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International expert panel’s potentially inappropriate prescribing cascades (PIPC) list

(2025) EUROPEAN GERIATRIC MEDICINE. 16(5). p.1573-1584
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Abstract
PURPOSE: Prescribing cascades contribute to potentially inappropriate prescribing, especially among older adults. With the prescribing cascade framework maturation, it is important to distinguish potentially inappropriate from potentially appropriate prescribing cascades. The objective was to create a comprehensive consensus list of Potentially Inappropriate Prescribing Cascades (PIPCs). METHODS: A prescribing cascade inventory was compiled using published lists. An international panel of 12 experts in geriatric medicine and pharmacology was selected. Panelists participated in a Delphi consensus process completing two questionnaire rounds and one discussion round. RESULTS: A total of 107 proposed prescribing cascades were identified. After Questionnaire Round 1, 56 prescribing cascades achieved a rating of agree or strongly agree by ≥75% of the panelists and were included in the PIPC list. For 32 of the 107 proposed cascades, 50% - 74% of panelists provided a rating of agree or strongly agree, and were moved to Round 2. In Questionnaire Round 2, 9 of 32 proposed cascades achieved a rating of agree or strongly agree by ≥75% of panelists and were included in the final PIPC list. For 14 prescribing cascades, 50-74% of panelists provided a rating of agree or strongly agree, and were included in the Discussion Round. After discussion, no additional prescribing cascades were included. CONCLUSION: An explicit list of 65 PIPCs was created using a rigorous Delphi consensus process conducted by international experts on pharmacotherapy for older adults. The PIPC list provides a crucial tool for clinicians and researchers to detect potentially inappropriate prescribing patterns and to foster efforts to improve medication safety.
Keywords
Prescribing cascade, Delphi consensus, Older adults, Optimizing drug therapy, POLYPHARMACY, PEOPLE

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Citation

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MLA
Rochon, Paula A., et al. “International Expert Panel’s Potentially Inappropriate Prescribing Cascades (PIPC) List.” EUROPEAN GERIATRIC MEDICINE, vol. 16, no. 5, 2025, pp. 1573–84, doi:10.1007/s41999-025-01215-x.
APA
Rochon, P. A., O’Mahony, D., Cherubini, A., Onder, G., Petrovic, M., Dalton, K., … Gurwitz, J. H. (2025). International expert panel’s potentially inappropriate prescribing cascades (PIPC) list. EUROPEAN GERIATRIC MEDICINE, 16(5), 1573–1584. https://doi.org/10.1007/s41999-025-01215-x
Chicago author-date
Rochon, Paula A., Denis O’Mahony, Antonio Cherubini, Graziano Onder, Mirko Petrovic, Kieran Dalton, Lisa M. McCarthy, et al. 2025. “International Expert Panel’s Potentially Inappropriate Prescribing Cascades (PIPC) List.” EUROPEAN GERIATRIC MEDICINE 16 (5): 1573–84. https://doi.org/10.1007/s41999-025-01215-x.
Chicago author-date (all authors)
Rochon, Paula A., Denis O’Mahony, Antonio Cherubini, Graziano Onder, Mirko Petrovic, Kieran Dalton, Lisa M. McCarthy, Shelley A. Sternberg, Donna R. Zwas, Nathan M. Stall, Christina E. Reppas-Rindlisbacher, Nathalie van der Velde, Sarah N. Hilmer, Wei Wu, Joyce Li, Amy Ly, and Jerry H. Gurwitz. 2025. “International Expert Panel’s Potentially Inappropriate Prescribing Cascades (PIPC) List.” EUROPEAN GERIATRIC MEDICINE 16 (5): 1573–1584. doi:10.1007/s41999-025-01215-x.
Vancouver
1.
Rochon PA, O’Mahony D, Cherubini A, Onder G, Petrovic M, Dalton K, et al. International expert panel’s potentially inappropriate prescribing cascades (PIPC) list. EUROPEAN GERIATRIC MEDICINE. 2025;16(5):1573–84.
IEEE
[1]
P. A. Rochon et al., “International expert panel’s potentially inappropriate prescribing cascades (PIPC) list,” EUROPEAN GERIATRIC MEDICINE, vol. 16, no. 5, pp. 1573–1584, 2025.
@article{01K1NNDQ5JR9MMJCXGGW8DG3YP,
  abstract     = {{PURPOSE:  Prescribing cascades contribute to potentially inappropriate prescribing, especially among older adults. With the prescribing cascade framework maturation, it is important to distinguish potentially inappropriate from potentially appropriate prescribing cascades. The objective was to create a comprehensive consensus list of Potentially Inappropriate Prescribing Cascades (PIPCs).    
METHODS:  A prescribing cascade inventory was compiled using published lists.  An international panel of 12 experts in geriatric medicine and pharmacology was selected. Panelists participated in a Delphi consensus process completing two questionnaire rounds and one discussion round.  
RESULTS:  A total of 107 proposed prescribing cascades were identified.  After Questionnaire Round 1, 56 prescribing cascades achieved a rating of agree or strongly agree by ≥75% of the panelists and were included in the PIPC list. For 32 of the 107 proposed cascades, 50% - 74% of panelists provided a rating of agree or strongly agree, and were moved to Round 2. 
In Questionnaire Round 2, 9 of 32 proposed cascades achieved a rating of agree or strongly agree by ≥75% of panelists and were included in the final PIPC list. For 14 prescribing cascades, 50-74% of panelists provided a rating of agree or strongly agree, and were included in the Discussion Round. After discussion, no additional prescribing cascades were included.
CONCLUSION:  An explicit list of 65 PIPCs was created using a rigorous Delphi consensus process conducted by international experts on pharmacotherapy for older adults.  The PIPC list provides a crucial tool for clinicians and researchers to detect potentially inappropriate prescribing patterns and to foster efforts to improve medication safety.}},
  author       = {{Rochon, Paula A. and O’Mahony, Denis and Cherubini, Antonio and Onder, Graziano and Petrovic, Mirko and Dalton, Kieran and McCarthy, Lisa M. and Sternberg, Shelley A. and Zwas, Donna R. and Stall, Nathan M. and Reppas-Rindlisbacher, Christina E. and van der Velde, Nathalie and Hilmer, Sarah N. and Wu, Wei and Li, Joyce and Ly, Amy and Gurwitz, Jerry H.}},
  issn         = {{1878-7649}},
  journal      = {{EUROPEAN GERIATRIC MEDICINE}},
  keywords     = {{Prescribing cascade,Delphi consensus,Older adults,Optimizing drug therapy,POLYPHARMACY,PEOPLE}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1573--1584}},
  title        = {{International expert panel’s potentially inappropriate prescribing cascades (PIPC) list}},
  url          = {{http://doi.org/10.1007/s41999-025-01215-x}},
  volume       = {{16}},
  year         = {{2025}},
}

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