Nicole Schönenberger

Background: Polypharmacy is increasingly common across all age groups and is often associated with the use of potentially inappropriate medications (PIMs), where harms may outweigh benefits, contributing to increased adverse drug events, reduced quality of life, and rising health care costs. However, existing deprescribing guidelines and PIM criteria, such as the Beers Criteria and STOPP/START (Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert to Right Treatment), primarily target older adults, overlooking the risks faced by younger populations. Objective: This study aims to develop an international consensus-based list of PIMs for adults aged 18 to 65 years through a modified Delphi process, addressing a critical gap in medication safety and deprescribing guidance. Methods: A 14-member international steering committee developed a preliminary list of candidate PIMs through a literature review and expert input. An international, interdisciplinary Delphi panel of 30 to 40 participants will evaluate this list across 3 survey rounds. Panelists will rate the relevance of potential PIMs using predefined criteria, including the balance of benefits and harms, patient preferences, and the availability of alternatives. Consensus will be defined as a median rating of ≥4 (for inclusion) or ≤2 (for exclusion) on a 5-point Likert scale (1=not relevant to 5=extremely relevant), with an IQR width of ≤1 and at least 70% directional agreement. Items not meeting thresholds will be carried forward to subsequent rounds for reconsideration. Quantitative analyses will summarize ratings and agreement levels, while qualitative free-text responses will undergo content analysis to provide context and capture nuanced perspectives. The process will yield a prioritized list of PIMs for adults aged 18 to 65 years. Results: Panel recruitment was completed between September and October 2025, with 36 participants. Three rounds of data collection were completed between October 2025 and January 2026. Interim analyses were conducted to inform structured feedback between rounds. Final data analysis is ongoing, and consensus results are expected to be reported in late 2026. Conclusions: This Delphi process will yield a consensus-based list of PIMs for adults aged 18 to 65 years, informing the development of an international guideline to support safer prescribing practices and to expand deprescribing efforts beyond geriatric care.

Background: Medication-related problems are especially frequent among home-care patients, who are predominantly older, multimorbid, polymedicated and interact with multiple professionals, necessitating timely, complete and accurate drug information communication. Aim: To pilot a standardised approach to interprofessional home-care medication management focusing on deprescribing. Methods: Home-care patients, cared for in their own homes by one professional nursing agency in the city of Bern, Switzerland, aged ≥ 64 and taking ≥ 4 prescribed medications were assessed for medication-related risk with the interprofessional, 10-item doMESTIC RISK tool. Community pharmacists performed structured medication reviews for at-risk patients, communicating with primary care physicians via standardised form. Results: Nurses initiated 106 risk analyses (as defined in the process) in consenting patients, with 76 (72%) completed by pharmacists; 30 analyses could not be completed due to missing information. Out of 76 patients with a completed risk assessment, 26 patients did not need a medication review; one score was missing. The 49 patients qualifying for a medication review were on average 84.0 ± 7.7 years old and took a mean of 11.2 ± 4.5 prescribed medications regularly and 2.8 ± 3.5 prescribed as-needed medications. Pharmacists identified a median of two problems per patient, suggesting 64 potential interventions. Forty-three priority interventions for 18 patients were communicated to physicians, mostly dose reduction (27%) and therapy cessation (23%). Despite providing comprehensive information in the requests, physicians only reacted to 50% of pharmacists’ recommendations (9/18 patients), accepting 57% of pharmacists suggestions in nine patients, predominantly deprescribing (nine medications). Conclusion: While pharmacists identified medication improvements through structured medication reviews, limited access to clinical information and insufficient communication between health care professionals were key barriers. Strengthening interprofessional collaboration and structured communication through shared platforms allowing clinical data exchange is essential to optimizing medication management in home-care. Clarification of the roles of the team members must be improved.

Purpose: Chronic non-cancer pain (CNCP) is a disabling condition affecting many older adult inpatients. While first-line therapy for CNCP consists of non-pharmacological approaches, many older adults receive pharmacotherapy nevertheless, putting them at a high risk of medication-related problems. Quality indicators (QIs) for the pharmacological management of CNCP could help reduce this risk. This Delphi study aimed to establish the face validity and feasibility of a list of previously developed QIs for the pharmacological management of CNCP in older adult inpatients. Patients and Methods: We followed the RAND/UCLA Delphi study methodology to establish an expert consensus on a list of proposed QIs. Over two written rounds, nursing, pharmacy and medical experts rated the face validity and feasibility of the QIs identified in a previous systematic literature search. QI ratings that were uncertain or disagreed upon after the first round were discussed in three expert focus group discussions. The QIs discussed were rated again in round two, and the most relevant QI in each category was prioritised. Results: Twenty-two experts agreed to participate in the study’s deliberations. Nineteen experts (86%) returned their ratings in each written round, and 9 (41%) participated in the focus groups. They evaluated 61 proposed QIs, modified 11 of them and suggested 13 new ones. The final set consisted of 51 QIs, with the experts prioritising 23 different ones. The 51 QIs covered the categories of general pharmacotherapy and the appropriate use of opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, metamizole and co-analgesics. Conclusion: Through consensus, we developed a first set of QIs for the pharmacological management of CNCP in older adult inpatients. This set will help standardise care, track and benchmark the quality of care, and be used as a trigger to prioritise patients for clinical or pharmacological interventions.

BACKGROUND: Medication-related readmissions are significant burdens on patients and healthcare systems and are particularly prevalent among older adults. We aimed to identify potentially preventable medication-related readmissions and to describe their causes. METHODS: We conducted a retrospective cohort study of 500 randomly selected patients, aged 65 or older, discharged from the general internal medicine department of a university hospital in Switzerland between January 2022 and October 2023 and readmitted within 30 days. Two pharmacists independently screened their electronic health records and analysed whether their readmission was medication-related using the AT-HARM10 tool. We assessed preventability using judgements similar to the Schumock statements. In cases of disagreement between the two pharmacists, readmissions were also screened by a senior physician. We analysed the causes of potentially preventable medication-related readmissions. RESULTS: We identified 116 (23.2%) potentially preventable medication-related readmissions among the 500 readmissions analysed. The most common diagnoses associated with readmission were heart failure (21.6%), worsening pain (12.1%) and infection (12.1%). The most common causes of readmission were underprescribing (29.3%), Other prescribing problems such as suboptimal medication selection or dosage issues (28.4%), and non-adherence (12.9%). Diuretics, analgesics and antibiotics were the most frequently involved medications. CONCLUSIONS: Nearly one-quarter of 30-day readmissions involving older adults were medication-related and potentially preventable. The primary contributing factors were prescribing and non-adherence issues. The study highlighted common causes of such readmissions and underlines the need for further research to determine which interventions – such as medication reviews or improved care transitions – are most effective in addressing them. Identifying high-risk patients will also be essential to optimise the use of healthcare resources.

Rationale: Chronic non‐cancer pain (CNCP) affects 28%–88% of older adults. They also experience more medication‐related problems and are more likely to receive insufficient pain therapy, impacting their quality of care. Quality indicators (QIs) can be used to assess and improve the quality of their care.Aims and Objectives: This integrative review aimed to consolidate the scientific evidence on existing QIs for the pharmacological care of older adult patients with CNCP.Methods: We systematically searched Medline and Embase via Ovid, CINAHL via EBSCO, the SCOPUS databases and Google Scholar. We used backward citation searching to identify additional studies. We included studies reporting validated QIs and studies reporting quality‐related factors associated with reduced medication safety caused by pain‐related medication therapy. Two reviewers independently screened the titles, abstracts and full texts. One extracted and charted the data and assessed the risk of bias; the second validated this.Results: We screened 4068 articles identified through the systematic search of databases and 2774 articles identified via citation searching. Seventy‐eight articles met our inclusion criteria and were retained for analysis. We extracted 11 validated QIs and developed a further 243 based on quality criteria reported in the literature. QIs covered different levels, from pharmacotherapy in general to particular substance groups and individual active substances. The risk of bias in the included studies was judged to be very high in the majority of studies.Conclusion: This integrative review established a scientific basis for developing QIs for the pharmacological management of older adult patients with CNCP. The high risk of bias present in the included studies, highlights the need for expert validation and input from patients. These indicators could help improve the quality of care provided to older adult patients with CNCP and help focus specific interventions on vulnerable patients.

Background: Preventable medication‐related readmissions (pMRRs) are a significant contributor to older adult morbidity, mortality, and health care costs. There are currently no specific screening tools for identifying patients at a high risk of pMRRs. This study aimed to develop and internally validate a screening tool to identify general internal medicine patients aged 65 or older at risk of 30‐day pMRRs.Methods: Data on 500 patients discharged between January 1, 2022 and October 18, 2023, and readmitted within 30 days were reviewed, and 116 pMRRs were identified. An additional 500 control patients without pMRRs were selected. A multivariable logistic regression model was developed using the four pre‐specified predictors of each patient's number of medications, hospitalizations in the past year, high‐risk medications at discharge (anticoagulants, opioids, and sedatives), and the number of the following diagnoses: heart failure, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease.Results: The screening tool's performance was evaluated and internally validated using bootstrapping. The screening tool demonstrated moderate discriminatory power, with a C‐statistic of 0.714 (95% confidence interval [CI]: 0.663–0.764). Overall performance was assessed as acceptable, with a Brier score of 0.177. Bootstrapping yielded an optimism‐corrected C‐statistic of 0.704 (95% CI: 0.654–0.755), indicating the tool's robustness.Conclusions: The screening tool's discriminatory power suggested its potential utility for flagging patients at risk of pMRRs. External validation and a search for additional predictors will be necessary to enhance the tool's performance and generalizability. If validated, a cost‐effectiveness analysis would be needed to ensure its feasibility for clinical implementation.

Background: Substantial numbers of hospital readmissions occur due to medication-related problems. Pharmacists can implement different interventions at hospital discharge that aim to reduce those readmissions. It is unclear which pharmacist-led interventions at hospital discharge are the most promising in reducing readmissions. Aim: This scoping review aimed to summarise pharmacist-led interventions conducted at hospital discharge that demonstrated a reduction in readmissions. Method: We searched the MEDLINE, EMBASE and CINAHL databases up to February 2024. We included studies that focused on pharmacist-led interventions at hospital discharge and reported significant readmission reductions. Two reviewers independently screened titles, abstracts and full texts. Data extracted included study characteristics, populations and the type of implemented pharmacist-led interventions along with the reduction in readmission rates achieved. Results: We included 25 articles for data synthesis. Many of the studies included either implemented at least two interventions concurrently or were part of broader programmes involving other healthcare professionals. The most common pharmacist-led interventions associated with reduced readmission rates included medication reconciliation, counselling and post-discharge follow-up by telephone. Follow-up primarily aimed to improve patients’ treatment adherence through education about their medications. Furthermore, many studies reported on multi-component interventions that began at hospital admission or during inpatient stays, not only at discharge. Conclusion: Successfully reducing readmissions through pharmacist-led interventions at hospital discharge suggests the effectiveness of a holistic approach incorporating multiple interventions. While these findings offer insights for pharmacists, further research should focus on conducting high-quality studies using a multifaceted approach to identify the most appropriate timing and combination.

Background: Hospital readmissions due to medication-related problems occur frequently, burdening patients and caregivers emotionally and straining health care systems economically. In times of limited health care resources, interventions to mitigate the risk of medication-related readmissions should be prioritized to patients most likely to benefit. Focusing on general internal medicine patients, this scoping review aims to identify risk factors associated with drug-related 30-day hospital readmissions. Methods: We began by searching the Medline, Embase, and CINAHL databases from their inception dates to May 17, 2022 for studies reporting risk factors for 30-day drug-related readmissions. We included all peer-reviewed studies, while excluding literature reviews, conference abstracts, proceeding papers, editorials, and expert opinions. We also conducted backward citation searches of the included articles. Within the final sample, we analyzed the types and frequencies of risk factors mentioned. Results: After deduplication of the initial search results, 1159 titles and abstracts were screened for full-text adjudication. We read 101 full articles, of which we included 37. Thirteen more were collected via backward citation searches, resulting in a final sample of 50 articles. We identified five risk factor categories: (1) patient characteristics, (2) medication groups, (3) medication therapy problems, (4) adverse drug reactions, and (5) readmission diagnoses. The most commonly mentioned risk factors were polypharmacy, prescribing problems—especially underprescribing and suboptimal drug selection—and adherence issues. Medication groups associated with the highest risk of 30-day readmissions (mostly following adverse drug reactions) were antithrombotic agents, insulin, opioid analgesics, and diuretics. Preventable medication-related readmissions most often reflected prescribing problems and/or adherence issues. Conclusions: This study’s findings will help care teams prioritize patients for interventions to reduce medication-related hospital readmissions, which should increase patient safety. Further research is needed to analyze surrogate social parameters for the most common drug-related factors and their predictive value regarding medication-related readmissions.