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Reliability of a modified medication appropriateness index in community pharmacies
Rosemin Kassam1, Linda G Martin, Karen B Farris
1Pharmacy Practice and Structured Pharmacy Education Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada. rokassam@unixg.ubc.ca
Background:
The medication appropriateness index (MAI) has demonstrated reliability in selected outpatient clinics where medical data were easily accessible from medical charts. However, its use in the community setting where patient data may be limited has not been examined.
Objective:
To evaluate the usefulness of a modified MAI for use in the community pharmacy setting by testing interrater reliability using 3 different rating schemes.
Methods:
Two raters evaluated 160 medications for 32 elderly ambulatory patients. Patient information was acquired using community pharmacist-collected medication histories. A summated MAI score, percent agreement, kappa, positive agreement, negative agreement, and intraclass correlation coefficient were calculated for each criterion using 3 scoring schemes. A paired samples t-test (95% CI) was used to test interrater reliability.
Results:
The kappa statistics were >0.75 for indication and effectiveness, but good (0.41-0.66) for the remaining criteria using the Hanlon scoring scheme. The intraclass coefficients (0.82, 0.86, 0.87) and overall kappa (0.65, 0.66, 0.61) were similar for the 3 schemes.
Conclusions:
This study suggests that the modified MAI has the potential to detect medication appropriateness and inappropriateness in the community pharmacy setting; however, it is not without limitations. Because the MAI has the most clinimetric and psychometric data available, the instrument should be studied further to increase its reliability and generalizability.
Insights
A modified Medication Appropriateness Index (MAI) shows potential for assessing medication appropriateness in community pharmacies. Further research is needed to enhance its reliability and generalizability in this setting.
Area of Science:
- Geriatric Pharmacy
- Health Services Research
- Clinical Pharmacology
Background:
- The Medication Appropriateness Index (MAI) is reliable in outpatient clinics with accessible medical data.
- Its utility in community pharmacies, with potentially limited patient data, remains unexamined.
Purpose of the Study:
- To assess the usefulness of a modified MAI in community pharmacy settings.
- To test the interrater reliability of the modified MAI using three distinct rating schemes.
Main Methods:
- Two raters evaluated 160 medications for 32 elderly ambulatory patients.
- Patient data were obtained via community pharmacist-collected medication histories.
- Interrater reliability was measured using kappa statistics, agreement percentages, and intraclass correlation coefficients across three scoring schemes.
Main Results:
- Kappa statistics exceeded 0.75 for indication and effectiveness criteria with the Hanlon scheme.
- Other criteria showed good kappa values (0.41-0.66).
- Intraclass coefficients (0.82-0.87) and overall kappa (0.61-0.66) were consistent across the three scoring schemes.
Conclusions:
- The modified MAI demonstrates potential for identifying appropriate and inappropriate medications in community pharmacies.
- Limitations exist, and further studies are recommended to improve the MAI's reliability and generalizability.