The home medication review (HMR) checklist: development, validation, and feasibility study

The Home Medication Review (HMR) is a structured, patient-centred service provided by pharmacists to facilitate the optimisation of medication therapy, mitigate drug-related issues, and improve health outcomes. Despite the global adoption of HMR, there is a lack of standardisation. To overcome this gap, a detailed HMR checklist was developed to ensure that all key elements of an HMR visit are covered. The aim was to develop and validate a comprehensive checklist to standardise the delivery of HMR and facilitate its widespread implementation in the Indian healthcare system, which can also be adopted internationally with regional modifications.

A detailed literature review was conducted to develop a preliminary checklist framework, which was subsequently refined through input from a seven-member advisory board. Content Validity Index (CVI) and modified kappa statistics (k*) were used to evaluate content validity by eleven experts. The checklist was tested for its usability in the home care environment through pharmacist-conducted reviews of medications in a feasibility study involving 20 participants.

The 12-domain, final 65-item HMR Checklist demonstrated high levels of content validity, with an average Cronbach's alpha (Ave-CVI) of 0.97, indicating high relevance and simplicity. In the case of Universal Agreement-CVI, the values were 0.78 and 0.75. The level of pharmacist compliance during the feasibility tests showed a high level of adherence (93.5% total compliance), with key areas demonstrating adherence at every visit. Further examination of the I-CVI and k* values was very high in all domains, demonstrating good item-level validity. Overall, the feasibility data demonstrated high patient acceptance and easy integration into the workflow.

Overall, content validity indices and content validation processes are considered crucial factors in the development of an instrument. The study demonstrates that the HMR Checklist is a reliable, holistic, and practical instrument that can be used to standardise and implement home medication reviews, led by clinical pharmacists. It has a strong potential to enhance medication safety and provides a solid foundation for future large-scale evaluations globally.