title: Development and validation of the PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) criteria to assess medication safety and use issues in patients with CKD.
abstract: BACKGROUND
  Explicit criteria for judging medication safety and use issues in patients with chronic kidney disease (CKD) are lacking.
  
  
  METHODS
  Quality improvement report.
  
  
  METHODS
  Nephrologists (n = 4), primary care physicians (n = 2), hospital pharmacists with expertise in nephrology (n = 4), and community pharmacists (n = 2). The PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) criteria were applied retrospectively to 90 patients with CKD in a randomized study.
  
  
  METHODS
  Development of an explicit set of criteria to enable rapid and systematic detection of drug-related problems (DRPs). Using a RAND method, experts judged the clinical significance of DRPs and the appropriateness of a community pharmacist intervention. The PAIR criteria include 50 DRPs grouped into 6 categories.
  
  
  RESULTS
  DRPs detected using the PAIR criteria compared with implicit clinical judgment by nephrology pharmacists.
  
  
  METHODS
  Prevalence of DRPs and reliability, validity, and responsiveness of the PAIR criteria.
  
  
  RESULTS
  A mean of 2.5 DRPs/patient (95% CI, 2.0-3.1) was identified based on the PAIR criteria compared with 3.9 DRPs/patient (95% CI, 3.4-4.5) based on clinical judgment of nephrology pharmacists. Inter-rater reliability coefficients (κ) by PAIR category varied from 0.80-1.00, with an intraclass correlation coefficient (ICC) of 0.93 (95% CI, 0.89-0.95) for total DRPs per patient. Test-retest reliability coefficients by category varied from 0.74-1.00, with an ICC of 0.91 (95% CI, 0.82-0.96) for total DRPs per patient. During the study, the mean number of DRPs per patient did not change significantly when assessed using the PAIR criteria and clinical judgment.
  
  
  CONCLUSIONS
  The prevalence of PAIR DRPs may be underestimated due to the retrospective nature of the validation.
  
  
  CONCLUSIONS
  The prevalence of DRPs requiring the intervention of community pharmacists is high in patients with CKD. The PAIR criteria are reliable, but their responsiveness remains to be shown.
authors.affiliation: Faculty of Pharmacy, Université de Montréal, Quebec, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Desrochers
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Lemieux
authors.forename: Claudia
authors.initials: C
authors.lastname: Morin-Bélanger
authors.forename: François Ste-Marie
authors.initials: FS
authors.lastname: Paradis
authors.forename: Anne
authors.initials: A
authors.lastname: Lord
authors.forename: Robert
authors.initials: R
authors.lastname: Bell
authors.forename: Djamal
authors.initials: D
authors.lastname: Berbiche
authors.forename: Patricia Quintana
authors.initials: PQ
authors.lastname: Bárcena
authors.forename: Noémie Charbonneau
authors.initials: NC
authors.lastname: Séguin
authors.forename: Katherine
authors.initials: K
authors.lastname: Desforges
authors.forename: Marie-Ève
authors.initials: MÈ
authors.lastname: Legris
authors.forename: Patricia
authors.initials: P
authors.lastname: Sauvé
authors.forename: Lyne
authors.initials: L
authors.lastname: Lalonde
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000592:standards*; D002908:Chronic Disease; D003157:Community Pharmacy Services / Q000592:standards*; D003376:Counseling; D004363:Drug Utilization; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D006801:Humans; D057970:Inappropriate Prescribing; D007674:Kidney Diseases / Q000188:drug therapy* / Q000453:epidemiology; D009398:Nephrology; D004366:Nonprescription Drugs; D015588:Observer Variation; D010353:Patient Education as Topic / Q000458:organization & administration; D010607:Pharmacy Service, Hospital; D010865:Pilot Projects; D015995:Prevalence; D011320:Primary Health Care; D058996:Quality Improvement; D015203:Reproducibility of Results
chemical_list: D004366:Nonprescription Drugs