Somers Annemie, Mallet Louise, van der Cammen Tischa, Robays Hugo, Petrovic Mirko
Department of Pharmacy, Ghent University Hospital, Gent, Belgium.
Am J Geriatr Pharmacother. 2012 Apr;10(2):101-9. doi: 10.1016/j.amjopharm.2012.01.003. Epub 2012 Feb 1.
High drug consumption by older patients and the presence of many drug-related problems require careful assessment of drug therapy, for which a structured approach is recommended.
The purpose of our study was to evaluate the applicability of an adapted version of the Medication Appropriateness Index (MAI) in 50 geriatric inpatients at the time of admission.
We reviewed, for 432 prescribed drugs, indication, right choice, dosage, directions, drug-disease interactions, drug-drug interactions, and duration of therapy. In addition, adverse drug reactions were evaluated, resulting in 8 questions per drug. MAI scores were attributed independently by a geriatrician and by a clinical pharmacist, and differences between them were assessed. Furthermore, the relationship between MAI score and drug-related hospital admission was explored.
Mean summed MAI scores of 13.7 according to the geriatrician and 13.6 according to the pharmacist were obtained. The highest scores were found for drugs for the central nervous and the urinary tract system; the highest scores per question were detected for right choice, adverse drug reactions, and drug-drug interactions. A good agreement between the scores of the geriatrician and the pharmacist was found: intraclass correlation coefficient was 0.91 and overall κ value was 0.71. A significantly higher MAI score was found for drug-related hospital admissions (P = 0.04 for the geriatrician and P = 0.03 for the pharmacist).
This adapted MAI score seems useful for detection of drug-related problems in geriatric inpatients and reliable with a low inter-rater variability and positive correlation between high score and drug-related hospital admission. We consider further application of the adapted MAI for teaching and training of clinical pharmacists, and as a systematic approach for detection of drug-related problems by the clinical pharmacists in our hospital.
老年患者药物消耗量高且存在许多与药物相关的问题，这需要对药物治疗进行仔细评估，为此推荐采用结构化方法。
我们研究的目的是评估修订版药物适宜性指数（MAI）在50名老年住院患者入院时的适用性。
我们审查了432种处方药的适应证、选择是否正确、剂量、用法、药物-疾病相互作用、药物-药物相互作用以及治疗持续时间。此外，还评估了药物不良反应，每种药物产生8个问题。MAI评分由一名老年病科医生和一名临床药师独立评定，并评估他们之间的差异。此外，还探讨了MAI评分与药物相关住院之间的关系。
老年病科医生评定的MAI总分均值为13.7，临床药师评定的为13.6。中枢神经系统和泌尿系统药物的评分最高；每个问题得分最高的是选择是否正确、药物不良反应和药物-药物相互作用。发现老年病科医生和临床药师的评分之间具有良好的一致性：组内相关系数为0.91，总体κ值为0.71。药物相关住院患者的MAI评分显著更高（老年病科医生评定的P = 0.04，临床药师评定的P = 0.03）。
这种修订后的MAI评分似乎有助于检测老年住院患者中与药物相关的问题，并且具有可靠性，评分者间变异性低，高分与药物相关住院之间呈正相关。我们考虑进一步应用修订后的MAI用于临床药师的教学和培训，并作为我院临床药师检测与药物相关问题的一种系统方法。
