229 OPTI-3S (criteria for optimising medicines by stopping, stepping down, or switching to safer alternatives): consensus validation via a Delphi method

Abstract Background No consensus-based criteria set exists specifically for Potentially Inappropriate Medications (PIMs in hospitalised frail older adults. This study aimed to develop the OPTI-3S core criteria for optimising medicines, using a modified Delphi method. Methods The OPTI-3S preliminary list was developed by the research team based on an extensive literature review. A modified Delphi method was conducted to validate a subset (‘core list’) of these preliminary statements. The Clinical Frailty Scale (CFS) was used to differentiate between frailty levels. Eleven practising experts reviewed the core list and full preliminary list in the first round. Participants were asked to rate their agreement with the core list of statements, using a 5-point Likert scale, and suggest additional statements from the full list, or based on their own knowledge. Statements with a median rating of 1 or 2 (i.e. strongly agree or agree) and 75th percentile of 2 or less were included in the final set. Results Nine experts completed the three rounds, after which consensus was reached on the inclusion of 45 statements: 17 statements in the first round, 25 in the second round, and three in the third round. These statements suggest optimising and/or deprescribing antidiabetic agents (n = 7), central nervous system (CNS) medications (n = 7), genito-urinary medications (n = 7), antithrombotic agents (n = 5), statins (n = 4), antihypertensives (n = 4), osteoporosis medications (n = 3), heart failure medications (n = 2), perioperative analgesia (n = 2), diuretics (n = 1), proton-pump inhibitors (n = 1), vitamins and supplements (n = 1), and anticholinergic medications (n = 1). 22 statements apply to a specific CFS frailty level, while the remainder apply to all frail older persons (i.e. CFS of 4 or more). Conclusion: The literature- and consensus- based OPTI-3S core criteria comprise 45 statements relating to PIMsand suggest preferential medications in hospitalised frail older adults. The OPTI-3S criteria may be a useful guide for medication optimisation in frail older people.