Bregnhøj Lisbeth, Thirstrup Steffen, Kristensen Mogens Brandt, Sonne Jesper
Clinical Pharmacology Unit, Gentofte University Hospital, Post 4022, Niels Andersensvej 65, 2900, Hellerup, Denmark.
Eur J Clin Pharmacol. 2005 Nov;61(10):769-73. doi: 10.1007/s00228-005-0963-0. Epub 2005 Oct 1.
To evaluate the inter-group and intra-group reliability of a modified Medication Appropriateness Index (MAI) for use in primary care.
Elderly (>65 years) polypharmacy (> or =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.
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.
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.
评估用于初级保健的改良药物适宜性指数（MAI）的组间和组内可靠性。
哥本哈根郡年龄大于65岁、服用多种药物（≥5种药物）的患者参与了本研究。其病史信息及所服用每种药物的信息由他们自己的全科医生提供。两组评估人员针对每种药物对MAI进行评分。为评估组间一致性，根据构成MAI的十条标准对30名患者服用的211种药物进行评分。两个评估组均提供了每位患者用药情况的评论总结。通过对10名患者服用的86种药物在两个不同时间进行两次MAI评分来确定组内一致性。确定一致性和经机遇校正的一致性，后者通过kappa统计量得出。还确定了阳性（ppos）和阴性（pneg）一致性的比例。
总体经机遇校正的组间一致性（kappa）为中等。在实用说明和药物 - 疾病相互作用标准方面一致性良好，在剂量和疗程标准方面为中等，在适应证、有效性、重复用药和费用标准方面为一般，在药物 - 药物相互作用标准方面较差。总体经机遇校正的组内一致性在所有标准方面均良好，在适应证和实用说明标准方面非常好。
MAI用于量化干预研究中处方的适宜与不适宜情况以及处方质量的变化。然而，在比较不同环境和评估人员的结果时应谨慎。我们的研究表明，仅当同一组对干预前后的适宜性进行评分时，该指数才可用于干预研究。
