Explicit definitions of potentially inappropriate prescriptions for
antidiabetic drugs in type 2 diabetes: a multidisciplinary,
nominal-groups approach
Abstract
Aim: The management of type 2 diabetes patients poses challenges for
non-diabetologists healthcare professionals and may result in
potentially inappropriate prescriptions of antidiabetic drugs which can
be limited using screening tools. The aim was to set up nominal groups
of healthcare professionals from several disciplines and develop a list
of explicit definition of potentially inappropriate prescriptions of
antidiabetic drugs. Methods: In a qualitative, nominal-groups approach,
expert diabetologists, general practitioners, and pharmacists in France
developed explicit definitions of potentially inappropriate
prescriptions of antidiabetic drugs in patients with type 2 diabetes.
The study was overseen by a steering committee and complied with the
Consolidated Criteria for Reporting Qualitative Research. Results: Three
nominal groups comprised a total of 30 participants (14 pharmacists, 10
diabetologists, and 6 general practitioners) and generated 89 explicit
definitions. These definitions were subsequently merged and validated by
the steering committee and nominal group participants, resulting in 38
validated explicit definitions of potentially inappropriate
prescriptions of antidiabetic drugs. The definitions encompassed four
contexts: (i) the temporary discontinuation of a medication during acute
illness (n=9; 24%), (ii) dose level adjustments (n=23; 60%), (iii)
inappropriate treatment initiation (n=3; 8%), and (iv) the need for
further monitoring in the management of type 2 diabetes (n=3; 8%).
Conclusion: This qualitative study is the first to have produced a
specific tool of explicit definitions of potentially inappropriate
prescriptions of antidiabetic drugs. Although the new list provides
valuable insights, it must be validated by expert consensus (e.g. in a
Delphi survey) before implementation in practice