The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients. A modified Delphi study.
OBJECTIVE
To establish a clinically relevant list with explicit criteria for pharmacologically inappropriate prescriptions in general practice for elderly people > or =70 years.


METHODS
A three-round Delphi process for validating the clinical relevance of suggested criteria (n = 37) for inappropriate prescriptions to elderly patients.


METHODS
A postal consensus process undertaken by a panel of specialists in general practice, clinical pharmacology, and geriatrics. Main outcome measures. The Norwegian General Practice (NORGEP) criteria, a relevance-validated list of drugs, drug dosages, and drug combinations to be avoided in the elderly (< or =70 years) patients.


RESULTS
Of the 140 invited panellists, 57 accepted to participate and 47 completed all three rounds of the Delphi process. The panellists reached consensus that 36 of the 37 suggested criteria were clinically relevant for general practice. Relevance of three of the criteria was rated significantly higher in Round 3 than in Round 1. At the end of the Delphi process, a significant difference between the different specialist groups' scores was seen for only one of the 36 criteria.


CONCLUSIONS
The NORGEP criteria may serve as rules of thumb for general practitioners (GPs) related to their prescribing practice for elderly patients, and as a tool for evaluating the quality of GPs' prescribing in settings where access to clinical information for individual patients is limited, e.g. in prescription databases and quality improvement interventions.
Rognstad
Sture
S
General Practice Research Unit, Section of General Practice/Family Medicine, Institute of General Practice and Community Health, University of Oslo, Oslo, Norway. sture.rognstad@medisin.uio.no
Brekke
Mette
M
Fetveit
Arne
A
Spigset
Olav
O
Wyller
Torgeir Bruun
TB
Straand
Jørund
J
D000368:Aged; D003697:Delphi Technique; D011307:Drug Prescriptions / Q000592:standards; D064420:Drug-Related Side Effects and Adverse Reactions; D005194:Family Practice / Q000592:standards; D005853:Geriatrics; D006801:Humans; D009664:Norway; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010601:Pharmacology, Clinical; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care
D004364:Pharmaceutical Preparations