Development of explicit definitions of potentially inappropriate prescriptions for antidiabetic drugs in people with type 2 diabetes: A Delphi survey and consensus meeting.

Abstract

Explicit definitions for potentially inappropriate prescriptions (PIPs) are useful for optimizing drug use. The objective of the present study was to validate a list of definitions of PIPs for antidiabetic drugs in a Delphi survey with general practitioners, diabetologists, community pharmacists, hospital pharmacists and pharmacologists from mainland France, Belgium, and Switzerland. The experts gave their opinion on each explicit definition and could suggest new definitions. Definitions with a 1-to-9 Likert score of between 7 and 9 from at least 75% of the participants were validated. The results were discussed during consensus meetings after each round. 46 participants were recruited, and 38 (82.6%) completed the survey. The Delphi survey resulted in a consensus list of 41 explicit definitions of PIPs for antidiabetic drugs in four groups: (i) the need to temporarily discontinue a medication in the event of acute illness (n = 9; 22%), (ii) the need to review and adjust the dosing regimen (n = 26; 36.6%), (iii) the initiation of an inappropriate drug (n = 3; 7.3%), and (iv) the need for further monitoring of a people with type 2 diabetes (n = 3; 7.3%). The list is specific for antidiabetic drugs (other than insulin) for people with type 2 diabetes. This explicit list could be implemented in a clinical decision support system for the automatic detection of PIPs and might help healthcare professionals involved in the management of people living with type 2 diabetes.