Enhancing Geriatric Medication Management: Development of a Decision Support Tool for Healthcare Providers to Ensure Appropriate Prescribing in Sri Lankan Older Adults: A Study Protocol

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.