Exploring the domains of appropriateness of drug therapy, using the Nominal Group Technique.
OBJECTIVE
To explore the domains encompassed within the assessment of the appropriateness of prescribing for an individual patient.


METHODS
The Nominal Group Technique was used to address the question "How can we assess inappropriate drug therapy of individual patients that is responsive to pharmaceutical care?" The group participants were a self-selected group of nine pharmacists and one pharmacologist attending an international working conference on the Outcomes of Pharmaceutical Care. Item generation was followed by discussion for clarification and operationalization. Voting achieved a consensus, defined as > or = 70%, agreement on the importance of items for inclusion in an instrument to assess appropriateness.


RESULTS
Sixty-seven items were initially generated. During discussion, similar items were combined and items were grouped into domains. Items that considered the patient's perspective were commonly suggested, but many were discarded after discussing their operationalization. Consensus was obtained that eighteen items, in seven domains, should be included in the instrument. The domains were indication and drug choice (5 items), effectiveness (2), risks and safety (2), dosage (3), interactions (1), practical use (4), and monitoring (1).


CONCLUSIONS
It is hoped that, with adequate testing, these indicators of appropriateness of prescribing can be used by pharmacists to begin to routinely assess the impact of pharmaceutical care on the quality of prescribing for patients under their care.
Tully
Mary P
MP
School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK. mary.tully@man.ac.uk
Cantrill
Judith A
JA
D003657:Decision Making; D004347:Drug Interactions; D011307:Drug Prescriptions; D004358:Drug Therapy / Q000592:standards*; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010595:Pharmacists; D018570:Risk Assessment; D016896:Treatment Outcome
D004364:Pharmaceutical Preparations