Reliability of a modified medication appropriateness index in community pharmacies.
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.
Kassam
Rosemin
R
Pharmacy Practice and Structured Pharmacy Education Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada. rokassam@unixg.ubc.ca
Martin
Linda G
LG
Farris
Karen B
KB
D003625:Data Collection / Q000379:methods; D017723:Drug Utilization Review / Q000379:methods*; D006801:Humans; D015588:Observer Variation; D010593:Pharmaceutical Services; D010594:Pharmacies / Q000706:statistics & numerical data; D010595:Pharmacists; D015203:Reproducibility of Results