eFacili y15
5FemaleLong‐Te mCa eFacili y11
6FemaleLong‐Te mCa eFacili y1
7FemaleLong‐Te mCa eFacili y3
8FemaleLong‐Te mCa eFacili y1
9FemaleHospi al3
10FemaleHospi al4
11MaleHospi al5
12MaleHospi al4
13MaleHospi al24
Panelis swe easked o a eeachPAT ega dingi ssui abili y o LTCpha macy
p ac ice(Howapp op ia ecould hisPATbeinp o idingca e oLTCpa ien s?),usinga
9‐poin sLike scale(1— o allyinapp op ia e;9— o allyapp op ia e),and ocommen
on hei a ings.Ra ingso 1–3,4–6and7–9we eclassi iedasInapp op ia e(I),Unce ain
(B),andApp op ia e(A), espec i ely.A e each ound, heg oupmedian a e,Disag ee‐
men Index(DI)andcommen ssuppo ing a ingswe eanonymouslysha edwi hall
panelis s,whowe eallowed ochange hei a ingsbe o e hesecond oundand ace‐ o‐
acemee ing.
Disag eemen Indexisanindica o o consensusand o i scalcula ion, he ollowing
equa ionwasused:DI=IPR/IPRAS(IPR,In e ‐Pe cen ileRange;IPRAS,In e ‐Pe cen ile
RangeAdjus ed o Symme y),conside ing he ollowing:i)IPR=70 h–30 hpe cen ile;
ii)IPRCen alPoin (IPRCP=(70 h+30 hpe cen ile)/2;iii)Asymme yIndex(AI)=(5–
IPRCP);i )IPRAS=2,5+(AI×1,5)[27].ADI alueless hano equal o1signalsag ee‐
men be weenpanelis s[29].
2.3.Face‐ o‐FaceMee ings
Li e emo emee ingswe eheldwi hpanelis sa e he wosilen ounds o eacha
consensus.Anea lie pilo panel,mee ingonlinewi h3LTCpha macis s, ook3hand15
min oi send.Thus, oassu e ha allpa icipan scouldexp ess hei e alua iono all
PATs,includingquali a i eaccoun s,wi hinanaccep able ime ame,i wasnecessa y o
con ene h eeg oupso 3–5panelis s.Allpanelsaimed o eachanag eemen onas‐
sessingPATsasApp op ia e,Unce ainandInapp op ia e, ega ding hei use ulness o
LTCpha macyp ac ice.Incasepanelis sdisag eed, ha panel’s a ingwasconside edas
Unce ain(B).Fo inalconsensusasInapp op ia e(I ),Unce ain(B ),andApp op ia e
(A ),a humb ulewas ollowed: o PATswi ha leas wopanels’ a ingalignedwi h
Pha macy2021,9,1945o 15
he2nd oundo e all a ingandaDIequalo below1, inalconsensusasI ,B o A was
conside edacco dingly o heo e allg oup’s a ing.I he wopanels’ a ingswe eno
alignedwi h heo e allg oup’s a ing, hePATwasclassi iedasUnce ain(B)use o
LTCpha macyp ac ice.
2.4.Analysiso Panellis s’Accoun sandFinalClassi ica ion
Toin o m easons o a ingsandconsensusandexplo ePATs’cha ac e is icsiden‐
i iedasmo esui able o pha macis LTCp ac ice,a eco do commen s(w i endu ing
hep i a e a ingand ansc ibed om ace‐ o‐ acemee ings)waspe o med.Thepanel‐
is s’accoun swe ein e p e ed,o ganized,andsyn hesizedin o womain hemes(posi‐
i e ea u esandusagehinde s)wi hou pu suingade ailedquali a i eanaly icalap‐
p oach.
3.Resul s
3.1.Li e a u eRe iew
Theli e a u e e iewp ocess(Figu e2) e ie ed24PATs(Supplemen a yTableS1).
Thesewe eo ganizedin odi e en p ac icea eas,namely:i)an icholine gicandseda i e
medicinesusage:ARS[30]andDBI[31];ii)hemo hagic isk:ATRIA[32],CHA2DS2VASc
[33],HAS‐BLED[34]andHEMORR2HAGES[35];iii)an ibio icsusage:Loeb[36];i )med‐
ica ioncomplexi y:MRCI[37,38]andM s.GRACE[39]; )comp ehensi eimplici assess‐
men o p esc ibing:MAI[40]andPAI[41]; i)comp ehensi e,explici assessmen o p e‐
sc ibing:Bee s’c i e ia[42];NORGEP[43];STOPP/START[44];FORTA[45,46];Wini ‐Wa ‐
jana’sc i e ia[47];Rancou ’sc i e ia[48];Poudel’sc i e ia[49];McLeod’sc i e ia[50];
La oche’sc i e ia[51];Aus alianP esc ibingIndica o sTool[52] ii)medicinesusagein
demen ia:APID[53],Holmes’c i e ia[54]andK oge ’sc i e ia[55].
Figu e2.Flowcha o li e a u e e iewandP esc ibing‐Assessmen Toolsiden i ica ion.
3.2.Panellis s’Cha ac e is ics
Pa icipan s’cha ac e is icsa edesc ibedinTable1.Pa icipan sen olledincluded
pha macis swo kinginLong‐Te mCa eFacili ies(LTCFs)o hospi als om ou Re‐
gionalHeal hAu ho i ies(RHAs)ca chmen a eas(ou o 5RAHsinmainlandPo ugal).
Th eemee ingswi h h eepanelis seachwe eo ganized.The ace‐ o‐ acepanels
we e o medbypa icipan s1,2,3(panel1–LTCpha macis s),4,5,6(panel2–LTCpha ‐
macis s),10,11,13(panel3–Hospi alpha macis s),i.e.,ad opou a eo 30%was e i ied
(pa icipan s7,8and9).
Pha macy2021,9,1946o 15
3.3.RAMRounds,Face‐ o‐FaceMee ingsandFinalConsensus
Fo 14PATs,consensuswas eachedinallcomponen s,i.e.,o e allg oup a ing
(wi hDI≤1)wasalignedwi h he h eepanels a ings.Fo ins ance,in hecaseo ATRIA,
hesecond‐ ound a ingwas7(A)–wi haDIo 0.164–andpanels’1,2,and3 a ingswe e
A; hus, he inalconsensuswasse asA (App op ia e).Fo 10PATs,onepanel a ing
wasno alignedwi h he es o he a ings.Fo ins ance,in hecaseo DBI, heo e all
g oup’s a ingwasC(Inapp op ia e)wi haDIo 0.438;panels’1and2 a ingswe eC,
whilepanel’s3 a ingwasB; hus, he inaldecisionwasC (Inapp op ia e).Fo allPATs,
DIa hesecond oundwaslowe han1.I his ulecouldno be ollowed,aPATwas
a ed o Unce ain(B )use ulnessinLTCpha macyp ac ice.Resul sa esumma izedin
Table2.
Table2.P esc ibing‐Assessmen Tools a ings, ep esen a i equo a ionsand inalconsensus.
P esc ibing‐
Assessmen
Tool
Round1
MedianRa ing
(13
Pa icipan s);
Disag eemen
Index
Round2
Median
Ra ing
(13
Pa icipan s)
;
Disag eeme
n Index
Face‐ o‐FacePanels
App op ia e(A),
Unce ain(B)o In‐
app op ia e(C) Rep esen a i eQuo a ions
App op ia e(A ),
Unce ain(B )o
Inapp op ia e
(C ) o LTC
Pha macy
P ac ice
Panel
1
Panel
2
Panel
3
ARS7;0.3747;0.164AAB
“I con ainsmanyd ugswi han icholine gicpo en ial,bu in
p ac ice, he eisno muchal e na i e.Wecane en ell hephysician
ha hesed ugscancauseanAd e seD ugE en (ADE),bu wha
is heal e na i e?In heo y,i isimpo an ,bu inp ac ice,no so
much”P11
“I indi e yuse ulbecausemos pa ien s ake hismedica ion”P7
“Canbeuse ul ominimizecommonADEs(e.g., allsin heelde ly)”
P13
A
DBI3;0.7482;0.438CCB
“isinapp op ia egi enmycon ex “P4
“I indi in e es ing,bu inp ac ical e ms,i doesno ma e ialise
in osome hingIcanuse”P10
“I indi in e es ingbecausei akesin oaccoun hedailydoseand
de ineddailydoseandallows o be e choiceso dosagesand
p omo iono non‐pha macologicals a egies; ocusesonmedicines
widelyusedinou agedpopula ion”P13
C
ATRIA6;0.5197;0.164AAA
“A hele elo dailyp o essionalp ac ice, hescaleissimple ouse,
allclinicalc i e iaa eeasilyaccessed,unlikeo he simila scalesin
whichpe sonalhis o yo o he diagnosesa eno alwaysspeci iedin
hehospi aldischa geno e”P5
“Ve yp ac icalands aigh o wa d, heexis enceo a“sco e”, ha is,
“aquan i iable alue”,makesi mucheasie oa guewi h he
physicians,whenonein ends omakemedica ion econcilia ion, o
ins ance,”P12
A
CHA2DS2VA
Sc6;0.5196;0.519BBA
“Easy‐ o‐applyalgo i hminmydailyp ac ice”P6
“Thisscalemaybemo edi icul ouse,oncewedono alwaysha e
access o hepe sonalbackg oundo pa ien s”P5
B
HAS‐BLED6;0.5197;0.217AAA“Comp ehensi e,use ul, e ysys ema ized”P4A
HEMORR2H
AGES5;0.9685;0.519BBB
“i maybeimpo an becausei includes heCYP2C9polymo phisms,
al hough hisin o ma ionis a elya ailable”P13
“P esen spe inen pa ame e ssuchasgene icpolymo phismsand
alcoholabuse”P7
“I indi ause ulalgo i hm,bu i equi esda a ha isno always
accessibleinmydailyp o essionalp ac ice”P6
B
Loebc i e ia6;1.046;0.652AAC
“Iconside analgo i hm e yadap ed o heLTC eali yino de o
assess hep esc ip iono an ibio ics o hemos commonin ec ions”
P5
“I add esses he h eemain ypeso in ec ion ha we acedailyand
allowsyou osc een heapp op ia enesso an ibio icp esc ip ionina
e yquickandsimpleway”P1
B
Pha macy2021,9,1947o 15
P esc ibing‐
Assessmen
Tool
Round1
MedianRa ing
(13
Pa icipan s);
Disag eemen
Index
Round2
Median
Ra ing
(13
Pa icipan s)
;
Disag eeme
n Index
Face‐ o‐FacePanels
App op ia e(A),
Unce ain(B)o In‐
app op ia e(C) Rep esen a i eQuo a ions
App op ia e(A ),
Unce ain(B )o
Inapp op ia e
(C ) o LTC
Pha macy
P ac ice
Panel
1
Panel
2
Panel
3
“No use ulinap ac icalcon ex ,sinceclinicalcondi ionsa emuch
mo ecomplex han healgo i hm e lec s”P12
MRCI5;1.705;0.702BBB
“Al hough imeconsuming, e yin e es ing”P2
“I isno easible o a egula usedue oi sleng h”P9
“Canbeuse ulin hepos ‐discha gemomen ;howe e ,i isno
p ac ical”P5
“I wouldbe e yuse ulinmyp o essionalp ac ice,since educing
hecomplexi yo he egimenswill educepo en ialmedica ione o s,
inc easeadhe enceand educecos s”P6
B
M s.G ace5;0.9975;0.997BBB
“Comple eandwi hobjec i eins uc ions o ac ion”P10
“Ve yin e es ing;howe e ,Ibelie ei simplemen a ionishinde ed
due o helimi edhuman esou cesa ailableinLTC”P4
“I indi e yuse ul ousei in heplanneddischa gesasaway o
adap he he apeu ic egimensindi idually o hepa ien and
ca egi e sandasaway op omo eadhe ence o he he apeu ic
egimen”P3
“ healgo i hmhasli lep ac icalapplica ionsincedu ingpa ien
s ayingi isno alwayspossible o“simpli y” he apydue oha inga
p e‐de inedd ug o mula y”P5
B
MAI7;0.2198;0.219ABA
“Ve yadap ed opha macis s.I indi pa icula lyuse ul o some
pa ien sandno o e e yone.I allowsou pa icipa ionin
mul idisciplina ymee ings obecomemo euse ul.I canbeimpo an
indep esc ibingac i i ies”P1
“I ind hisalgo i hm e yuse ulandeasy oque y.Howe e ,i is
e y ime‐consumingasi isnecessa y o e ieweachd uga en
di e en poin s o eachpa ien ”P6
“In e es ing o he apeu ic econcilia ion,al hough heseaspec sa e
al eady akenin oaccoun .I canse emo easaguide han o usein
p ac ice”P4
A
PAI5;0.0005;0.000BCB
“The ea emanyques ions ha weal eadyaskindailyp ac ice”P5
“I indi e yeasy ouse,clea ,simple;I hinki couldbea
complemen oMAI”P10
B
Aus alian
P esc ibing
Indica o s
Tool
3;0.5613;0.519CCB
“Time‐consuming,andi susemayno alwaysbe easible.Con ains
e yuse ulin o ma ion o my echnical‐scien i icde elopmen ”P13
“I isa ooleng hyPAT”P9
“Iconside hisPATimp ac ical oconsul due oi so ganiza ionby
s a emen sandno bymedica ions,physiologicalsys emso
he apeu icclasses”P6
C
Bee sc i e ia7;0.2927;0.292AAA
“Qui eadequa e o he eali yo LTC.Al houghi is hebes known
amongheal hp o essionalsand hisimplies ha hep esc ip ionsa e
e ymuchinlinewi h hisc i e ion,Ibelie ei suseis undamen al”
P1
“Ve yuse ul,jus missing hesugges iono al e na i e”P4
A
FORTA7;0.0007;0.09AAA
“Goodins umen o medica ion e iewin heelde lyandbasedona
diagnosis.Facili a o o doc o ‐pha macis andnu se‐pha macis
in e ac ions”P13
“Ve yo ganizedandquickandeasy oconsul ”P2
A
La oche
c i e ia7;0.0007;0.000AAA
“Ve yuse ulandeasy oapplyinmydailyp o essionalp ac ice.I s
mainad an ageis he ac ha i p esen s he easons o non‐
sui abili yandwha a e hesa es al e na i es”P6
“I hasagoodcomp omisebe weenex ension, easonsand
al e na i es”P3
A
McLeod
c i e ia6;0.2176;0.217ABB“Iapp ecia e hisPATbecausei o e sal e na i es, he iskassocia ed
oPIMsand hes a is icsabou heconsensus”P9B
Pha macy2021,9,1948o 15
P esc ibing‐
Assessmen
Tool
Round1
MedianRa ing
(13
Pa icipan s);
Disag eemen
Index
Round2
Median
Ra ing
(13
Pa icipan s)
;
Disag eeme
n Index
Face‐ o‐FacePanels
App op ia e(A),
Unce ain(B)o In‐
app op ia e(C) Rep esen a i eQuo a ions
App op ia e(A ),
Unce ain(B )o
Inapp op ia e
(C ) o LTC
Pha macy
P ac ice
Panel
1
Panel
2
Panel
3
“I iso ganizedbyinco ec p ac iceandno bymedica ion;i isno
sodi ec ,i islessp ac ical”P10
“I canbedi icul oconsul ,bu i isuse ul osugges he apeu ic
al e na i es op esc ibe s”P2
NORGEP3;0.6523;0.652CCC“I didn’ seem e yuse ul omedue oi sspa seco e age”P4
“Li lein o ma ioncompa ed oo he c i e ia”P11C
Poudel
c i e ia8;0.2928;0.292AAA
“ThisPATis e yin e es ingbecausei hasindica ions o
wi hd awal egimens,inaddi ion o he apeu ical e na i es”P2
“I complemen s heBee sc i e iabyp esen ingsugges ionso d ug
ape ing.Mo eo e ,i p esen s he apeu ical e na i es,simila o
La oche’sc i e ia”P12
A
Rancou
c i e ia5;0.8515;0.851BBB
“I indi in e es ingin e mso posology–du a iono ea men and
dosage–asaway osensi ize hedoc o ”P13
“I isno e yin e es ing,asi didno sugges al e na i eso gi e
guidance,compa ed oo he PATs”P4
“I isno o allyincomple ebecausei conside sin e ac ionsand
dosages”P6
B
STOPP/STAR
T7;0.1647;0.164AAA
“Easy oconsul sincei iso ganizedbyphysiologicalsys ems.I also
has head an ageo allowing heiden i ica iono po en ial
p esc ibingomissions”P6
“Comple eandwi hclea indica ionso ac ions”P10
A
Wini ‐
Wa jana
c i e ia
5;0.9684;0.519BBC
“I summa izes hemos signi ican in e ac ionsandad e se
eac ions,beinguse ul o aconsul a ion”P5
“Nowadayslis ingin e ac ionsdoesn’ makemuchsensebecausewe
ha esea chengines o in e ac ions”P10
“Doesno p oposeal e na i es.Jus men ionMPIsandsome
in e ac ions”P13
B
APID5;0.9685;0.968BBB
“Weo endono ha eda aonadmissionabou hepa ien oanswe
heseques ions”P6
“I shouldincludesi ua ionso exace ba ion(e.g.,deli ium)”P12
B
Holmes
c i e ia5;0.8515;0.851BBB“In o ma i eanduse ‐ iendly”P10
“Ve yli lein o ma ion[...]dependsoneachcase”P4B
K oge
c i e ia6;0.5196;0.376BBA
“I isanadequa ePATbecausei o e ssomejus i ica ionand
a ionale o heuseo medica ion”P9
“Mo ein e es ing o echnicalde elopmen han o p ac ical
applica ion”P4
B
3.4.Rele an Cha ac e is icso PATs
Se e alcha ac e is icso in e es eme ged omcommen sand ace‐ o‐ acemee ings
quali a i eanalysis(Table3).
Table3.P esc ibing‐Assessmen Tools’use ulcha ac e is icsand ep esen a i equo a ions.
P esc ibing‐Assessmen Tools’
Use ulCha ac e is icRep esen a i eQuo a ions
Le elso e idence [FORTA]becausei iso ganizedbyle elo e idence(P7)
[...]ha ing head an ageo p esen ing hele elo e idence(P8,onBee s’)
Doseanddu a iono ea men
Iconside i a e ycomple eand aluablec i e ionasi conside s ac o ssuchasdoseand
du a iono ea men (P8onRancou ’s)
I indi e yin e es ingbecausei conside sdailydoseandallows ochoosebe e posology
(P13,onDBI’s)
Pha macy2021,9,1949o 15
P esc ibing‐Assessmen Tools’
Use ulCha ac e is icRep esen a i eQuo a ions
Use ulbecausei gi esamaximumo days,andmany imesphysicianswan ouse
an ibio icsmo edays han hosep econized(P3,onLoeb’s)
Sco ingsys em
[…]a“sco e”,i.e.,aquan i iable alue,g ea ly acili a esdiscussionwi hphysicianswhen
deli e ing he apeu ic econcilia ion, o example(P12,onATRIA’s)
Reasons o PIMclassi ica ion
Con ains e yuse ulin o ma ionsuchas easons o PIMclassi ica ion(P13,on
La oche’s)
P esen s he easonswhy hemedicineispo en iallyinapp op ia e(P8,onBee s’)
Inclusiono al e na i es oPIMs
Ve yuse ul,only hesugges iono al e na i esismissing(P4,onBee s’)
sugges s he apeu ical e na i es(P1,onLa oche’s)
I isahelp ulPATbecausei sugges s he apeu icalal e na i es(P9,onLa oche’s)
[...]sugges s he apeu icalal e na i e[...](P5,onMcLeod’s)
[...]i o e s he apeu icalal e na i es[...](P9,onMcLeod’s)
[...]p esen s he apeu icalal e na i es,simila ly oLa oche’s(P12,onPoudel’s)
I doesno sugges al e na i es;jus men ionPIMsandin e ac ions(P13,onWini ‐
Wa jana’s)
[...]ahelp ulPATshouldinclude he apeu icalal e na i es(P3,McLeod)
Con ains aluablein o ma ionsuchasal e na i emedicines(P13,onLa oche’s)
I sugges s he apeu icalal e na i es(P13,onPoudel’s)
I doesno ha eal e na i es;Iconside i a“lowe e sion”(P12,onWini ‐Wa jana’s)
O ganisedbymedicinesg oups
Iconside hisc i e ionmo ecomplex oconsul becausei iso ganizedbyinapp op ia e
p ac iceandno bymedicine, he apeu icindica ion,o physiologicalsys em(P8,on
McLeod’s)
Ip e e a ool ha e alua esbypha maco he apeu icg oupandno somuchbypa hology
becausewhenI’me alua ingap esc ip ion,Ie alua emedicinebymedicineand,i a
ques iona ises,i willhelpme oha eaPATby hepha maco he apeu icg oup oconsul
andp e e ably,wi hal e na i esincaseyou indsome hingw ong(P10)
APATo ganizedbypha maco he apeu icg oupshelpsmo e;i makesi simple (P13)
I seemed obe hemos o ganizedasi isdi idedin o he apeu icg oups(P3,on
McLeod’s)
Easy oconsul asi iso ganizedby he apeu icg oups(P2,onPoudel’s)
Inclusiono iskassocia edwi h
PIM
I ind hisPATin e es ingbecausei men ions he isk o hepa ien (P5,onMcLeod’s)
I includes he isk o hepa ien […](P9,onMcLeod’s)
I has he iskassocia edwi h hepa ien (P3,McLeod’s)
O ganisedbydisease/synd omeIp e e adisease‐o ien edPAT(P11)
I includes hemos p e alen diseaseson heLTCna ionalne wo k(P1,onFORTA’s)
ConsensusonPIM/al e na i e
I includes hepanelag eemen on hePIMal e na i e(P5,onMcLeod’s)
I includess a is icsabou heconsensuson heuseo apa icula medicine(P9,on
McLeod’s)
Wi hd awal egimens
I hasindica ionsonhow owi hd aw hePIM,beingadi e en ia ing ac o om heo he
PATs(P5,onPoudel’s)
Inaway,i complemen s heBee s’c i e ia,asi sugges swi hd awal egimens(P12,on
Poudel’s)
I sugges swi hd awal egimens(P13,onPoudel’s)
Fou maing oupso po en ialde e minan shinde ing heuseo PATsha ealsobeen
iden i ied h oughquali a i eanalysis(Table4).
Table4.Po en ialde e minan shinde ingP esc ibing‐Assessmen Tooluse.
Po en ialPATsUseHinde sRep esen a i eQuo a ions
