Advertisement

Pharmacy World and Science

, Volume 24, Issue 4, pp 128–131 | Cite as

Exploring the domains of appropriateness of drug therapy, using the Nominal Group Technique

  • Mary P. TullyEmail author
  • Judith A. Cantrill
Article

Abstract

Objective: To explore the domains encompassed within the assessment of the appropriateness of prescribing for an individual patient.Method: The Nominal Group Technique was used to address the question "How can we assess inappropriate drug therapy of individual patients that is responsive to pharmaceutical care?" The group participants were a self-selected group of nine pharmacists and one pharmacologist attending an international working conference on the Outcomes of Pharmaceutical Care. Item generation was followed by discussion for clarification and operationalisation. Voting achieved a consensus, defined as ≥70%, agreement on the importance of items for inclusion in an instrument to assess appropriateness.Results: Sixty-seven items were initially generated. During discussion, similar items were combined and items were grouped into domains. Items that considered the patient's perspective were commonly suggested, but many were discarded after discussing their operationalisation. Consensus was obtained that eighteen items, in seven domains, should be included in the instrument. The domains were indication and drug choice (5 items), effectiveness (2), risks and safety (2), dosage (3), interactions (1), practical use (4), and monitoring (1).Conclusion: It is hoped that, with adequate testing, these indicators of appropriateness of prescribing can be used by pharmacists to begin to routinely assess the impact of pharmaceutical care on the quality of prescribing for patients under their care.

Appropriateness Nominal group technique Prescribing 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Buetow SA, Sibbald B, Cantrill JA, Halliwell S. Appropriateness in health care: application to prescribing. Soc Sci Med 1997;45:261-71.PubMedGoogle Scholar
  2. 2.
    Coste J, Venot A. An epidemiological approach to drug prescribing quality assessment. A study in primary care practice in France. Med Care 1999;37:1294-307.PubMedGoogle Scholar
  3. 3.
    Britten N, Brant S, Cairns A, Hall WW, Jones I, Salisbury C et al. Continued prescribing of inappropriate drugs in general practice. J Clin Pharm Therap 1995;20:199-205.Google Scholar
  4. 4.
    Willcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly. JAMA 1994;272:292-6.PubMedGoogle Scholar
  5. 5.
    Oborne CA, Batty GM, Maskrey V, Swift CG, Jackson SHD. Development of prescribing indicators for elderly medical inpatients. Br J Clin Pharmacol 1997;43:91-97.PubMedGoogle Scholar
  6. 6.
    Cantrill JA, Sibbald B, Buetow S. Indicators of the appropriateness of long term prescribing in general practice in the United Kingdom: consensus development, face and content validity, feasibility and reliability. Qual Health Care 1998;7:130-5.PubMedGoogle Scholar
  7. 7.
    Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992;45:1045-51.PubMedGoogle Scholar
  8. 8.
    Tully MP, Cantrill JA. The use of the Nominal Group Technique in pharmacy practice research: processes and practicalities. J Soc Admin Pharm 1997;14:93-104.Google Scholar
  9. 9.
    Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 1991;151:1825-32.PubMedGoogle Scholar
  10. 10.
    McLeod PJ, Huang AR, Tamblyn RM, Cayton DC. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. Can Med Assoc J 1997;156:385-91.Google Scholar
  11. 11.
    Bateman DN, Soutter J, Eccles M, Roberts SJ, Campbell M, Smith JM. Setting standards of prescribing performance in primary care: use of a consensus group of general practitioners and application of standards to practices in the north of England. Br J Gen Pract 1996;46:20-5.PubMedGoogle Scholar
  12. 12.
    Cribb A, Barber N. Prescribers, patients and policy: the limits of technique. Health Care Analysis 1997;5:292-8.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  1. 1.School of Pharmacy and Pharmaceutical SciencesUniversity of ManchesterManchesterUK

Personalised recommendations