Drug-specific PIM statements were extracted from each of the nine criteria and entered into an Excel file. One author (JP) examined the selected criteria and created the summary table. If the criteria included a statement to avoid a medicine class, the statement was documented in the summary for medicines mentioned by name in other criteria. For example, the NORGEP-NH includes a statement about regular use of hypnotics. According to the Anatomical Therapeutic Chemical (ATC) classification system by the World Health Organization [28 ], the code for hypnotics and sedatives is N05C. Based on this international drug classification, the statement from NORGEP-NH was documented for drugs whose ATC code is N05C and those listed in other included criteria. Unclear classifications were discussed among the three authors (JP, JJ, EJ).
We did not consider the following kinds of PIM statements from the final table: (1) concurrent use of two or more drugs (e.g., warfarin combined with non-steroidal anti-inflammatory drugs (NSAIDs)), (2) PIMs and specific conditions (e.g., Angiotensin Receptor Blockers in patients with hyperpotassemia), (3) PIMs and restriction of treatment duration or dose, (4) PIMs with limited research evidence or experience among older people, and (5) anticholinergic medicines without a specific active substance. Not including a statement was related to the restrictions on the data. First, the statements requiring additional clinical information (e.g., diagnosis, renal insufficiency, dosage, treatment duration) were not applied since such details could not be captured from the national prescription register. Second, some of the included criteria (e.g., Meds75+ database, Beers criteria) contain a special category for medicines with specific caution (e.g. use with caution, present evidence or experience with use in older persons is vague). Overall, the comparison of criteria focused on identifying PIMs to avoid generally without considering additional clinical information. This research strategy collected a summary of 352 ATC codes considered as PIMs (see Additional file1 ).
The summary was screened using both the Social Insurance Institution (SII) of Finland’s Medicinal Products Database and Finnish Medicines Agency’s FimeaWeb to exclude medicines not available in Finland. If the medicine was available on the market only in combination (e.g., codeine), the medicine was still included. In addition, if the medicine was available both as a single active substance and in combination (e.g., oxycodone), both ATC codes were included. Finally, after screening the summary, 172 ATC codes were considered as PIMs available on Finnish pharmaceutical market (see Additional file1 ).
We did not consider the following kinds of PIM statements from the final table: (1) concurrent use of two or more drugs (e.g., warfarin combined with non-steroidal anti-inflammatory drugs (NSAIDs)), (2) PIMs and specific conditions (e.g., Angiotensin Receptor Blockers in patients with hyperpotassemia), (3) PIMs and restriction of treatment duration or dose, (4) PIMs with limited research evidence or experience among older people, and (5) anticholinergic medicines without a specific active substance. Not including a statement was related to the restrictions on the data. First, the statements requiring additional clinical information (e.g., diagnosis, renal insufficiency, dosage, treatment duration) were not applied since such details could not be captured from the national prescription register. Second, some of the included criteria (e.g., Meds75+ database, Beers criteria) contain a special category for medicines with specific caution (e.g. use with caution, present evidence or experience with use in older persons is vague). Overall, the comparison of criteria focused on identifying PIMs to avoid generally without considering additional clinical information. This research strategy collected a summary of 352 ATC codes considered as PIMs (see Additional file
The summary was screened using both the Social Insurance Institution (SII) of Finland’s Medicinal Products Database and Finnish Medicines Agency’s FimeaWeb to exclude medicines not available in Finland. If the medicine was available on the market only in combination (e.g., codeine), the medicine was still included. In addition, if the medicine was available both as a single active substance and in combination (e.g., oxycodone), both ATC codes were included. Finally, after screening the summary, 172 ATC codes were considered as PIMs available on Finnish pharmaceutical market (see Additional file
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