title: Selection of tools for reconciliation, compliance and appropriateness of treatment in patients with multiple chronic conditions.
abstract: BACKGROUND
  The healthcare models developed for patients with multiple chronic diseases agree on the need for improving drug therapy in these patients. The issues of patient compliance, appropriateness of prescriptions and the reconciliation process are of vital importance for patients receiving multiple drug treatment.
  
  
  OBJECTIVE
  To identify and select the most appropriate tools for measuring treatment compliance and appropriateness in multiple-disease patients, as well as the best reconciliation strategy.
  
  
  METHODS
  The study used the Delphi methodology. We identified compliance and appropriateness questionnaires and scales, as well as functional organisation models for reconciliation that had been used in patients with multiple chronic conditions. Based on the strength of the evidence, their usefulness in these patients and ease of use, the panel selected the most appropriate ones.
  
  
  RESULTS
  We selected 46 indications for the panel: 5 on compliance, 20 on appropriateness, and 31 on reconciliation. The tool considered most appropriate and with a high degree of agreement was the "Adherence to Refills and Medication Scale" questionnaire. For appropriateness, the Medication Appropriateness Index questionnaire was considered appropriate. The STOPP/START criteria were the most appropriate. The greatest degree of agreement regarding reconciliation was on the information that needed to be collected and the variables considered as discrepancies.
  
  
  CONCLUSIONS
  The "Adherence to Refills and Medication Scale" questionnaire for compliance, the STOPP/START criteria, the Medication Appropriateness Index questionnaire for appropriateness and the development of a specific strategy for reconciliation were considered appropriate for the assessment of drug therapy in patients with multiple chronic conditions.
authors.affiliation: Unidad de Gestión Clínica de Farmacia, Hospital Universitario Virgen del Rocío, Seville, Spain. eralfarolara@gmail.com
authors.forename: Eva Rocío
authors.initials: ER
authors.lastname: Alfaro Lara
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Vega Coca
authors.forename: Mercedes
authors.initials: M
authors.lastname: Galván Banqueri
authors.forename: Roberto
authors.initials: R
authors.lastname: Marín Gil
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Nieto Martín
authors.forename: Concepción
authors.initials: C
authors.lastname: Pérez Guerrero
authors.forename: Manuel
authors.initials: M
authors.lastname: Ollero Baturone
authors.forename: Bernardo
authors.initials: B
authors.lastname: Santos-Ramos
mesh_terms: D002908:Chronic Disease / Q000188:drug therapy*; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D059065:Medication Reconciliation / Q000379:methods*; D010349:Patient Compliance / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016903:Drug Monitoring