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

Objective: Our hypothesis was that the intervention would decrease (or at least not increase) the number of potentially inappropriate medications (PIMs) and the number of hospital readmissions within 30 days of discharge per hospital stay. Methods: A cohort of hospitalized older adults enrolled in the PAERPA integrated care pathway (the exposed cohort) was matched retrospectively with hospitalized older adults not enrolled in the pathway (unexposed cohort) between January 1st, 2015, and December 31st, 2018. It was an analysis of French health administrative database. The inclusion criteria for exposed patients were admission to an acute care department in general hospital, age 75 or over, at least three comorbidities or the prescription of diuretics or oral anticoagulants, discharge alive, and performance of a medication review. Results: For the study population (n=582), the mean ± standard deviation age was 82.9 ± 4.9, and 190 (65.3%) were women. Depending on the definition used, the overall median number of PIMs ranged from 2 [0;3] upon admission to 3 [0;3] at discharge. The intervention was not associated with a significant difference in the mean number of PIMs. Patients in the exposed cohort were half as likely to be readmitted to hospital within 30 days of discharge, relative to patients in the unexposed cohort. Conclusion: Our results show that a medication review was not associated with a decrease in the mean number of PIMs. However, the integrated care intervention including the medication review was associated with a reduction in the number of hospital readmissions at 30 days.