Abstract:
Background: As the aging population expands, ensuring the appropriate prescribing of
medication for older adults is increasingly vital. Despite the availability of numerous decision
support tools, their applicability to Sri Lankan settings is limited due to unique healthcare
dynamics. The development of such tools should follow a meticulously controlled and formalized
process grounded in scientific methods to ensure the validity, reliability, and applicability of the
resulting tool.
Objective: To develop country-specific prescribing appropriateness criteria tool to assist
healthcare providers in ensuring the judicious prescribing of medication for Sri Lankan older
adults
Methods: This systematic approach comprises three primary stages: preliminary criteria
development, expert consensus, and pilot testing. To initiate the preliminary criteria development,
an extensive literature review will be conducted to gather pertinent evidence, guidelines, and best
practices, both globally and within the Sri Lankan context. Preliminary criteria list will be
formulated by the principal investigator and reviewed by three internal evaluators, including two
clinical pharmacists from Australia and one consultant physician from Sri Lanka. Following this,
the finalized preliminary list will undergo validation by a multidisciplinary panel of experts,
including Sri Lankan geriatric care specialists, pharmacologists, and Australian clinical
pharmacists. The validation process will utilize the RAND/UCLA Appropriateness Method
(RAM), which involves rating the preliminary criteria list and conducting face-to-face interviews
to address any discrepancies, introduce new criteria, and enhance clarity between rating rounds.
Finally, the validated tool will undergo pilot testing in real-world clinical settings. This will be a
cross-sectional study applying the criteria to a sample of older adult patients attending monthly
clinics at a tertiary care public hospital.
Results: The resulting tool will be characterized by its scientific integrity, providing healthcare
providers with valid and reliable information to support evidence-based prescribing decisions for
Sri Lankan older adults.
Conclusions: This validated tool will hold potential utility for prescribers and hospital
pharmacists within the Sri Lankan public healthcare sector, fostering improvements in prescribing
practices and promoting the quality use of medicines among the elderly population.
