Internal Medicine Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Spain.
Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Departament of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Spain.
Arch Gerontol Geriatr. 2014 May-Jun;58(3):460-4. doi: 10.1016/j.archger.2013.12.006. Epub 2014 Jan 2.
There are limited tools to assess potential prescribing omissions (PPOs) or underprescribing in the elderly. The ACOVE project defines comprehensive quality care indicators for older people and some of these indicators focused on appropriate use of medicines. The aim of the present study was to assess the inter-rater reliability between observers using the ACOVE 3 prescribing indicated medications indicators and compare it with the inter-rater reliability obtained for the Screening Tool of Older Person's Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria.
In the context of an observational and multicentric study of a cohort of 672 patients 75 years and older who were hospitalized in Internal Medicine services of seven Spanish hospitals, an inter-rater reliability study using the ACOVE selected indicators and the STOPP/START criteria was carried out between April 2011 and March 2012. Three patients were randomly selected in each participating hospital, one for each four months of study.
A total of 21 patients (mean (SD) age of 84.3 (5.6) years, 57.1% female) were included in the inter-rater reliability study. For the STOPP, START and ACOVE criteria, the median kappa coefficient for the seven hospital analyses was 0.97, 0.92 and 0.95, respectively. Out of 123 total indicators in only 7 (5.7%) was the kappa coefficient value below 0.75. Only for 2 (5.6%) of the 37 studies selected ACOVE quality indicators was the kappa coefficient value less than 0.75.
A high inter-rater reliability was obtained for the selected underprescribing quality indicators of ACOVE 3. These quality indicators may be considered a useful tool in detecting underprescribing to the elderly patients.
评估老年人潜在的处方遗漏（PPO）或用药不足的工具有限。ACOVE 项目为老年人制定了全面的质量护理指标，其中一些指标侧重于药物的合理使用。本研究的目的是评估使用 ACOVE 3 项规定用药指标的观察者之间的评分者间信度，并将其与获得的 Screening Tool of Older Person's Prescriptions（STOPP）/Screening Tool to Alert Doctors to Right Treatment（START）标准的评分者间信度进行比较。
在一项对 672 名 75 岁及以上患者的观察性、多中心队列研究中，该研究在西班牙七家医院的内科住院服务中进行，在 2011 年 4 月至 2012 年 3 月期间，使用 ACOVE 选定的指标和 STOPP/START 标准进行了评分者间信度研究。在每个参与医院随机选择 3 名患者，每个患者每四个月选择一名。
共有 21 名患者（平均（SD）年龄 84.3（5.6）岁，57.1%为女性）纳入评分者间信度研究。对于 STOPP、START 和 ACOVE 标准，七个医院分析的中位数 Kappa 系数分别为 0.97、0.92 和 0.95。在 123 个总指标中，仅有 7 个（5.7%）的 Kappa 系数值低于 0.75。只有在 37 项选定的 ACOVE 质量指标中，有 2 项（5.6%）的 Kappa 系数值低于 0.75。
ACOVE 3 选定的用药不足质量指标获得了较高的评分者间信度。这些质量指标可作为检测老年患者用药不足的有用工具。
