Table 3 Consensus on the inappropriateness of prescribing scenarios rated in both rounds of the e-Delphi survey
No | Scenario | Round 1 | Round 2 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Median (30th, 70th) | Number of ratings | Agreement (index) | Median (30th, 70th) | Number of ratings | Agreement (index) | Modified | |||||||
1–3 | 4–6 | 7–9 | 1–3 | 4–6 | 7–9 | ||||||||
1 | Persistent prescription of opioid analgesics to a patient with a medical history of alcohol addiction, abuse, or dependence [32, 47,48,49] | 3 (2, 3) | 18 | 5 | 1 | A/IA (0.275) | 2 (2, 3) | 19 | 0 | 0 | A/IA (0.220) | ||
2 | Acute or persistent prescription of opioid analgesics to a woman during pregnancy [50,51,52,53,54,55,56,57,58] | 2 (2, 3) | 18 | 6 | 0 | A/IA (0.220) | 3 (2, 3) | 17 | 2 | 0 | A/IA (0.330) | # | |
3 | Persistent prescription of opioid analgesics to a patient with hypothyroidism [59,60,61] | 5 (4, 7) | 7 | 10 | 7 | Neutral (0.658) | 5 (4, 6) | 4 | 12 | 3 | Neutral (0.599) | # | |
4 | Persistent prescription of opioid analgesics to a patient with paralytic ileus [62, 63] | 2 (1, 2) | 23 | 1 | 0 | A/IA (0.220) | 2 (1, 2) | 19 | 0 | 0 | A/IA (0.220) | ||
5 | Persistent prescription of opioid analgesics to a patient with dementia [64, 65] | 3 (2, 4) | 16 | 7 | 1 | A/IA (0.299) | 2 (2, 3) | 15 | 4 | 0 | A/IA (0.220) | ||
6 | Persistent prescription of opioid analgesics to a patient with chronic obstructive pulmonary disease or asthma [66] | 4 (3, 6) | 10 | 10 | 4 | Neutral (0.526) | 4 (3, 4) | 9 | 9 | 1 | Neutral (0.440) | # | |
7 | Co-prescription of opioid analgesics with carbamazepine, phenytoin, or phenobarbital to a patient with epilepsy [67,68,69,70,71] | 4 (3, 6) | 9 | 11 | 4 | Neutral (0.502) | 3 (3, 5) | 10 | 8 | 1 | A/IAa (0.359) | # | |
8 | Persistent prescription of opioid analgesics to a patient with myasthenia gravis [72,73,74] | 4 (3, 5) | 11 | 10 | 3 | Neutral (0.458) | 3 (2, 4) | 10 | 7 | 2 | A/IAa (0.359) | ||
9 | Acute or persistent co-prescription of opioid analgesics with antidepressants, i.e. monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, or serotonin and norepinephrine [32, 68, 69, 75,76,77,78] | 5 (4, 6) | 7 | 13 | 4 | Neutral (0.539) | 4 (3, 5) | 6 | 11 | 2 | Neutral (0.479) | $ | |
10 | Acute or persistent co-prescription of opioid analgesics with a benzodiazepine [79,80,81,82,83] | 4 (2, 5) | 12 | 10 | 2 | A/IA (0.461) | 3 (2, 3) | 14 | 4 | 1 | A/IA (0.330) | # | |
11 | Acute or persistent co-prescription of opioid analgesics with a gabapentinoid, i.e. gabapentin or pregabalin [84,85,86,87] | 5 (3, 5) | 11 | 10 | 3 | Neutral (0.564) | 4 (3, 4) | 9 | 10 | 0 | Neutral (0.440) | # | |
12 | Acute or persistent prescription of opioid analgesics to a patient with galactose intolerance, lactase deficiency, or glucose-galactose malabsorption [88, 89] | 5 (5, 6) | 5 | 13 | 6 | Neutral (0.549) | 5 (3, 5) | 6 | 13 | 0 | Neutral (0.599) | # | |
13 | Persistent prescription of opioid analgesics to a patient with constipation and without a concurrently prescribed laxative [90, 91] | 2 (2, 3) | 19 | 4 | 1 | A/IA (0.229) | 2 (2, 2) | 18 | 1 | 0 | A/IA (0.203) | # | |
14 | Persistent prescription of opioid analgesics for greater than or equal to 6 months without a concurrently prescribed laxative [90, 91] | 2 (2, 3) | 18 | 5 | 1 | A/IA (0.220) | 2 (2, 2) | 17 | 2 | 0 | A/IA (0.203) | ||
15 | Prescription of codeine or morphine to a patient with severe renal impairment, i.e. the most recent eGFR < 30 mL/min per 1.73 m2 [92, 93] | 1 (2, 4) | 13 | 8 | 3 | A/IA (0.120) | 2 (2, 2) | 17 | 2 | 0 | A/IA (0.203) | ||
16 | Persistent prescription of one or more opioid analgesics at a dose above the equivalent of 120 mg of oral morphine per day [32, 61, 78] | 2 (2, 2) | 23 | 0 | 1 | A/IA (0.211) | 2 (2, 2) | 19 | 0 | 0 | A/IA (0.203) | # | |
17 | Acute or persistent prescription of opioid analgesics to a patient for more than 3 months following the patient’s discharge from the hospital after surgery [94, 95] | 2 (2, 2) | 21 | 3 | 0 | A/IA (0.203) | 2 (2, 2) | 19 | 0 | 0 | A/IA (0.203) | # | |
18 | Persistent prescription of opioid analgesics to a patient with at least moderate hepatic impairment [96,97,98] | 2 (2, 5) | 13 | 10 | 1 | A/IA (0.251) | 3 (2, 3) | 17 | 2 | 0 | A/IA (0.330) | ||
19 | Persistent prescription of opioid analgesics to a patient aged over 65 years with a recent medical history of falling [81, 82, 99] | 2 (2, 4) | 16 | 8 | 0 | A/IA (0.240) | 2 (2, 2) | 18 | 1 | 0 | A/IA (0.203) | # | |
20 | Persistent prescription of tramadol, buprenorphine, or oxycodone to a patient with a medical history of ventricular tachycardia [100, 101] | 2 (2, 4) | 17 | 6 | 1 | A/IA (0.229) | 2 (2,3) | 15 | 4 | 0 | A/IA (0.220) | ||