Applicability of an adapted medication appropriateness index for detection of drug-related problems in geriatric inpatients.
BACKGROUND
High drug consumption by older patients and the presence of many drug-related problems require careful assessment of drug therapy, for which a structured approach is recommended.


OBJECTIVE
The purpose of our study was to evaluate the applicability of an adapted version of the Medication Appropriateness Index (MAI) in 50 geriatric inpatients at the time of admission.


METHODS
We reviewed, for 432 prescribed drugs, indication, right choice, dosage, directions, drug-disease interactions, drug-drug interactions, and duration of therapy. In addition, adverse drug reactions were evaluated, resulting in 8 questions per drug. MAI scores were attributed independently by a geriatrician and by a clinical pharmacist, and differences between them were assessed. Furthermore, the relationship between MAI score and drug-related hospital admission was explored.


RESULTS
Mean summed MAI scores of 13.7 according to the geriatrician and 13.6 according to the pharmacist were obtained. The highest scores were found for drugs for the central nervous and the urinary tract system; the highest scores per question were detected for right choice, adverse drug reactions, and drug-drug interactions. A good agreement between the scores of the geriatrician and the pharmacist was found: intraclass correlation coefficient was 0.91 and overall κ value was 0.71. A significantly higher MAI score was found for drug-related hospital admissions (P = 0.04 for the geriatrician and P = 0.03 for the pharmacist).


CONCLUSIONS
This adapted MAI score seems useful for detection of drug-related problems in geriatric inpatients and reliable with a low inter-rater variability and positive correlation between high score and drug-related hospital admission. We consider further application of the adapted MAI for teaching and training of clinical pharmacists, and as a systematic approach for detection of drug-related problems by the clinical pharmacists in our hospital.
Department of Pharmacy, Ghent University Hospital, Gent, Belgium.
Annemie
A
Somers
Louise
L
Mallet
Tischa
T
van der Cammen
Hugo
H
Robays
Mirko
M
Petrovic
D000368:Aged; D000369:Aged, 80 and over; D004347:Drug Interactions; D005260:Female; D005853:Geriatrics / Q000458:organization & administration; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D015588:Observer Variation; D010343:Patient Admission; D010595:Pharmacists / Q000458:organization & administration; D055553:Prescription Drugs / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015203:Reproducibility of Results; D012189:Retrospective Studies
D055553:Prescription Drugs