title: MAT-CAP: a novel medication assessment tool to explore adherence to clinical practice guidelines in community-acquired pneumonia.
abstract: OBJECTIVE
  Community-acquired pneumonia (CAP) is a disease with high morbidity and mortality. Adherence to clinical practice guidelines (CPGs) in treatment of CAP is associated with favourable outcome. We aimed to develop and validate a medication assessment tool (MAT) to explore adherence to CPG recommendations in patients with CAP admitted to a Norwegian hospital. The tool is named MAT-CAP.
  
  
  METHODS
  Sixteen quality indicators (QIs) based on local and international CPGs were developed. Content validity was explored in an expert panel using a two-round modified Delphi technique. QIs demonstrating content valdity were reformulated into review criteria forming the MAT-CAP. Feasibility and adherence to MAT-CAP were explored in a retrospective study using data from electronic patient records of CAP patients admitted to the University Hospital of North Norway Tromso during 2008. Reliability was explored using Cohen's kappa (ĸ) statistics for inter- and intra-observer agreements.
  
  
  RESULTS
  Content validity was demonstrated for 15 QIs covering areas as initial empirical treatment, microbiological diagnostics, pathogen specific treatment, dose adjustment according to renal function, switch from intravenous to oral treatment and treatment duration. Overall reliability was excellent with ĸ-values of 0.88 and 0.95 for inter-observer and intra-observer agreements, respectively. Overall applicability was 37.2%, and mean application times were 3.1 and 3.8 min for the two observers. Overall adherence to 812 criteria applied was 59% (range 0-100).
  
  
  CONCLUSIONS
  We have demonstrated content validity, feasibility and reliability of a 15-criterion MAT-CAP. Adherence results from applying MAT-CAP criteria pinpointed areas with good clinical performance and areas with improvement potentials.
authors.affiliation: Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: June Utnes
authors.initials: JU
authors.lastname: Høgli
authors.forename: Lars
authors.initials: L
authors.lastname: Småbrekke
authors.forename: Beate Hennie
authors.initials: BH
authors.lastname: Garcia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000188:drug therapy*; D057286:Electronic Health Records; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D008297:Male; D009664:Norway; D011014:Pneumonia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: clinical pharmacy; clinical practice guidelines; community-acquired pneumonia; medication assessment tool; pharmacoepidemiology