Mol P G M, Gans R O B, Panday P V Nannan, Degener J E, Laseur M, Haaijer-Ruskamp F M
Department of Clinical Pharmacology, University Medical Center Groningen, The Netherlands; Pharmacy Department, University Medical Center Groningen, The Netherlands.
J Hosp Infect. 2005 Aug;60(4):321-8. doi: 10.1016/j.jhin.2004.11.022.
Assessment procedures for adherence to a guideline must be reliable and credible. The aim of this study was to explore the reliability of assessment of adherence, taking account of the professional backgrounds of the observers. A secondary analysis explored the impact of case characteristics on assessment. Six observers (two hospital pharmacists, two internists and two clinical microbiologists) assessed a random sample of 22 prescriptions made to infectious disease cases admitted to a department of internal medicine between February and August 2001. Agreement between observers with regard to adherence of these prescriptions to guideline recommendations concerning drug choice, duration of treatment, dosage and route of administration was measured using Cohen's kappa. Case characteristics were compared between cases where observers agreed and disagreed with two-sided Fisher's exact test. Agreement between all professionals was moderate for drug choice (0.59), fair for duration of therapy (0.36), moderate for dosage (0.48), and fair for route of administration (0.37). Agreement on drug choice was good within (0.75 and 0.83) and between (0.74) the internists and the hospital pharmacists, but was less within (0.31) the clinical microbiologists and between the clinical microbiologists and the internists (0.44) and the hospital pharmacists (0.42). Within the clinical microbiologists, agreement was good for dosage (0.79) and route of administration (0.66). There was frequent disagreement between observers regarding cases with combination therapy and non-immunocompromised patients. Despite the small number of cases, our results suggest that internists and hospital pharmacists can reliably be used to assess adherence for drug choice. The level of agreement seems to be affected by combination therapy and the immune status of the patient.
评估对指南的依从性的程序必须可靠且可信。本研究的目的是探讨考虑观察者专业背景的依从性评估的可靠性。一项二次分析探讨了病例特征对评估的影响。六位观察者（两名医院药剂师、两名内科医生和两名临床微生物学家）对2001年2月至8月间内科病房收治的传染病病例所开具的22份随机处方进行了评估。使用科恩kappa系数测量观察者之间在这些处方对于药物选择、治疗持续时间、剂量和给药途径方面遵循指南建议的一致性。对于观察者意见一致和不一致的病例，使用双侧费舍尔精确检验比较病例特征。所有专业人员在药物选择方面的一致性为中等（0.59），治疗持续时间方面为一般（0.36），剂量方面为中等（0.48），给药途径方面为一般（0.37）。内科医生和医院药剂师在药物选择上的一致性在内部（0.75和0.83）和彼此之间（0.74）良好，但临床微生物学家内部（0.31）以及临床微生物学家与内科医生（0.44）和医院药剂师（0.42）之间的一致性较低。在临床微生物学家内部，剂量（0.79）和给药途径（0.66）的一致性良好。观察者之间在联合治疗病例和非免疫功能低下患者方面经常存在分歧。尽管病例数量较少，但我们的结果表明，内科医生和医院药剂师可可靠地用于评估药物选择的依从性。一致性水平似乎受联合治疗和患者免疫状态的影响。
