Drug-Associated Risk Tool: development and validation of a self-assessment questionnaire to screen for hospitalised patients at risk for drug-related problems

Abstract

IntroductionIdentifying patients with a high risk for drug-related problems (DRPs) might optimise the allocation of targeted pharmaceutical care during the hospital stay and on discharge.ObjectiveTo develop a self-assessment screening tool to identify patients at risk for DRPs and validate the tool regarding feasibility, acceptability and the reliability of the patients’ answers.DesignProspective validation study.SettingTwo mid-sized hospitals (300–400 beds).Participants195 patients, exclusion criteria: under 18 years old, patients with a health status not allowing a meaningful communication (eg, delirium, acute psychosis, advanced dementia, aphasia, clouded consciousness state), palliative or terminally ill patients.MethodsTwenty-seven risk factors for the development of DRPs, identified in a previous study, provided the basis of the self-assessment questionnaire, the Drug-Associated Risk Tool (DART). Consenting patients filled in DART, and we compared their answers with objective patient data from medical records and laboratory data.ResultsOne hundred and sixty-four patients filled in DART V.1.0 in an average time of 7 min. After a first validation, we identified statements with a low sensitivity and revised the wording of the questions related to heart insufficiency, renal impairment or liver impairment. The revised DART (V.2.0) was validated in 31 patients presenting heart insufficiency, renal impairment or liver impairment as comorbidity and reached an average specificity of 88% (range 27–100) and an average sensitivity of 67% (range 21–100).ConclusionsDART showed a satisfying feasibility and reliability. The specificity of the statements was mostly high. The sensitivity varied and was higher in statements concerning diseases that require regular disease control and attention to self-care and drug management. Asking patients about their conditions, medications and related problems can facilitate getting a first, broad picture of the risk for DRPs and possible pharmaceutical needs.

Screening Tools Used by Clinical Pharmacists to Identify Elderly Patients at Risk of Drug-Related Problems on Hospital Admission: A Systematic Review

“…Two studies [ 18 , 38 ] did not report the age demographics of the study participants (although participants were adults). The remaining studies were conducted in adult patients (including but not exclusively elderly patients) [ 3 , 20 , 34 , 35 , 36 , 37 , 39 , 40 , 42 ]. The majority of the studies presented either the mean or median age for participants, with the mean age of participants varying from 51.4 years [ 20 ] to 86.7 years [ 33 ], showing significant variations between the participants of the various studies.…”

“…There were significant differences in the gender profiles for participants in the differing studies, with four studies [ 18 , 30 , 38 , 42 ] not reporting this characteristic; in the remaining fifteen studies, female participants represented 46%–72% of the sample populations, so there were significant differences between the study populations with regard to this, with differences also observed between those included in the development and individual validation studies carried out by the same researchers, e.g., females accounted for 49% of participants in the first validation study conducted by Kaufmann et al in 2018, compared to 61% of participants in the second validation study after the questionnaire was revised [ 37 ].…”

“…One study involved the development and external validation of a tool [ 30 ], whilst another involved the development, internal and external validation of a tool [ 25 ]. One study [ 20 ] only described the development of an assessment tool (which was subsequently utilised in a further study; see below [ 35 ]); another study described the development and subsequent utilisation (rather than validation) of a tool [ 38 ], four studies described the utilisation or internal validation of a previously developed tool [ 35 , 36 , 37 , 39 ], and two studies provided external validation (only) of the previously developed GerontoNet ADR Risk Score [ 32 , 43 ].…”

Assessing the ability of the Drug-Associated Risk Tool (DART) questionnaire to stratify hospitalised older patients according to their risk of drug-related problems: a cross-sectional validation study

“…The Drug-Associated Risk Tool (DART) is a 35-item questionnaire about risk factors deemed to be associated with DRPs. 16 The DART was developed to assist clinical pharmacists in stratifying their patients for medication reviews and to tailor clinical pharmacy services according to available resources. The items of the questionnaire were identified by triangulation, including quantitative and qualitative methods, described elsewhere.…”

“…The applicability of the DART used as a self-administered questionnaire has been shown for hospitalised patients; compared with documented medical records, patients from geriatric, medical and orthopaedic wards with a median age of 81, 65 and 67.5 years, respectively, were able to adequately reproduce their medical information, limitations being renal and hepatic insufficiency. 16 …”