Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly.
Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly.
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DOI：
10.1007/s40266-013-0146-0
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发表时间：
2014-02
期刊：
影响因子：
2.8
通讯作者：
Wehling, Martin
中科院分区：
文献类型：
--
作者：
Kuhn-Thiel, Alexandra M.;Weiss, Christel;Wehling, Martin
多药治疗和多种药物治疗是老年患者的主要问题;改善药物治疗方案很重要，列表方法（例如Beers列表）被认为可能有用。本研究的目的是进行专家共识验证的FORTA（适合老年人）名单，药物分类结合积极和消极标签的药物长期处方给老年患者。来自德国和奥地利的20名专家、17名老年内科医生和3名老年精神科医生进行了两轮德尔菲程序，评价了分配给190种物质或物质组的标签。根据安全性、有效性和总体年龄适当性的证据状态，这些标签的范围从A（必不可少）、B（有益）、C（可疑）到D（避免）。专家们还被要求提出更多的物质和适应症领域，以供评估和可能列入FORTA清单。为每种物质生成加权（校正）一致系数，以反映（1）与原始标签的一致性，以及（2）评分员标签之间的分布。所有项目和评分员的总体共识为92%（更正）。对于54/190项（28.4%），对于基于原始作者的FORTA标签选择，获得了一致的响应。24种物质（12.6%）未达到共识临界值，并在第二轮中重新评估。这确认了171/190或90%的原始作者为基础的FORTA标签。共有35种新物质也被纳入FORTA清单。用于痴呆和痴呆综合征的药物引起特定的反应异质性。FORTA清单现在反映了专家之间更广泛的共识，增加了其临床使用的有效性。它是一种通过识别不适当和遗漏的药物，从而识别过度治疗和治疗不足，来提高老年患者药物处方质量的工具。FORTA对临床终点影响的验证已经产生了有希望的初步结果，将在正在进行的大型试验中得到证实。本文的在线版本（doi：10.1007/s40266-013-0146-0）包含补充材料，可供授权用户使用。
Multimorbidity and polypharmacy represent a major problem for elderly patients; improvement of medication schemes is important and listing approaches (e.g. Beers list) are considered to be potentially useful. The aim of this study was to perform expert consensus validation of the FORTA (Fit fOR The Aged) List, a drug classification combining positive and negative labelling of drugs chronically prescribed to elderly patients. A two-round Delphi procedure was conducted involving 20 experts, 17 geriatric internists and 3 geriatric psychiatrists from Germany and Austria, evaluating the labels assigned to 190 substances or substance groups. These labels ranged from A (indispensable), B (beneficial), C (questionable) to D (avoid), depending on the state of evidence for safety, efficacy and overall age-appropriateness. The experts were also requested to suggest additional substances and indication areas for assessment and possible inclusion in the FORTA List. A weighted (corrected) consensus coefficient was generated for each substance to reflect (1) agreement with the original label, and (2) distribution among raters’ labels. The overall consensus for all items and raters was 92 % (corrected). For 54/190 items (28.4 %), a unanimous response was achieved as to the original author-based FORTA label choice. Twenty-four substances (12.6 %) fell short of the consensus cutoff and were re-evaluated in a second round. This yielded confirmation of 171/190, or 90 %, of the original author-based FORTA labels. A total of 35 new substances were also accepted for the FORTA List. Drugs used for dementia and dementia syndromes provoked particular response heterogeneity. The FORTA List now reflects a wider consensus among experts, increasing its validity for clinical use. It represents a tool to improve the quality of drug prescription in older patients by identifying both inappropriate and omitted drugs, and thus overtreatment and undertreatment. The validation of FORTA’s impact on clinical endpoints has yielded promising preliminary results, to be corroborated in ongoing larger trials. The online version of this article (doi:10.1007/s40266-013-0146-0) contains supplementary material, which is available to authorized users.
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