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Background <p>Polypharmacy is common in older persons, and some of the prescribed drugs may be potentially inappropriate medications (PIMs), whose risks outweigh their benefits. It is therefore necessary to review medication intake of older patients and deprescribe the ones that are not appropriate. Although there are many tools for deprescribing, none of these have been developed for the Indian context, where there is widespread use of fixed dose combinations (FDCs), medicines from different systems of medicines, and different levels of healthcare. Also, some of the medications listed in existing tools are not marketed in India, while some which are commonly prescribed in the country are not listed in the tools. We therefore undertook to develop a deprescribing tool for the older persons in India.</p> Methods <p>A draft deprescribing tool was developed through a modified Delphi consensus process by 18 panellists. Item level content validity index (I-CVI) and scale level content validity index (S-CVI) were calculated from the Delphi round 1 and 2 responses. In addition, face and content validity of the tool was carried out by 6 experts and content validity ratio (CVR’) and I-CVI were calculated.</p> Results <p>Our draft Deprescribing tool included 63 drugs/groups organized in three sections-drugs/drug groups to avoid generally in all older patients (39 items), herb-drug interactions (5 interactions) and drugs which should be avoided in renal dysfunction (15 allopathic and 4 herbal medicines). After Delphi process and tool validation, ten drugs/drug groups were removed due to CVR’ value &lt; 0.62 or I-CVI value &lt; 0.67, and recommendations and/or alternatives were modified for nine drugs/groups, so that the final the tool includes 52 items – 30 drugs/drug groups to be avoided in all older persons, 7 herb-drug interactions and 15 drugs to be avoided in renal dysfunction. The scale-level content validity index (S-CVI) was 0.87 for the entire tool, which is higher than the generally acceptable 0.8.</p> Conclusion <p>A deprescribing tool containing drugs/drug groups commonly prescribed and relevant for the older persons in India, including important herb-drug interactions, and restricted to drugs available and prescribed in India, has been developed through the Delphi process followed by tool validation.</p>

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Development and validation of a deprescribing tool relevant to older persons in India using modified Delphi consensus technique

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  • 发表日期：

    2025年12月2日

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  • Ratinder Jhaj,
  • Atiya R. Faruqui,
  • Santanu Kumar Tripathi,
  • Minakshi Dhar,
  • Rajnish Joshi,
  • Bhushan Shah,
  • Snehil Gupta,
  • Rehan Ul-Haq,
  • Danish Javed,
  • Ajay Kumar Shukla,
  • Shubham Atal,
  • Anindo Majumdar,
  • Jerin Jose Cherian,
  • Sowparnika Treasa Sabu,
  • Sandeep Tiwari,
  • Bushra Siddiqui,
  • Padmini Devi D,
  • Ashish Kumar Kakkar,
  • Sandhiya Selvarajan,
  • Arunansu Talukdar,
  • Vishakha Jain,
  • Bidita Khandelwal,
  • Ravi Kirti,
  • Ashish Goel,
  • Vinod Joseph Abraham,
  • Barun Kumar,
  • Satyajit Singh,
  • Kiron Varghese,
  • Tarun Goyal,
  • Pankaj Kandwal,
  • John Ashutosh Santoshi,
  • Nishant Goyal,
  • Palanimuthu Thangaraju Sivakumar,
  • Mathew Varghese,
  • Jaideep Menon,
  • S. P. Dhaneria,
  • Jyotirmoy Pal,
  • Arvind Mathur,
  • Sandeep Grover,
  • Anil Jain

摘要

Background

Polypharmacy is common in older persons, and some of the prescribed drugs may be potentially inappropriate medications (PIMs), whose risks outweigh their benefits. It is therefore necessary to review medication intake of older patients and deprescribe the ones that are not appropriate. Although there are many tools for deprescribing, none of these have been developed for the Indian context, where there is widespread use of fixed dose combinations (FDCs), medicines from different systems of medicines, and different levels of healthcare. Also, some of the medications listed in existing tools are not marketed in India, while some which are commonly prescribed in the country are not listed in the tools. We therefore undertook to develop a deprescribing tool for the older persons in India.

Methods

A draft deprescribing tool was developed through a modified Delphi consensus process by 18 panellists. Item level content validity index (I-CVI) and scale level content validity index (S-CVI) were calculated from the Delphi round 1 and 2 responses. In addition, face and content validity of the tool was carried out by 6 experts and content validity ratio (CVR’) and I-CVI were calculated.

Results

Our draft Deprescribing tool included 63 drugs/groups organized in three sections-drugs/drug groups to avoid generally in all older patients (39 items), herb-drug interactions (5 interactions) and drugs which should be avoided in renal dysfunction (15 allopathic and 4 herbal medicines). After Delphi process and tool validation, ten drugs/drug groups were removed due to CVR’ value < 0.62 or I-CVI value < 0.67, and recommendations and/or alternatives were modified for nine drugs/groups, so that the final the tool includes 52 items – 30 drugs/drug groups to be avoided in all older persons, 7 herb-drug interactions and 15 drugs to be avoided in renal dysfunction. The scale-level content validity index (S-CVI) was 0.87 for the entire tool, which is higher than the generally acceptable 0.8.

Conclusion

A deprescribing tool containing drugs/drug groups commonly prescribed and relevant for the older persons in India, including important herb-drug interactions, and restricted to drugs available and prescribed in India, has been developed through the Delphi process followed by tool validation.