Educational Intervention and Development of a Tool to Improve the Use of Potentially Inappropiate Medication in Older Adults

Abstract

[EN] Potentially inappropriate medication (PIM) use among older adults is a widespread challenge associated with increased adverse drug events, hospitalizations, and healthcare costs. This thesis addresses the development, implementation, and evaluation of a multifaceted intervention combining educational strategies with a digital tool, APIMedOlder, aimed at reducing PIM prescription in older patients within primary care settings in Portugal.

Initially, a systematic review of 47 studies identified effective interventions to reduce PIM, highlighting that medication review was most effective in hospital settings, whereas educational strategies yielded better results in primary care. A complementary review on barriers and facilitators to digital health tool adoption identified key factors affecting healthcare professionals engagement, including training needs, time constraints, ease of use, and workflow integration.

A retrospective study comparing established PIM criteria in 1200 Portuguese older adults revealed high PIM prevalence and poor concordance between criteria, emphasizing the complexity of medication management in this population.

The APIMedOlder web application was developed based on the EU(7)-PIM list and assessed for usability by a multidisciplinary group of healthcare professionals, achieving high satisfaction scores and positive feedback regarding its ease of use. Over one year, usage data recorded 400 searches predominantly by pharmacists and physicians, with a significant proportion related to PIM, indicating growing awareness and engagement.

Focus groups with 37 general practitioners revealed five main themes: factors associated with polypharmacy, challenges in deprescribing, problems related to PIM, strategies to manage polypharmacy, and barriers and facilitators to adopting digital tools for medication optimization. Participants highlighted time constraints, limited integration of tools, and inconsistent application of PIM criteria as key challenges, reinforcing the need for accessible and integrated solutions like APIMedOlder to support clinical decision-making.

Finally, a nonrandomized cluster-controlled intervention involving educational sessions and APIMedOlder use suggested a modest short-term reduction in PIM prescribing to older adults by general practitioners, though long-term sustainability appeared limited. These findings underscore the necessity of continuous educational support, system integration, and addressing practical barriers to achieve lasting improvements.

Overall, this research demonstrates that combining targeted educational interventions with user-friendly digital tools offers a promising and scalable approach to enhancing prescribing safety in older adults. Recommendations include integrating APIMedOlder into electronic health record systems, providing ongoing training, and evaluating clinical outcomes over longer periods. Future studies should also explore patient perspectives and leverage emerging technologies to further personalize and optimize medication management in geriatric care.