JMIR Publications

ABSTRACT

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 healthcare costs. However, existing deprescribing guidelines and PIM criteria, such as the Beers Criteria and STOPP/START, 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 18–65 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 30–40 participants will evaluate this list across three survey rounds. Panelists will rate the relevance of potential PIMs using predefined criteria, including the balance of benefits and harms, patient preferences, and availability of alternatives. Consensus will be defined as a median rating ≥4 (for inclusion) or ≤2 (for exclusion) on a 5-point Likert scale (1–Not relevant to 5–Extremely relevant), with an interquartile range ≤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 18–65.

Results:

Panel recruitment was completed between September and October 2025. At the time of manuscript submission, Delphi data collection was ongoing; interim analyses were conducted solely to inform structured feedback between rounds, and no final analyses had been completed. Consensus results are expected to be disseminated in Spring 2026.

Conclusions:

This Delphi process will yield a prioritized list of PIMs for adults aged 18–65, informing the development of an international guideline to support safer prescribing practices and expand deprescribing efforts beyond geriatric care.