Advertisement

Pharmacy World & Science

, Volume 31, Issue 3, pp 380–386 | Cite as

Reliability of the medication appropriateness index in Dutch residential home

  • Clementine C. M. StuijtEmail author
  • Eric J. F. Franssen
  • Antoine C. G. Egberts
  • Stephen A. Hudson
Research Article

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.

Keywords

Long term care Medication Appropriateness Index Netherlands Older people Validation 

Notes

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.

Funding

None.

Conflict of interest

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

References

  1. 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.PubMedGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 4.
    Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005;330(7494):781–3. doi: 10.1136/bmj.330.7494.781.PubMedCrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 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.PubMedGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 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.PubMedGoogle Scholar
  15. 15.
    Health Base Foundation. Comments on Medication Surveillance Pharmacom and Medicom. Deventer: GrafiData; 2003.Google Scholar
  16. 16.
    Health Care Insurance Board (CVZ). Pharmacotherapeutic formulary [Farmacotherapeutisch Kompas]. Utrecht: Roto Smeets; 2004.Google Scholar
  17. 17.
    Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37(5):360–3.PubMedGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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. 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.PubMedCrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Clementine C. M. Stuijt
    • 1
    • 6
    Email author
  • Eric J. F. Franssen
    • 2
  • Antoine C. G. Egberts
    • 3
    • 4
  • Stephen A. Hudson
    • 5
  1. 1.Department of Clinical PharmacyAcademic Medical CentreAmsterdamThe Netherlands
  2. 2.Department of PharmacyOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
  3. 3.Department of Clinical PharmacyUniversity Medical Centre UtrechtUtrechtThe Netherlands
  4. 4.Department of Pharmacoepidemiology and PharmacotherapyUtrecht Institute for Pharmaceutical Sciences (UIPS)UtrechtThe Netherlands
  5. 5.Institute of Pharmacy and Biomedical SciencesUniversity of StrathclydeGlasgowUK
  6. 6.AmsterdamThe Netherlands

Personalised recommendations