title: A reliable and valid index was developed to measure appropriate psychotropic drug use in dementia.
abstract: OBJECTIVE
  The aim of this study was to develop an index derived from the Medication Appropriateness Index (MAI) items that is suited for clinical studies evaluating appropriateness of psychotropic drug use (PDU) for neuropsychiatric symptoms (NPS) in patients with dementia in nursing homes and to test its reliability and validity.
  
  
  METHODS
  An expert panel reviewed the MAI items to develop items for appropriateness of PDU; a second, independent, expert panel determined content validity of the items. An interrater reliability study was conducted (N = 54), and a summated index score, based on weighted item scores, was developed to enhance the use in clinical studies. Construct validity was explored using a representative sample of 560 medical records.
  
  
  RESULTS
  Five existing MAI items were used, the MAI item "indication" was adjusted, a new item "evaluation" was added, and scoring rules were based on guideline recommendations, to create the Appropriate Psychotropic drugs use In Dementia (APID) index. The second expert panel concluded that all items contributed to the construct "appropriateness." All items and the summated index score had moderate to almost perfect interrater reliability (intraclass correlation coefficient for agreement, 0.577-1). The summated index score showed promising construct validity, for example, no multicollinearity issues were found.
  
  
  CONCLUSIONS
  The results of this study show that the APID index is reliable and valid for measuring appropriateness of PDU for NPS in dementia in nursing homes in clinical studies.
authors.affiliation: Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, P.O. Box 9101, Nijmegen 6500 HB, The Netherlands. Electronic address: klaas.vanderspek@radboudumc.nl.
authors.forename: Klaas
authors.initials: K
authors.lastname: van der Spek
authors.affiliation: Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, P.O. Box 9101, Nijmegen 6500 HB, The Netherlands.
authors.forename: Debby L
authors.initials: DL
authors.lastname: Gerritsen
authors.affiliation: Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, P.O. Box 7057, Amsterdam 1007 MB, The Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: Smalbrugge
authors.affiliation: Dutch Institute for Rational Use of Medicine, P.O. Box 3089, Utrecht 3502 GB, The Netherlands.
authors.forename: Marjorie H J M G
authors.initials: MH
authors.lastname: Nelissen-Vrancken
authors.affiliation: Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, P.O. Box 9101, Nijmegen 6500 HB, The Netherlands.
authors.forename: Roland B
authors.initials: RB
authors.lastname: Wetzels
authors.affiliation: Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, P.O. Box 9101, Nijmegen 6500 HB, The Netherlands.
authors.forename: Claudia H W
authors.initials: CH
authors.lastname: Smeets
authors.affiliation: Department of General Practice, University of Groningen, University Medical Center Groningen, HPC FA21, P.O. Box 196, Groningen 9700 AD.
authors.forename: Sytse U
authors.initials: SU
authors.lastname: Zuidema
authors.affiliation: Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen Huispost 117 ELG, P.O. Box 9101, Nijmegen 6500 HB, The Netherlands.
authors.forename: Raymond T C M
authors.initials: RT
authors.lastname: Koopmans
mesh_terms: D000368:Aged; D003704:Dementia / Q000188:drug therapy*; D004347:Drug Interactions; D017723:Drug Utilization Review / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D015203:Reproducibility of Results
chemical_list: D011619:Psychotropic Drugs
keywords: Appropriate; Dementia; Index development; Neuropsychiatric symptoms; Nursing home patients; Psychotropic drug use