Faculty of Pharmacy, Université de Montréal, Quebec, Canada.
Am J Kidney Dis. 2011 Oct;58(4):527-35. doi: 10.1053/j.ajkd.2011.04.020. Epub 2011 Jul 20.
Explicit criteria for judging medication safety and use issues in patients with chronic kidney disease (CKD) are lacking.
Quality improvement report.
SETTING & PARTICIPANTS: Nephrologists (n = 4), primary care physicians (n = 2), hospital pharmacists with expertise in nephrology (n = 4), and community pharmacists (n = 2). The PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) criteria were applied retrospectively to 90 patients with CKD in a randomized study.
Development of an explicit set of criteria to enable rapid and systematic detection of drug-related problems (DRPs). Using a RAND method, experts judged the clinical significance of DRPs and the appropriateness of a community pharmacist intervention. The PAIR criteria include 50 DRPs grouped into 6 categories.
DRPs detected using the PAIR criteria compared with implicit clinical judgment by nephrology pharmacists.
Prevalence of DRPs and reliability, validity, and responsiveness of the PAIR criteria.
A mean of 2.5 DRPs/patient (95% CI, 2.0-3.1) was identified based on the PAIR criteria compared with 3.9 DRPs/patient (95% CI, 3.4-4.5) based on clinical judgment of nephrology pharmacists. Inter-rater reliability coefficients (κ) by PAIR category varied from 0.80-1.00, with an intraclass correlation coefficient (ICC) of 0.93 (95% CI, 0.89-0.95) for total DRPs per patient. Test-retest reliability coefficients by category varied from 0.74-1.00, with an ICC of 0.91 (95% CI, 0.82-0.96) for total DRPs per patient. During the study, the mean number of DRPs per patient did not change significantly when assessed using the PAIR criteria and clinical judgment.
The prevalence of PAIR DRPs may be underestimated due to the retrospective nature of the validation.
The prevalence of DRPs requiring the intervention of community pharmacists is high in patients with CKD. The PAIR criteria are reliable, but their responsiveness remains to be shown.
缺乏明确的标准来判断慢性肾脏病（CKD）患者的药物安全性和使用问题。
质量改进报告。
肾病学家（n=4）、初级保健医生（n=2）、具有肾病专业知识的医院药剂师（n=4）和社区药剂师（n=2）。PAIR（慢性肾脏疾病药物治疗评估）标准被应用于一项随机研究中的 90 名 CKD 患者，进行回顾性评估。
制定一套明确的标准，以实现对药物相关问题（DRP）的快速和系统检测。专家们使用 RAND 方法来判断 DRP 的临床意义以及社区药剂师干预的适当性。PAIR 标准包括 50 个 DRP，分为 6 个类别。
PAIR 标准检测到的 DRP 与肾病药师的隐性临床判断相比。
使用 PAIR 标准检测到的 DRP 的患病率以及 PAIR 标准的可靠性、有效性和反应性。
根据 PAIR 标准，每位患者平均发现 2.5 个 DRP（95%CI，2.0-3.1），而根据肾病药师的临床判断，每位患者发现 3.9 个 DRP（95%CI，3.4-4.5）。PAIR 类别的组内相关系数（κ）范围为 0.80-1.00，每位患者的总 DRP 内的组内相关系数（ICC）为 0.93（95%CI，0.89-0.95）。每个类别中的测试-重测可靠性系数范围为 0.74-1.00，每位患者的总 DRP 内的 ICC 为 0.91（95%CI，0.82-0.96）。在研究过程中，使用 PAIR 标准和临床判断评估时，每位患者的 DRP 平均数量没有显著变化。
由于验证的回顾性性质，PAIR DRP 的流行率可能被低估。
CKD 患者需要社区药剂师干预的 DRP 患病率较高。PAIR 标准可靠，但反应性仍有待证明。
