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Reliability of the medication appropriateness index in Dutch residential home

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Abstract

Objective To validate the reliability of the Medication Appropriateness Index in the appraisal of quality of prescribing by assessing the inter- and intra-group variation in Dutch residential home patients. Setting and method Eight raters evaluated 81 medication records of 15 patients from a group of older patients living in a residential nursing home the Netherlands. These patients had been recruited for a medication review investigation throughout a period of 12 months over the period April 2003 until April 2004. Patient information was acquired by connecting the medical record with the complete prescription record and pharmaceutical record. Each patient was assessed twice by two independent reviewers on the basis of a patient profile in combination with the extracted medical record and using a structured procedure. Main outcome A summed MAI score, percent agreement, kappa, positive and negative agreement as well as intra-class correlation coefficient were calculated for each criterion. Measure Medication appropriateness was assessed with the Medication Appropriateness Index (MAI) by an independent panel of Dutch hospital and community pharmacists. Results The overall percentage agreement was 83%. For each of the 10 different medication appropriateness questions it ranged from 79 to 100% for appropriate and from 47 to 60% for inappropriate ratings. The overall chance adjusted inter-rater agreement reached a moderate kappa score of 0.47. The overall intra-group agreement was very good with an overall percentage of 98 and a kappa score of at least 0.84 (all schemes). Conclusion In a Dutch institutionalised setting with representative raters, the unmodified MAI can be used as an instrument to quantify changes in appropriateness of prescribing.

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References

  1. Higashi T, Shekelle PG, Solomon DH, Knight EL, Roth C, Chang JT, et al. The quality of pharmacologic care for vulnerable older patients. Ann Intern Med. 2004;140(9):714–20.

    PubMed  Google Scholar 

  2. Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;54(10):1516–23. doi:10.1111/j.1532-5415.2006.00889.x.

    Article  PubMed  Google Scholar 

  3. Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008;168(17):1890–6.

    Article  PubMed  Google Scholar 

  4. Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005;330(7494):781–3. doi:10.1136/bmj.330.7494.781.

    Article  PubMed  Google Scholar 

  5. Shelton PS, Fritsch MA, Scott MA. Assessing medication appropriateness in the elderly: a review of available measures. Drugs Aging. 2000;16(6):437–50. doi:10.2165/00002512-200016060-00004.

    Article  PubMed  CAS  Google Scholar 

  6. 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(10):1045–51. doi:10.1016/0895-4356(92)90144-C.

    Article  PubMed  CAS  Google Scholar 

  7. Fitzgerald LS, Hanlon JT, Shelton PS, Landsman PB, Schmader KE, Pulliam CC, et al. Reliability of a modified medication appropriateness index in ambulatory older persons. Ann Pharmacother. 1997;31(5):543–8.

    PubMed  CAS  Google Scholar 

  8. Kassam R, Martin LG, Farris KB. Reliability of a modified medication appropriateness index in community pharmacies. Ann Pharmacother. 2003;37(1):40–6. doi:10.1345/aph.1C077.

    Article  PubMed  Google Scholar 

  9. Bregnhoj L, Thirstrup S, Kristensen MB, Sonne J. Reliability of a modified medication appropriateness index in primary care. Eur J Clin Pharmacol. 2005;61(10):769–73. doi:10.1007/s00228-005-0963-0.

    Article  PubMed  Google Scholar 

  10. Spinewine A, Dumont C, Mallet L, Swine C. Medication appropriateness index: reliability and recommendations for future use. J Am Geriatr Soc. 2006;54(4):720–2. doi:10.1111/j.1532-5415.2006.00668_8.x.

    Article  PubMed  Google Scholar 

  11. Stuijt CC, Franssen EJ, Egberts AC, Hudson SA. Appropriateness of prescribing among elderly patients in a Dutch residential home: observational study of outcomes after a pharmacist-led medication review. Drugs Aging. 2008;25(11):947–54. doi:10.2165/0002512-200825110-00005.

    Article  PubMed  Google Scholar 

  12. Samsa GP, Hanlon JT, Schmader KE, Weinberger M, Clipp EC, Uttech KM, et al. A summated score for the medication appropriateness index: development and assessment of clinimetric properties including content validity. J Clin Epidemiol. 1994;47(8):891–6. doi:10.1016/0895-4356(94)90192-9.

    Article  PubMed  CAS  Google Scholar 

  13. Buurma H, De Smet PA, Leufkens HG, Egberts AC. Evaluation of the clinical value of pharmacists’ modifications of prescription errors. Br J Clin Pharmacol. 2004;58(5):503–11. doi:10.1111/j.1365-2125.2004.02181.x.

    Article  PubMed  Google Scholar 

  14. Denneboom W, Dautzenberg MG, Grol R, De Smet PA. Analysis of polypharmacy in older patients in primary care using a multidisciplinary expert panel. Br J Gen Pract. 2006;56(528):504–10.

    PubMed  Google Scholar 

  15. Health Base Foundation. Comments on Medication Surveillance Pharmacom and Medicom. Deventer: GrafiData; 2003.

  16. Health Care Insurance Board (CVZ). Pharmacotherapeutic formulary [Farmacotherapeutisch Kompas]. Utrecht: Roto Smeets; 2004.

  17. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37(5):360–3.

    PubMed  Google Scholar 

  18. Feinstein AR, Cicchetti DV. High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol. 1990;43(6):543–9. doi:10.1016/0895-4356(90)90158-L.

    Article  PubMed  CAS  Google Scholar 

  19. Cicchetti DV, Feinstein AR. High agreement but low kappa: II. Resolving the paradoxes. J Clin Epidemiol. 1990;43(6):551–8. doi:10.1016/0895-4356(90)90159-M.

    Article  PubMed  CAS  Google Scholar 

  20. Robson C. Real world research: a resource for social scientists and practitioner-researchers. 2nd ed. Oxford, UK: Blackwell Publishing Ltd.; 2002.

    Google Scholar 

  21. Smith PC, Araya-Guerra R, Bublitz C, Parnes B, Dickinson LM, Van Vorst R, et al. Missing clinical information during primary care visits. JAMA. 2005;293(5):565–71. doi:10.1001/jama.293.5.565.

    Article  PubMed  CAS  Google Scholar 

  22. Schurink CA, Van Nieuwenhoven CA, Jacobs JA, Rozenberg-Arska M, Joore HC, Buskens E, et al. Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability. Intensive Care Med. 2004;30(2):217–24. doi:10.1007/s00134-003-2018-2.

    Article  PubMed  Google Scholar 

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Acknowledgement

The authors would like to express their sincere gratitude to all supporting hospital and community pharmacists from the Onze Lieve Vrouwe Gasthuis (OLVG) (CTM van der Linden, EAF Haak, GKKE Thio, ME Attema- de Jonge, MJHA Vanenburg, KD Yap, EL Sanders), Academic Medical Centre (AMC) (RAJ Kuiper and SM Smorenburg) both in Amsterdam and Ijsselmeerziekenhuizen (Almere and Lelystad) (J Dijkstra and PAMM Boermans) as they invested a number of private hours in the scoring of the MAI.

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Conflict of interest

The authors have no conflict of interest that are directly relevant to the contents of this article.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, Academic Medical Centre, Meibergdreef 9, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands

    Clementine C. M. Stuijt

  2. Department of Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    Eric J. F. Franssen

  3. Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands

    Antoine C. G. Egberts

  4. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, The Netherlands

    Antoine C. G. Egberts

  5. Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK

    Stephen A. Hudson

  6. Michelangelostraat 62-2, 1077CG, Amsterdam, The Netherlands

    Clementine C. M. Stuijt

Authors
  1. Clementine C. M. Stuijt
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  2. Eric J. F. Franssen
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  3. Antoine C. G. Egberts
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  4. Stephen A. Hudson
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Corresponding author

Correspondence to Clementine C. M. Stuijt.

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Stuijt, C.C.M., Franssen, E.J.F., Egberts, A.C.G. et al. Reliability of the medication appropriateness index in Dutch residential home. Pharm World Sci 31, 380–386 (2009). https://doi.org/10.1007/s11096-009-9283-2

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  • DOI: https://doi.org/10.1007/s11096-009-9283-2

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