Skip to main content

Advertisement

SpringerLink
Log in

Reliability of a modified medication appropriateness index in primary care

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the inter-group and intra-group reliability of a modified Medication Appropriateness Index (MAI) for use in primary care.

Methods

Elderly (>65 years) polypharmacy (≥5 drugs) patients in Copenhagen County participated in the study. Information concerning their medical history and information regarding each drug taken by them was provided by their own general practitioners. A MAI was scored by two groups of evaluators for every drug. To evaluate inter-group agreement, 211 drugs taken by 30 patients were rated according to the ten criteria making up the MAI. Both evaluator groups provided summaries of comments on the medication of each patient. Intra-group agreement was determined from MAI ratings performed twice at two different times on 86 drugs taken by ten patients. Agreement and chance-adjusted agreement were determined, the latter through kappa statistics. The proportion of positive (ppos) and negative (pneg) agreement was also determined.

Results

The overall chance-adjusted inter-group agreement (kappa) was moderate. The agreement was good on the criteria practical directions and drug–disease interaction, moderate on the criteria dosage and duration, fair on the criteria indication, effectiveness, duplication and expense, and poor on the criterion drug–drug interaction. The overall chance-adjusted intra-group agreement was good for all criteria and very good for the criteria indication and practical directions.

Conclusion

The MAI is used to quantify appropriate and inappropriate prescribing and changes in prescribing quality in intervention studies. However, caution should be used when comparing results across different settings and evaluators. Our study suggests that the index should only be used in intervention studies if the same group rates the appropriateness pre- and post-intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Buetow SA, Sibbald B, Cantrill JA, Halliwell S (1996) Prevalence of potentially inappropriate long term prescribing in general practice in the United Kingdom, 1980–1995 systematic literature review. BMJ 313:1371–1374

    PubMed  CAS  Google Scholar 

  2. Curtis LH, Ostbye T, Sendersky V, Hutchison S, Dans PE, Wright A et al (2004) Inappropriate prescribing for elderly Americans in a large outpatient population. Arch Intern Med 164:1621–1625

    Article  PubMed  Google Scholar 

  3. Goulding MR (2004) Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med 164:305–312

    Article  PubMed  Google Scholar 

  4. Gurwitz JH, Field TS, Avorn J, McCormick D, Jain S, Eckler M et al (2000) Incidence and preventability of adverse drug events in nursing homes. Am J Med 109:87–94

    Article  PubMed  CAS  Google Scholar 

  5. Zhan C, Sangl J, Bierman AS, Miller MR, Friedman B, Wickizer SW et al (2001) Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA 286:2823–2829

    Article  PubMed  CAS  Google Scholar 

  6. Hallas J, Gram LF, Grodum E, Damsbo N, Brosen K, Haghfelt T et al (1992) Drug related admissions to medical wards: a population based survey. Br J Clin Pharmacol 33:61–68

    PubMed  CAS  Google Scholar 

  7. Schneeweiss S, Hasford J, Gottler M, Hoffmann A, Riethling AK, Avorn J (2002) Admissions caused by adverse drug events to internal medicine and emergency departments in hospitals: a longitudinal population-based study. Eur J Clin Pharmacol 58:285–291

    Article  PubMed  Google Scholar 

  8. Fitzgerald LS, Hanlon JT, Shelton PS, Landsman PB, Schmader KE, Pulliam CC et al (1997) Reliability of a modified medication appropriateness index in ambulatory older persons. Ann Pharmacother 31:543–548

    PubMed  CAS  Google Scholar 

  9. Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK et al (1992) A method for assessing drug therapy appropriateness. J Clin Epidemiol 45:1045–1051

    Article  PubMed  CAS  Google Scholar 

  10. Fitzgerald LS, Hanlon JT, Shelton PS, Landsman PB, Schmader KE, Pulliam CC et al (1997) Reliability of a modified medication appropriateness index in ambulatory older persons. Ann Pharmacother 31:543–548

    PubMed  CAS  Google Scholar 

  11. Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK et al (1992) A method for assessing drug therapy appropriateness. J Clin Epidemiol 45:1045–1051

    Article  PubMed  CAS  Google Scholar 

  12. Kassam R, Martin LG, Farris KB (2003) Reliability of a modified medication appropriateness index in community pharmacies. Ann Pharmacother 37:40–46

    Article  PubMed  Google Scholar 

  13. Fitzgerald LS, Hanlon JT, Shelton PS, Landsman PB, Schmader KE, Pulliam CC et al (1997) Reliability of a modified medication appropriateness index in ambulatory older persons. Ann Pharmacother 31:543–548

    PubMed  CAS  Google Scholar 

  14. Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK et al (1992) A method for assessing drug therapy appropriateness. J Clin Epidemiol 45:1045–1051

    Article  PubMed  CAS  Google Scholar 

  15. Fitzgerald LS, Hanlon JT, Shelton PS, Landsman PB, Schmader KE, Pulliam CC et al (1997) Reliability of a modified medication appropriateness index in ambulatory older persons. Ann Pharmacother 31:543–548

    PubMed  CAS  Google Scholar 

  16. Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK et al (1992) A method for assessing drug therapy appropriateness. J Clin Epidemiol 45:1045–1051

    Article  PubMed  CAS  Google Scholar 

  17. Cicchetti DV, Feinstein AR (1990) High agreement but low kappa: II. Resolving the paradoxes. J Clin Epidemiol 43:551–558

    Article  PubMed  CAS  Google Scholar 

  18. Feinstein AR, Cicchetti DV (1990) High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol 43:543–549

    Article  PubMed  CAS  Google Scholar 

  19. Fitzgerald LS, Hanlon JT, Shelton PS, Landsman PB, Schmader KE, Pulliam CC et al (1997) Reliability of a modified medication appropriateness index in ambulatory older persons. Ann Pharmacother 31:543–548

    PubMed  CAS  Google Scholar 

  20. Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK et al (1992) A method for assessing drug therapy appropriateness. J Clin Epidemiol 45:1045–1051

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This study was financially supported by the Hørslev Foundation, The Danish Research Foundation for General Practice, The Health Insurance Foundation and the Copenhagen County Health Administration.

Author information

Authors and Affiliations

  1. Clinical Pharmacology Unit, Gentofte University Hospital, Post 4022, Niels Andersensvej 65, 2900, Hellerup, Denmark

    Lisbeth Bregnhøj & Jesper Sonne

  2. Clinical Pharmacology Unit, The Danish Medicines Agency, Axel Heides Gade 1, 2300, Copenhagen S, Denmark

    Steffen Thirstrup & Mogens Brandt Kristensen

Authors
  1. Lisbeth Bregnhøj
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steffen Thirstrup
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mogens Brandt Kristensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jesper Sonne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisbeth Bregnhøj.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bregnhøj, L., Thirstrup, S., Kristensen, M.B. et al. Reliability of a modified medication appropriateness index in primary care. Eur J Clin Pharmacol 61, 769–773 (2005). https://doi.org/10.1007/s00228-005-0963-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-005-0963-0

Keywords

Search

Navigation