Assessment tool for hospital admissions related to medications: development and validation in older patients

Area of Science:

• Pharmacovigilance
• Medication Safety
• Health Services Research

Background:

• Medication-related hospital admissions (MRAs) are crucial outcome measures in medication review studies.
• Current MRA identification methods are subjective and time-intensive, necessitating practical, validated alternatives.
• Developing efficient tools is essential for improving medication safety research.

Purpose of the Study:

• To develop and validate a practical tool, AT-HARM10, for identifying medication-related hospital admissions (MRAs).
• To assess the inter-rater reliability (IRR) and criterion-related validity (CRV) of the AT-HARM10 tool.
• To establish a reliable method for MRA identification in clinical practice and research.

Main Methods:

• Literature review to inform tool development.
• Iterative development of the AT-HARM10 tool, including content validity and feasibility testing.
• Assessment of IRR and CRV using final-year undergraduate/postgraduate pharmacy students and experienced clinicians as a gold standard on 100 patient admissions.

Main Results:

• The AT-HARM10 tool, comprising ten closed questions, effectively differentiates between possibly and unlikely medication-related admissions.
• Moderate to substantial IRR was achieved (Cohen's kappa: 0.45-0.75; Fleiss' kappa: 0.46-0.58).
• The tool demonstrated acceptable validity (sensitivity: 70-86%; specificity: 70-74%; PPV: 73-74%; NPV: 71-83%), with similar MRA identification rates to the gold standard (~50%).

Conclusions:

• AT-HARM10 is a practical and validated tool for identifying medication-related hospital admissions (MRAs).
• The tool is suitable for use by final-year undergraduate and postgraduate pharmacy students in older patient populations.
• AT-HARM10 offers a reliable alternative to subjective and time-consuming MRA identification methods.