Reliability of the medication appropriateness index in Dutch residential home

Stuijt, Clementine C. M.; Franssen, Eric J. F.; Egberts, Toine C. G.; Hudson, Steve

doi:10.1007/s11096-009-9283-2

Cited by 20 publications

(16 citation statements)

References 16 publications

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“…Using these measures, intra-rater reliability of MAI ratings showed almost perfect agreement81 and intra-rater reliability was slightly better, which is in line with former observations 6269 73 Evaluated secondary outcomes showed small changes but supported for most of them a further use in the main study (EQ-5D and adherence-related measures such as medication complexity). As observed in earlier studies,82 measures of self-reported adherence did not appear to provide valid results, as they contradicted results from comparisons of prescribed with taken medicines, and showed ceiling versus floor effects.…”

Section: Discussionsupporting

confidence: 86%

Pilot study to test the feasibility of a trial design and complex intervention onPRIoritisingMUltimedication inMultimorbidity in general practices (PRIMUMpilot)

et al. 2016

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ObjectiveTo improve medication appropriateness and adherence in elderly patients with multimorbidity, we developed a complex intervention involving general practitioners (GPs) and their healthcare assistants (HCA). In accordance with the Medical Research Council guidance on developing and evaluating complex interventions, we prepared for the main study by testing the feasibility of the intervention and study design in a cluster randomised pilot study.Setting20 general practices in Hesse, Germany.Participants100 cognitively intact patients ≥65 years with ≥3 chronic conditions, ≥5 chronic prescriptions and capable of participating in telephone interviews; 94 patients completed the study.InterventionThe HCA conducted a checklist-based interview with patients on medication-related problems and reconciled their medications. Assisted by a computerised decision-support system (CDSS), the GPs discussed medication intake with patients and adjusted their medication regimens. The control group continued with usual care.Outcome measuresFeasibility of the intervention and required time were assessed for GPs, HCAs and patients using mixed methods (questionnaires, interviews and case vignettes after completion of the study). The feasibility of the study was assessed concerning success of achieving recruitment targets, balancing cluster sizes and minimising drop-out rates. Exploratory outcomes included the medication appropriateness index (MAI), quality of life, functional status and adherence-related measures. MAI was evaluated blinded to group assignment, and intra-rater/inter-rater reliability was assessed for a subsample of prescriptions.Results10 practices were randomised and analysed per group. GPs/HCAs were satisfied with the interventions despite the time required (35/45 min/patient). In case vignettes, GPs/HCAs needed help using the CDSS. The study made no patients feel uneasy. Intra-rater/inter-rater reliability for MAI was excellent. Inclusion criteria were challenging and potentially inadequate, and should therefore be adjusted. Outcome measures on pain, functionality and self-reported adherence were unfeasible due to frequent missing values, an incorrect manual or potentially invalid results.ConclusionsIntervention and trial design were feasible. The pilot study revealed important limitations that influenced the design and conduct of the main study, thus highlighting the value of piloting complex interventions.Trial registration numberISRCTN99691973; Results.

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Section: Discussionsupporting

confidence: 86%

Pilot study to test the feasibility of a trial design and complex intervention onPRIoritisingMUltimedication inMultimorbidity in general practices (PRIMUMpilot)

et al. 2016

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“…In terms of the latter, although a number of approaches have been attempted to categorising medication errors for older people in hospital, community and general practice [58-60], it is only very recently that this debate has extended to care homes [61]. Furthermore, existing criteria concentrate almost exclusively on identifying errors in prescribing, and only rarely errors in administration [62].…”

Section: Discussionmentioning

confidence: 99%

Medication administration errors for older people in long-term residential care

2011

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BackgroundOlder people in long-term residential care are at increased risk of medication prescribing and administration errors. The main aim of this study was to measure the incidence of medication administration errors in nursing and residential homes using a barcode medication administration (BCMA) system.MethodsA prospective study was conducted in 13 care homes (9 residential and 4 nursing). Data on all medication administrations for a cohort of 345 older residents were recorded in real-time using a disguised observation technique. Every attempt by social care and nursing staff to administer medication over a 3-month observation period was analysed using BCMA records to determine the incidence and types of potential medication administration errors (MAEs) and whether errors were averted. Error classifications included attempts to administer medication at the wrong time, to the wrong person or discontinued medication. Further analysis compared data for residential and nursing homes. In addition, staff were surveyed prior to BCMA system implementation to assess their awareness of administration errors.ResultsA total of 188,249 medication administration attempts were analysed using BCMA data. Typically each resident was receiving nine different drugs and was exposed to 206 medication administration episodes every month. During the observation period, 2,289 potential MAEs were recorded for the 345 residents; 90% of residents were exposed to at least one error. The most common (n = 1,021, 45% of errors) was attempting to give medication at the wrong time. Over the 3-month observation period, half (52%) of residents were exposed to a serious error such as attempting to give medication to the wrong resident. Error incidence rates were 1.43 as high (95% CI 1.32-1.56 p < 0.001) in nursing homes as in residential homes. The level of non-compliance with system alerts was very low in both settings (0.075% of administrations). The pre-study survey revealed that only 12/41 staff administering drugs reported they were aware of potential administration errors in their care home.ConclusionsThe incidence of medication administration errors is high in long-term residential care. A barcode medication administration system can capture medication administration errors and prevent these from occurring.

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“…In four studies, using clinical data from elderly hospital inpatients or outpatients from Belgium, Ireland and the US, the kappa statistic for each item was >0.40 indicating good reproducibility regardless of whether the pair of evaluators were both pharmacists, both physicians or a pharmacist and physician [10,14,16,18]. Two studies from Europe (Netherlands and Denmark) examining medications from older primary care and nursing home patients both found kappa statistics <0.40 for the effectiveness item whereas similar disagreement with the indication, therapeutic duplication and expense items were found in the Denmark study only [15,17]. It is important to note that the overall kappa statistic in both studies were >0.40 as was that from four other studies [10,13,14,16].…”

Section: 0 Data Synthesismentioning

confidence: 94%

The Medication Appropriateness Index at 20: Where It Started, Where It Has Been, and Where It May Be Going

2013

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Potentially inappropriate prescribing for older adults is a major public health concern. While there are multiple measures of potentially inappropriate prescribing, the Medication Appropriateness Index (MAI) is one of the most common implicit approaches published in the scientific literature. The objective of this narrative review is to describe findings regarding the MAI’s reliability, comparison of the MAI with other quality measures of potentially inappropriate prescribing, it’s predictive validity with important health outcomes, and it’s responsiveness to change within the framework of randomized controlled trials. A search restricted to English-language literature involving humans aged 65+ years from January 1992 to June 2013 was conducted using MEDLINE and EMBASE Databases for the search term “Medication Appropriateness Index”. A manual search of the reference lists from identified articles and the authors’ article files, book chapters, and recent reviews was conducted to identify additional articles. A total of 26 articles were identified for inclusion in this narrative review. The main findings were that the MAI has acceptable inter- and intra- rater reliability, more frequently detects potentially inappropriate prescribing than a commonly used set of explicit criteria, predicts adverse health outcomes and is able to demonstrate the positive impact of interventions to improve this public health problem. We conclude that the MAI may serve as a valuable tool for measuring potentially inappropriate prescribing in older adults.

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Reliability of the medication appropriateness index in Dutch residential home

Abstract: In a Dutch institutionalised setting with representative raters, the unmodified MAI can be used as an instrument to quantify changes in appropriateness of prescribing.

Cited by 20 publications

References 16 publications

Pilot study to test the feasibility of a trial design and complex intervention onPRIoritisingMUltimedication inMultimorbidity in general practices (PRIMUMpilot)

Pilot study to test the feasibility of a trial design and complex intervention onPRIoritisingMUltimedication inMultimorbidity in general practices (PRIMUMpilot)

Medication administration errors for older people in long-term residential care

The Medication Appropriateness Index at 20: Where It Started, Where It Has Been, and Where It May Be Going

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