@article{8766573,
  abstract     = {{Background and Objective Prescribing cascades occur when a drug is prescribed to manage side effects of another drug, typically when a side effect is misinterpreted as a new condition. A consensus list of clinically important prescribing cascades that adversely affect older persons’ health (i.e., where risks of the prescribing cascade usually exceed benefits) was developed to help identify, prevent, and manage prescribing cascades.
Methods Three rounds of a modified Delphi process were conducted with a multidisciplinary panel of 38 clinicians from
six countries with expertise in geriatric pharmacotherapy. The clinical importance of 139 prescribing cascades was assessed in Round 1. Cascades highly rated by ≥ 70% of panelists were included in subsequent rounds. Factors influencing ratings in Rounds 1 and 3 were categorized. After three Delphi rounds, highly rated prescribing cascades were reviewed by the study team to determine the final list of clinically important cascades consistent with potentially inappropriate prescribing.
Results After three rounds, 13 prescribing cascades were highly rated by panelists. Following a study team review, the final tool includes nine clinically important prescribing cascades consistent with potentially inappropriate prescribing. Panelists reported that their ratings were influenced by many factors (e.g., how commonly they encountered the medications involved and the cascade itself, the severity of side effects, availability of alternatives). The relative importance of these factors in determining clinical importance varied by panelist.
Conclusions A nine-item consensus-based list of clinically important prescribing cascades, representing potentially inappropriate prescribing, was developed. Panelists’ decisions about what constituted a clinically important prescribing cascade were multi-factorial. This tool not only raises awareness about these cascades but will also help clinicians recognize these and other important prescribing cascades. This list contributes to the prevention and management of polypharmacy and medication-related harm in older people.}},
  author       = {{McCarthy, Lisa and Savage, Rachel and Dalton, Kieran and Mason, Robin and Li, Joyce and Lawson, Andrea and Wu, Wei and Sternberg, Shelley A. and Byrne, Stephen and Petrovic, Mirko and Onder, Graziano and Cherubini, Antonio and O’Mahony, Denis and Gurwitz, Jerry and Pegreffi, Francesco and Rochon, Paula}},
  issn         = {{1170-229X}},
  journal      = {{DRUGS & AGING}},
  keywords     = {{prescribing cascades,older people,polypharmacy,inappropriate prescribing,ThinkCascades,STOPP/START CRITERIA,APPROPRIATENESS}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{829--840}},
  title        = {{ThinkCascades : a tool for identifying clinically important prescribing cascades affecting older people}},
  url          = {{http://doi.org/10.1007/s40266-022-00964-9}},
  volume       = {{39}},
  year         = {{2022}},
}

Altmetric

View in Altmetric

Web of Science

Times cited: