title: Development and testing of a tool for assessing and resolving medication-related problems in older adults in an ambulatory care setting: the individualized medication assessment and planning (iMAP) tool.
abstract: BACKGROUND
  Medication is one of the most important interventions for improving the health of older adults, yet it has great potential for causing harm. Clinical pharmacists are well positioned to engage in medication assessment and planning. The Individualized Medication Assessment and Planning (iMAP) tool was developed to aid clinical pharmacists in documenting medication-related problems (MRPs) and associated recommendations.
  
  
  OBJECTIVE
  The purpose of our study was to assess the reliability and usability of the iMAP tool in classifying MRPs and associated recommendations in older adults in the ambulatory care setting.
  
  
  METHODS
  Three cases, representative of older adults seen in an outpatient setting, were developed. Pilot testing was conducted and a "gold standard" key developed. Eight eligible pharmacists consented to participate in the study. They were instructed to read each case, make an assessment of MRPs, formulate a plan, and document the information using the iMAP tool. Inter-rater reliability was assessed for each case, comparing the pharmacists' identified MRPs and recommendations to the gold standard. Consistency of categorization across reviewers was assessed using the κ statistic or percent agreement.
  
  
  RESULTS
  The mean κ across the 8 pharmacists in classifying MRPs compared with the gold standard was 0.74 (range, 0.54-1.00) for case 1 and 0.68 (range, 0.36-1.00) for case 2, indicating substantial agreement. For case 3, percent agreement was 63% (range, 40%-100%). The mean κ across the 8 pharmacists when classifying recommendations compared with the gold standard was 0.87 (range, 0.58-1.00) for case 1 and 0.88 (range, 0.75-1.00) for case 2, indicating almost perfect agreement. For case 3, percent agreement was 68% (range, 40%-100%). Clinical pharmacists found the iMAP tool easy to use.
  
  
  CONCLUSIONS
  The iMAP tool provides a reliable and standardized approach for clinical pharmacists to use in the ambulatory care setting to classify MRPs and associated recommendations. Future studies will explore the predictive validity of the tool on clinical outcomes such as health care utilization.
authors: Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, USA. gcrisp@unch.unc.edu
authors: Ginny D
authors: GD
authors: Crisp
authors: Jena Ivey
authors: JI
authors: Burkhart
authors: Denise A
authors: DA
authors: Esserman
authors: Morris
authors: M
authors: Weinberger
authors: Mary T
authors: MT
authors: Roth
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration*; D010865:Pilot Projects; D057285:Precision Medicine; D024382:Professional Role; D015203:Reproducibility of Results
chemical_list: D004364:Pharmaceutical Preparations