TY - BOOK T1 - Sterbeverfügung praxisbezogen T2 - Umfassende juristische und medizinische Information zum Sterbeverfügungsgesetz Y1 - 2023 A1 - Stefanie Fasching A1 - Wilfried M. Tschiggerl AB -

Umfassende juristische und medizinische Information zum Sterbeverfügungsgesetz

Inhalt:
Selbstbestimmtes Sterben in Österreich
Die Sterbeverfügung
Hilfeleistung i. S. d. StVfG
Die ärztliche Aufklärung gem. StVfG: Umfang, Dokumentation, Das ärztliche Aufklärungsgespräch,
Das Präparat, Die Begleitmedikation, etc.
Medizinisches Fachpersonal als Hilfe leistende Person
Die Totenbeschau
Verweise und Links

https://www.allmed.at/info-arzt/dfp-fortbildung/fachthemen/stvf-praxis

JF - Umfassende juristische und medizinische Information zum Sterbeverfügungsgesetz PB - Ärztekammer für Kärnten und Österreichisches Institut für Allgemeinmedizin (ÖIfAM) ER - TY - JOUR T1 - Diagnostic protocols—A consultation tool still to be discovered JF - Journal of evaluation in Clinical Practice Y1 - 2017 A1 - Waltraud Fink A1 - Gustav Kamenski A1 - M. Konitzer KW - consultation KW - Diagnostic ER - TY - JOUR T1 - [Health disorders and their prevalence in two primary care practices from the perspective of different coding]. JF - Wien Med Wochenschr Y1 - 2017 A1 - Fink, Waltraud A1 - Kasper, Otto A1 - Kamenski, Gustav KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Austria KW - Child KW - Child, Preschool KW - Clinical Coding KW - Cross-Sectional Studies KW - Episode of Care KW - Female KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Morbidity KW - Primary Health Care KW - Referral and Consultation KW - Rural Health Services KW - Young Adult AB -

Family practices provide medical care for the majority of health problems. This already highlights the importance of primary health care with respect to quantity. A detailed five-year survey of cases in two rural practices gives insight into everyday practice. During the whole period of this year's prevalence survey, 24,541 or 32,605 episodes of care were recorded in a mean practice population of 1500 or 1700 persons, respectively. The frequency rates of more than 500 different health problems show a typical Pareto distribution. This distribution of the cases characterizes the subject of general practice/family medicine and essentially determines handling illness in practice. Lack of a common technical language, with regard to the classification of health disorders, becomes evident when comparing the practices. An issue whose impact on medical care, education and research should be further investigated.

VL - 167 UR - http://link.springer.com/article/10.1007/s10354-017-0567-1 IS - 13-14 U1 - https://www.ncbi.nlm.nih.gov/pubmed/28493140?dopt=Abstract ER - TY - JOUR T1 - Interventions to reduce inappropriate polypharmacy: Implications for research and practice. JF - Maturitas Y1 - 2017 A1 - Johansson, Tim A1 - Flamm, Maria A1 - Sönnichsen, Andreas A1 - Schuler, Jochen VL - 97 U1 - https://www.ncbi.nlm.nih.gov/pubmed/28081964?dopt=Abstract ER - TY - JOUR T1 - Impact of strategies to reduce polypharmacy on clinically relevant endpoints: a systematic review and meta-analysis. JF - Br J Clin Pharmacol Y1 - 2016 A1 - Johansson, Tim A1 - Abuzahra, Muna E A1 - Keller, Sophie A1 - Mann, Eva A1 - Faller, Barbara A1 - Sommerauer, Christina A1 - Höck, Jennifer A1 - Löffler, Christin A1 - Köchling, Anna A1 - Schuler, Jochen A1 - Flamm, Maria A1 - Sönnichsen, Andreas KW - Aged KW - Drug-Related Side Effects and Adverse Reactions KW - Hospitalization KW - Humans KW - Inappropriate Prescribing KW - Outcome Assessment, Health Care KW - Polypharmacy KW - Practice Patterns, Physicians' KW - Randomized Controlled Trials as Topic AB -

AIM: The aim of the present study was to explore the impact of strategies to reduce polypharmacy on mortality, hospitalization and change in number of drugs.

METHODS: Systematic review and meta-analysis: a systematic literature search targeting patients ≥65 years with polypharmacy (≥4 drugs), focusing on patient-relevant outcome measures, was conducted. We included controlled studies aiming to reduce polypharmacy. Two reviewers independently assessed studies for eligibility, extracted data and evaluated study quality.

RESULTS: Twenty-five studies, including 10 980 participants, were included, comprising 21 randomized controlled trials and four nonrandomized controlled trials. The majority of the included studies aimed at improving quality or the appropriateness of prescribing by eliminating inappropriate and non-evidence-based drugs. These strategies to reduce polypharmacy had no effect on all-cause mortality (odds ratio 1.02; 95% confidence interval 0.84, 1.23). Only single studies found improvements, in terms of reducing the number of hospital admissions, in favour of the intervention group. At baseline, patients were taking, on average, 7.4 drugs in both the intervention and the control groups. At follow-up, the weighted mean number of drugs was reduced (-0.2) in the intervention group but increased (+0.2) in controls.

CONCLUSIONS: There is no convincing evidence that the strategies assessed in the present review are effective in reducing polypharmacy or have an impact on clinically relevant endpoints. Interventions are complex; it is still unclear how best to organize and implement them to achieve a reduction in inappropriate polypharmacy. There is therefore a need to develop more effective strategies to reduce inappropriate polypharmacy and to test them in large, pragmatic randomized controlled trials on effectiveness and feasibility.

VL - 82 IS - 2 U1 - https://www.ncbi.nlm.nih.gov/pubmed/27059768?dopt=Abstract ER - TY - Generic T1 - Opportunistisches- vs. Recall-System beim Zervixkarzinom-Screening Y1 - 2016 A1 - Theresa Drexel ED - Christoph Fischer KW - Cervixkarzinom JF - Tiroler Gesellschaft für Allgemeinmedizin PB - Medizinische Universität Innsbruck CY - Innsbruck VL - Doktorin der gesamten Heilkunde (Dr. med. univ.) ER - TY - JOUR T1 - Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): study protocol for a cluster-randomised controlled trial. JF - Implement Sci Y1 - 2015 A1 - Richter, Christin A1 - Berg, Almuth A1 - Fleischer, Steffen A1 - Köpke, Sascha A1 - Balzer, Katrin A1 - Fick, Eva-Maria A1 - Sönnichsen, Andreas A1 - Löscher, Susanne A1 - Vollmar, Horst Christian A1 - Haastert, Burkhard A1 - Icks, Andrea A1 - Dintsios, Charalabos-Markos A1 - Mann, Eva A1 - Wolf, Ursula A1 - Meyer, Gabriele KW - Accidental Falls KW - Antipsychotic Agents KW - Costs and Cost Analysis KW - Dementia KW - Drug Utilization KW - Germany KW - Homes for the Aged KW - Humans KW - Inservice Training KW - Mental Disorders KW - Nursing Homes KW - Patient-Centered Care KW - Psychomotor Agitation KW - Quality of Life KW - Research Design AB -

BACKGROUND: The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany, antipsychotic drugs are regularly prescribed as first-line treatment of neuropsychiatric symptoms in persons with dementia, although guidelines clearly prioritise non-pharmacological interventions. Frequently, antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. The aim of the study is to investigate whether a person-centred care approach, successfully evaluated in nursing homes in the United Kingdom, can be implemented in German nursing homes and, in comparison with a control group, can result in a clinically relevant reduction of the proportion of residents with antipsychotic prescriptions.

METHODS/DESIGN: The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial training on person-centred care and ongoing training and support programme) with a control group. Both study groups will receive, as optimised usual care, a medication review by an experienced psychiatrist/geriatrician providing feedback to the prescribing physician. Overall, 36 nursing homes in East, North, and West Germany will be randomised. The primary outcome is the proportion of residents receiving at least one antipsychotic prescription (long-term medication) after 12 months of follow-up. Secondary outcomes are residents' quality of life, agitated behaviour, as well as safety parameters like falls and fall-related medical attention. A health economic evaluation and a process evaluation will be performed alongside the study.

DISCUSSION: To improve care, a reduction of the current high prescription rate of antipsychotics in nursing homes by the intervention programme is expected.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT02295462.

VL - 10 U1 - https://www.ncbi.nlm.nih.gov/pubmed/26037324?dopt=Abstract ER - TY - JOUR T1 - The impact of preoperative testing for blood glucose concentration and haemoglobin A1c on mortality, changes in management and complications in noncardiac elective surgery: a systematic review. JF - Eur J Anaesthesiol Y1 - 2015 A1 - Bock, Matthias A1 - Johansson, Tim A1 - Fritsch, Gerhard A1 - Flamm, Maria A1 - Hansbauer, Bernhard A1 - Mann, Eva A1 - Sönnichsen, Andreas KW - Biomarkers KW - Blood Glucose KW - Diabetes Mellitus KW - Elective Surgical Procedures KW - Glycated Hemoglobin KW - Humans KW - Orthopedic Procedures KW - Predictive Value of Tests KW - Preoperative Care KW - Risk Assessment KW - Risk Factors KW - Time Factors KW - Treatment Outcome KW - Vascular Surgical Procedures AB -

BACKGROUND: The risks associated with surgery are elevated in patients with diabetes mellitus. For this reason, preoperative diagnostics frequently include the measurement of blood glucose and haemoglobin A1c (HbA1c), but it is unclear whether these tests contribute to improved perioperative or postoperative outcomes.

OBJECTIVES: This systematic review aimed to evaluate the evidence that preoperative testing for blood glucose and HbA1c might influence the following outcome parameters: changes in clinical management; mortality; and the incidence of perioperative and postoperative complications in patients undergoing elective, noncardiac surgery.

DESIGN: We performed a systematic search of the literature from January 2001 to March 2013, thus updating a review carried out by the National Institute for Health and Clinical Excellence (NICE) up to the year 2001.

ELIGIBILITY CRITERIA: Controlled studies including cohort and case-control studies with a population of at least 60 patients were eligible.

RESULTS: The search retrieved 1346 records (including hand-search). Twenty-two studies met all inclusion criteria and were included in the review. Fifteen cohort and two case-control studies evaluated the effectiveness of preoperative blood glucose testing and nine studies the effectiveness of testing HbA1c. Four of the included studies evaluated both tests. There were no data derived from high-quality studies supporting routine preoperative testing for blood glucose or HbA1c in otherwise healthy adult patients undergoing elective noncardiac surgery. Only in vascular and orthopaedic surgery may screening identify patients at an increased risk.

CONCLUSION: Preoperative blood glucose testing and testing for HbA1c is not required in nondiabetic patients unless there are clinical sings arousing suspicion. Patients scheduled for vascular and orthopaedic surgery carry an elevated risk justifying preoperative testing for blood glucose or HbA1c as a screening tool.

VL - 32 IS - 3 U1 - https://www.ncbi.nlm.nih.gov/pubmed/25046561?dopt=Abstract ER - TY - JOUR T1 - Physicians' exodus: why medical graduates leave Austria or do not work in clinical practice. JF - Wien Klin Wochenschr Y1 - 2015 A1 - Scharer, Sebastian A1 - Freitag, Andreas KW - Attitude of Health Personnel KW - Austria KW - Career Choice KW - Curriculum KW - Education, Medical, Graduate KW - Emigration and Immigration KW - Faculty, Medical KW - General Practice KW - Health Care Reform KW - Humans KW - Job Satisfaction KW - Licensure, Medical KW - Medicine KW - National Health Programs KW - Physician's Role KW - Specialty Boards KW - Students, Medical AB -

BACKGROUND: Austria has the highest number of medical graduates of all Organisation for Economic Co-operation and Development (OECD) countries in relation to its population size, but over 30% choose not to pursue a career as physicians in the country.

OBJECTIVE AND RESEARCH DESIGN: This article describes under- and postgraduate medical education in Austria and analyses reasons for the exodus of physicians.

MEDICAL EDUCATION: In Austria, medicine is a 5- or 6-year degree offered at four public and two private medical schools. Medical graduates have to complete training in general medicine or a speciality to attain a licence to practice. While not compulsory for speciality training, board certification in general medicine has often been regarded as a prerequisite for access to speciality training posts.

ANALYSIS: Unstructured postgraduate training curricula, large amounts of administrative tasks, low basic salaries and long working hours present for incentives for medical graduates to move abroad or to work in a non-clinical setting. The scope of current reforms, such as the establishment of a new medical faculty and the implementation of a common trunk, is possibly insufficient in addressing the issue.

CONCLUSION: Extensive reforms regarding occupational conditions and the structure of postgraduate medical education are necessary to avoid a further exodus of junior doctors.

VL - 127 IS - 9-10 U1 - https://www.ncbi.nlm.nih.gov/pubmed/25931135?dopt=Abstract ER - TY - ABST T1 - Versorgungsmodell für Betroffene mit Chronisch-Entzündlichen Darmerkrankungen in Wien – Interdisziplinär konsentierte Versorgungspfade gemäß der Wiener Zielsteuerung Gesundheit Y1 - 2015 A1 - Vogelsang, Harald A1 - Maier, Manfred A1 - Novacek, Gottfried A1 - Feichtenschlager, Thomas A1 - Pichlhöfer, Otto A1 - Beyer, Anita A1 - Gross, Evelyn A1 - Linsbichler, Susanna A1 - Sokele, Sigrid A1 - Stift, Anton A1 - Pichlbauer, Ernest G ER - TY - JOUR T1 - Compliance with trial registration in five core journals of clinical geriatrics: a survey of original publications on randomised controlled trials from 2008 to 2012. JF - Age Ageing Y1 - 2014 A1 - Mann, Eva A1 - Nguyen, Natalie A1 - Fleischer, Steffen A1 - Meyer, Gabriele KW - Geriatrics KW - Guideline Adherence KW - Guidelines as Topic KW - Humans KW - Periodicals as Topic KW - Publication Bias KW - Randomized Controlled Trials as Topic KW - Registries KW - Research Design AB -

OBJECTIVE: to assess the proportion of registered randomised controlled trials in five core clinical geriatric journals and to analyse whether registered study outcomes correspond with published outcomes.

DESIGN: survey of original papers published 2008 to 2012.

METHODS: two independent reviewers retrieved the sample through search in the web-based archives of Age and Ageing, the Journal of the American Geriatric Society, the American Journal of Geriatric Psychiatry, the Journal of the American Medical Directors Association and International Psychogeriatrics. Data extraction was performed by two independent reviewers using a pre-tested 13-item checklist. Registration status was checked and information provided in registers compared with information presented in the original publication. A third reviewer was consulted if no consensus could be reached.

RESULTS: the sample comprised 220 original publications on randomised controlled trials. A total of 140 (63.6%) were registered. Registration was in accordance with the ICMJE requirements in 54 out of 140 registered trials (38.6%). Less than one-third of registered papers (n = 40) reported on all study outcomes listed in the study register. In 74 out of the 80 non-registered trials, the missing registration was not declared in the publication. There was no consistent upward trend towards higher registration compliance throughout journals and years.

CONCLUSION: our survey shows that prospective trial registration and compliance between outcomes declared in the registry and reported in the publication is poor. Concerted action of authors, editors and peer-reviewers is overdue aimed to irreversibly implement the imperative of registration of randomised controlled trials and complete outcome reporting.

VL - 43 IS - 6 U1 - https://www.ncbi.nlm.nih.gov/pubmed/24982096?dopt=Abstract ER - TY - RPRT T1 - Möglichkeiten und Grenzen des Brustkrebsscreening Y1 - 2014 A1 - Rabady, Susanne A1 - Andrea Fried ED - Gerald Gartlehner ED - Michael Stierer ED - Irmgard Schiller-Frühwirt ED - Andrea Siebenhofer-Kroitzsch ED - Herbert Bachler ED - Reinhold Glehr KW - Bias KW - Brustkrebs KW - Früherkennung KW - Mammakarzinom KW - Mammographie KW - Screening PB - Österreichische Gesellschaft für Allgemeinmedizin (ÖGAM) CY - Wien ER - TY - JOUR T1 - Effectiveness of non-cardiac preoperative testing in non-cardiac elective surgery: a systematic review. JF - Br J Anaesth Y1 - 2013 A1 - Johansson, T A1 - Fritsch, G A1 - Flamm, M A1 - Hansbauer, B A1 - Bachofner, N A1 - Mann, E A1 - Bock, M A1 - Sönnichsen, A C KW - C-Reactive Protein KW - Elective Surgical Procedures KW - Hematocrit KW - Hemoglobins KW - Humans KW - Kidney Function Tests KW - Leukocyte Count KW - Liver Function Tests KW - Preoperative Care KW - Randomized Controlled Trials as Topic AB -

Elective surgery is usually preceded by preoperative diagnostics to minimize risk. The results are assumed to elicit preventive measures or even cancellation of surgery. Moreover, physicians perform preoperative tests as a baseline to detect subsequent changes. This systematic review aims to explore whether preoperative testing leads to changes in management or reduces perioperative mortality or morbidity in unselected patients undergoing elective, non-cardiac surgery. We systematically searched all relevant databases from January 2001 to February 2011 for studies investigating the relationship between preoperative diagnostics and perioperative outcome. Our methodology was based on the manual of the Ludwig Boltzmann Institute for Health Technology Assessment, the Scottish Intercollegiate Guidelines Network (SIGN) handbook, and the PRISMA statement for reporting systematic reviews. One hundred and one of the 25 281 publications retrieved met our inclusion criteria. Three test grid studies used a randomized controlled design and 98 studies used an observational design. The test grid studies show that in cataract surgery and ambulatory surgery, there are no significant differences between patients with indicated preoperative testing and no testing regarding perioperative outcome. The observational studies do not provide valid evidence that preoperative testing is beneficial in healthy adults undergoing non-cardiac surgery. There is no evidence derived from high-quality studies that supports routine preoperative testing in healthy adults undergoing non-cardiac surgery. Testing according to pathological findings in a patient's medical history or physical examination seems justified, although the evidence is scarce. High-quality studies, especially large randomized controlled trials, are needed to explore the effectiveness of indicated preoperative testing.

VL - 110 IS - 6 U1 - https://www.ncbi.nlm.nih.gov/pubmed/23578861?dopt=Abstract ER - TY - JOUR T1 - Prevalence and associations of potentially inappropriate prescriptions in Austrian nursing home residents: secondary analysis of a cross-sectional study. JF - Wien Klin Wochenschr Y1 - 2013 A1 - Mann, Eva A1 - Haastert, Burkhard A1 - Böhmdorfer, Birgit A1 - Frühwald, Thomas A1 - Iglseder, Bernhard A1 - Roller-Wirnsberger, Regina A1 - Meyer, Gabriele KW - Adult KW - Age Distribution KW - Aged KW - Austria KW - Cognition Disorders KW - Comorbidity KW - Cross-Sectional Studies KW - Diclofenac KW - Female KW - Humans KW - Inappropriate Prescribing KW - Lorazepam KW - Male KW - Middle Aged KW - Nursing Care KW - Nursing Homes KW - Prescriptions KW - Prevalence KW - Psychomotor Agitation KW - Psychotropic Drugs KW - Risk Assessment AB -

BACKGROUND: Potentially inappropriate prescriptions (PIP) are an important cause of adverse medication-related events and increases morbidity, hospitalization, and health care costs, especially in nursing home residents. However, little is known about the associations between PIP and residents' characteristics.

OBJECTIVE: The aim of our study was to analyse the prevalence and associations of PIP with residents' and facilities' characteristics.

METHODS: We performed a secondary analysis of a cross-sectional study with 48 out of 50 eligible nursing homes and 1,844 out of 2,005 eligible residents in a defined rural-urban area in Austria. The Austrian list of potentially inappropriate medications was applied for the evaluation of inappropriate prescribing. Cluster-adjusted multiple regression analysis was used to investigate institutional and residents' characteristics associated with PIP.

RESULTS: Mean cluster-adjusted prevalence of residents with at least one PIP was 70.3 % (95 % CI 67.2-73.4). The number of residents with at least one psychotropic PIP was 1.014 (55 %). The most often prescribed PIP were Prothipendyl (25.9 % residents), Lorazepam (14.5 %) and Diclofenac (6.1 %). Multiple regression analysis showed an inverse association of PIP with cognitive impairment and significant positive associations with permanent restlessness and permanent negative attitude. The associations of PIP with age and male gender were inconsistent. No significant associations were found for PIP and the ratio of staff nurses to residents.

CONCLUSIONS: Our study results confirm that PIP is highly prevalent in the nursing home population. These results urgently call for effective interventions. Initiatives and successful interventions performed in other countries could serve as examples for safer prescribing in residents in Austria.

VL - 125 IS - 7-8 U1 - https://www.ncbi.nlm.nih.gov/pubmed/23536016?dopt=Abstract ER - TY - JOUR T1 - Quality improvement in preoperative assessment by implementation of an electronic decision support tool. JF - J Am Med Inform Assoc Y1 - 2013 A1 - Flamm, Maria A1 - Fritsch, Gerhard A1 - Hysek, Martin A1 - Klausner, Sabine A1 - Entacher, Karl A1 - Panisch, Sigrid A1 - Soennichsen, Andreas C KW - Adult KW - Aged KW - Austria KW - Decision Support Systems, Clinical KW - Diagnostic Tests, Routine KW - Elective Surgical Procedures KW - Female KW - Guideline Adherence KW - Humans KW - Male KW - Middle Aged KW - Practice Guidelines as Topic KW - Preoperative Care KW - Quality Improvement AB -

OBJECTIVES: To evaluate the impact of the electronic decision support (eDS) tool 'PReOPerative evaluation' (PROP) on guideline adherence in preoperative assessment in statutory health care in Salzburg, Austria.

MATERIALS AND METHODS: The evaluation was designed as a non-randomized controlled trial with a historical control group (CG). In 2007, we consecutively recruited 1363 patients admitted for elective surgery, and evaluated the preoperative assessment. In 2008, PROP was implemented and available online. In 2009 we recruited 1148 patients preoperatively assessed using PROP (294 outpatients, 854 hospital sector). Our analysis includes full blood count, liver function tests, coagulation parameters, electrolytes, ECG, and chest x-ray.

RESULTS: The number of tests/patient without indication was 3.39 in the CG vs 0.60 in the intervention group (IG) (p<0.001). 97.8% (CG) vs 31.5% (IG) received at least one unnecessary test. However, we also observed an increase in recommended tests not performed/patient (0.05±0.27 (CG) vs 0.55±1.00 (IG), p<0.001). 4.2% (CG) vs 30.1% (IG) missed at least one necessary test. The guideline adherence (correctly tested/not tested) improved distinctively for all tests (1.6% (CG) vs 49.3% (IG), p<0.001).

DISCUSSION: PROP reduced the number of unnecessary tests/patient by 2.79 which implied a reduction of patients' burden, and a relevant cut in unnecessary costs. However, the advantage in specificity caused an increase in the number of patients incorrectly not tested. Further research is required regarding the impact of PROP on perioperative outcomes.

VL - 20 IS - e1 U1 - https://www.ncbi.nlm.nih.gov/pubmed/23599223?dopt=Abstract ER - TY - JOUR T1 - Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. JF - Wien Klin Wochenschr Y1 - 2012 A1 - Mann, Eva A1 - Böhmdorfer, Birgit A1 - Frühwald, Thomas A1 - Roller-Wirnsberger, Regina E A1 - Dovjak, Peter A1 - Dückelmann-Hofer, Christine A1 - Fischer, Peter A1 - Rabady, Susanne A1 - Iglseder, Bernhard KW - Aged KW - Aged, 80 and over KW - Austria KW - Female KW - Humans KW - Inappropriate Prescribing KW - Male AB -

BACKGROUND: The practice of inappropriate medication and drug prescription is a major risk factor for adverse drug reactions in geriatric patients and increases the individual, as well as overall, rates of hospital admissions, resulting in increased health care expenditures. A consensus-based list of drugs, generally to be avoided in geriatric patients, is a practical tool to possibly improve the quality of prescribing.

OBJECTIVE: The aim was to develop a consensus-based list of potentially inappropriate medications (PIM) for geriatric patients in Austria. Local market characteristics and documented prescribing regimens were considered in detail.

METHODS: A two-round Delphi process involving eight experts in the field of geriatric medicine was undertaken to create a list of potentially inappropriate medications. Using a 5-point Likert scale (from strong agreement to strong disagreement), mean ratings from the experts were evaluated for each drug selected in the first round. The participants were first asked to comment on the potential inappropriateness of a preliminary list of drugs, and to propose alternate substances missing in the previous questionnaire for a second rating process. All drugs whose upper limit of the 95% CI was less than 3.0 were classified as potentially inappropriate. Drugs with a 95% CI enclosing 3.0 entered a second rating by the experts, in addition to other substances suggested during the first questionnaire. Drugs in the second rating were evaluated in comparable fashion to the first one. The final list was synthesized from the results in both rounds.

RESULTS: Out of a preliminary list of 102 drugs, 61 drugs (59.2%) were classified as potentially inappropriate for geriatric persons in the first Delphi- round. In the second rating, six drugs that were reevaluated, and six drugs proposed additionally, were rated as potentially inappropriate. The final list contains 73 drugs to be avoided in older patients because of an unfavorable benefit/risk profile and/or unproven effectiveness. The list also contains suggestions for therapeutic alternatives and information about pharmacological and pharmacokinetic characteristics of all drugs judged as potentially inappropriate.

CONCLUSION: The current Austrian list of potentially inappropriate medications may be a helpful tool for clinicians to increase the quality of prescribing in older patients. Like all explicit lists previously published, its validity needs to be proven in validation studies.

VL - 124 IS - 5-6 U1 - https://www.ncbi.nlm.nih.gov/pubmed/22134410?dopt=Abstract ER -