Development and validation of PolyScan, an information technology triage tool for older adults with polypharmacy: a healthcare informatics study
Lisheng Liu
1 2 , Rashmi Alate 3 , Jeff Harrison 1 *
1 School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
2 Primary, Public and Community Health, MidCentral District, Te Whatu Ora, PO Box 2056, Palmerston North 4440, New Zealand.
3 Data Quality and Health Information Team, MidCentral District, Te Whatu Ora, PO Box 2056, Palmerston North 4440, New Zealand.
Journal of Primary Health Care 15(3) 215-223 https://doi.org/10.1071/HC23034
Published: 11 July 2023
Abstract
Polypharmacy is associated with potentially inappropriate medicine prescribing and avoidable medicine-related harm. Polypharmacy should not be perceived as inherently harmful. Instead, priority should be placed on reducing inappropriate prescribing.
The study aimed to develop and validate PolyScan, a primary care information technology tool, to triage older adults with polypharmacy who are prescribed potentially inappropriate medicines.
Twenty-one indicators from a New Zealand criteria of potentially inappropriate medicines to correct for older adults with polypharmacy were developed into a set of implementable definitions. The definitions were applied as algorithmic logic statements used to interrogate hospital and emergency department records and pharmaceutical collection data to classify whether each indicator was present at an individual patient level, and then triage individuals based on the number of indicators met. Validity was evaluated by comparing PolyScan’s accuracy against a manual review of healthcare records for 300 older adults.
PolyScan was successfully implemented as a tool that can be used to identify potentially inappropriate prescribing in older adults with polypharmacy at different levels of aggregation. The tool has utility for individual practitioners delivering patient care, primary care organisations undertaking quality improvement programmes, and policymakers considering system-level interventions for medicines-related safety. During the validity assessment, PolyScan identified nine individuals (3%) with polypharmacy and indicators of potentially inappropriate medicine. Five unique indicators were detected. PolyScan achieved 100% sensitivity, specificity, and positive and negative predictive values.
PolyScan can support clinicians, clinics, and policymakers with allocation of resources, rational medicine campaigns, and identifying individuals prescribed potentially inappropriate medicines for review.
Keywords: aged, health informatics, inappropriate prescribing, medical informatics, pharmaceutical preparations, polypharmacy, primary health care, triage.
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