Background

Early detection and timely resolution of potentially inappropriate prescribing (PIP) prevents adverse outcomes and improves patient care. An explicit tool specifically designed to detect PIP among people with Type 2 Diabetes Mellitus (T2DM) has not been published.

Objectives

This study aims to develop and validate the Inappropriate Medication Prescribing Assessment Criteria for Type 2 Diabetes Mellitus (IMPACT2DM); an explicit tool that can be used to identify PIP for adults with T2DM.

Methods

Current national and international guidelines for the management of T2DM and drug information software programs were used to generate potential items. The content of the IMPACT2DM was validated by 2 consecutive rounds of Delphi method. Physicians and clinical pharmacists experienced in providing care for people with diabetes and authors of selected diabetes guidelines were invited to participate in the Delphi panel. Consensus was assumed if 90% (first round) and 85% (second round) of expert panelists showed agreement to include or exclude an item.

Results

A total of 95 potential items were generated from selected diabetes guidelines and drug information software programs. After the first Delphi round 27 items had ≥90% agreement and were included in the tool; 19 items were considered not PIP and were excluded from the tool. The second round contained 49 items; of these 43 were included and 6 were excluded from the tool. The final IMPACT2DM contains 70 items categorized by type of PIP and arranged in terms of medical conditions and medication classes. IMPACT2DM can be applied using information on medical charts and requires minimal or no clinical knowledge to assess quality of diabetes care and improve medication selection.

Conclusions

IMPACT2DM has been developed from current quality evidence and undergone content validation. It is the first explicit tool specifically designed to identify PIP for adults with T2DM.

中文翻译：

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制定和验证明确的标准，以识别成人 2 型糖尿病潜在的不当处方

背景

及早发现并及时解决潜在的不当处方 (PIP) 可防止不良后果并改善患者护理。专门用于检测 2 型糖尿病 (T2DM) 患者 PIP 的明确工具尚未发布。

目标

本研究旨在制定和验证 2 型糖尿病的不适当药物处方评估标准 (IMPACT2DM)；一种明确的工具，可用于识别成人 T2DM 的 PIP。

方法

当前的国家和国际 T2DM 管理指南和药物信息软件程序用于生成潜在项目。IMPACT2DM 的内容通过 2 轮连续的 Delphi 方法进行验证。在为糖尿病患者提供护理方面经验丰富的医生和临床药剂师以及选定的糖尿病指南的作者被邀请参加德尔福小组。如果 90%（第一轮）和 85%（第二轮）的专家小组成员同意纳入或排除一个项目，则假设达成共识。

结果

从选定的糖尿病指南和药物信息软件程序中产生了总共 95 个潜在项目。在第一轮 Delphi 之后，有 27 个项目的一致性≥90% 并被包含在工具中；19 个项目被认为不是 PIP，因此被排除在工具之外。第二轮包含49个项目；其中 43 个被包括在内，6 个被排除在工具之外。最终的 IMPACT2DM 包含 70 个按 PIP 类型分类的项目，并按照医疗条件和药物类别进行排列。IMPACT2DM 可以使用病历上的信息来应用，并且需要很少或不需要临床知识来评估糖尿病护理的质量和改进药物选择。

结论

IMPACT2DM 是根据当前的质量证据开发的，并经过了内容验证。它是第一个专门设计用于识别成人 T2DM 的 PIP 的明确工具。