Developing a national digital platform for detecting potentially inappropriate medications: adaptation of the EU(7)-PIM list to Bulgarian healthcare practice

Objective : Population aging in Europe, particularly in Bulgaria, where adults ≥ 65 years represent 24% of the population, increases risks related to multimorbidity, polypharmacy, potentially inappropriate prescribing (PIP), and potentially inappropriate medications (PIM). This study aimed to adapt the EU(7)-PIM List for the national context, assess national market availability of listed substances, and develop a comprehensive technical framework for digital integration. Materials and methods : A three-stage methodological approach was applied: (1) Bulgarian translation and expert validation of the EU(7)-PIM List; (2) verification of authorization and market availability of all included international nonproprietary names (INNs) using the Bulgarian Drug Agency (BDA) and National Council on Prices and Reimbursement (NCPR) databases; and (3) development of technical specifications for digitalization and interoperability with NCPR registries. Results : Of 277 INNs, 138 (49.8%) were available on the Bulgarian market. A comprehensive digital framework was designed. Conclusion : This study provides the first methodological and technical basis for a nationally integrated PIM identification system in Bulgaria, supporting safer pharmacotherapy in older adults.