OPTIMA-ID: development and validation of a medicine optimization tool for older adults with intellectual disability

Older people (i.e. ≥40 years) with intellectual disability have unique medication needs and may experience high levels of potentially inappropriate prescribing. Despite the availability of tools to optimize older adults’ prescriptions, there is no comprehensive tool specifically for use in older adults with intellectual disability. We aimed to develop a tool for this purpose: Optimizing Pharmaco-Therapy and Improving Medication for Ageing with Intellectual Disability (OPTIMA-ID). A draft tool was developed based on literature review and clinical expertise. Focus groups with healthcare professionals and people with intellectual disability were conducted to refine the tool. The tool was presented electronically to an expert panel for Delphi validation. Median level of agreement and 75^th percentile values were used to establish if consensus was reached. Criteria were accepted, rejected, revised or removed to develop the final tool. Following two Delphi rounds, consensus on the content of OPTIMA-ID was reached for 67 prescribing criteria, 63 of which were agreed upon after Round 1 and a further 4 criteria accepted after Round 2. OPTIMA-ID contains 67 criteria that can optimize medications for older people with intellectual disability. Its effectiveness, feasibility and impact on patient outcomes need to be established.

40岁及以上的智力障碍（intellectual disability）老年群体存在独特的用药需求，且可能面临较高的潜在不适当处方风险。尽管目前已有可用于优化老年群体处方的工具，但尚无专门面向智力障碍老年群体的综合用药优化工具。为此，本研究旨在开发一款适配该需求的专用工具：智力障碍老年群体药物治疗优化与用药改善工具（Optimizing Pharmaco-Therapy and Improving Medication for Ageing with Intellectual Disability，简称OPTIMA-ID）。研究团队首先通过文献综述与临床专家经验，开发了该工具的初稿版本；随后开展了针对医疗专业人员与智力障碍群体的焦点小组访谈，以优化完善该工具初稿。随后以电子形式将该工具提交至专家小组，开展德尔菲（Delphi）法验证。研究采用同意程度中位数与75百分位数作为共识达成的判定依据，针对各项处方标准，通过采纳、驳回、修订或移除等操作，最终形成正式工具版本。经过两轮德尔菲法调研后，研究团队就OPTIMA-ID的67项处方标准达成共识：其中63项在第一轮调研中即获得同意，另有4项在第二轮调研中获得通过。OPTIMA-ID共包含67项可用于优化智力障碍老年群体用药的标准，其实际应用效果、可行性以及对患者结局的影响仍有待进一步验证。