一种电子药理学工具的开发、验证与评估：药物负担指数计算器©

Development, validation and evaluation of an electronic pharmacological tool: The Drug Burden Index Calculator©.

作者信息

Kouladjian Lisa, Gnjidic Danijela, Chen Timothy F, Hilmer Sarah N

机构信息

Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia; Sydney Medical School - Northern, University of Sydney, New South Wales 2006, Australia.

出版信息

Res Social Adm Pharm. 2016 Nov-Dec;12(6):865-875. doi: 10.1016/j.sapharm.2015.11.002. Epub 2015 Nov 11.

DOI:10.1016/j.sapharm.2015.11.002

PMID:26655397

Abstract

BACKGROUND

The Drug Burden Index (DBI) is a pharmacological risk assessment tool that measures the total exposure to anticholinergic and sedative medicines, which may impair function in older adults. A computerized clinical decision support system (CCDSS) for DBI has not been previously developed or evaluated.

OBJECTIVES

(a) Develop a CCDSS that calculates and generates reports on DBI; (b) validate the CCDSS for accuracy; and (c) evaluate the CCDSS for use in clinical practice.

METHODS

The DBI Calculator© application, based on the published formula and Australian registered prescribing information was built and designed using Microsoft Access 2010. Accuracy testing involved the comparison of DBI scores computed manually (gold standard) with those computed using The DBI Calculator© for 25 published medication review case studies. Agreement was measured using Cohen's Kappa statistic. To evaluate the CCDSS application in practice, ten pharmacists completed a performance test and usability survey. Participants were timed performing a DBI calculation with the application for a fictitious patient case. The interface, functionality, clinical applications and user satisfaction of the application were rated using 5-point, Likert-type scales.

RESULTS

Excellent agreement between the manual and CCDSS application was observed (Cohen's Kappa 0.95). In the evaluation phase, the average time (mins:sec ± SD) for participants to complete the task was 7:20 ± 1:45 and the DBI Calculator© was considered useful by 80% of pharmacists for recognizing sedative and anticholinergic medicines in practice.

CONCLUSION

A reliable CCDSS has been developed to report DBI of older patients taking multiple medications. Future studies should test the utility of The DBI Calculator© in clinical practice.

摘要

背景

药物负担指数（DBI）是一种药理学风险评估工具，用于衡量抗胆碱能药物和镇静药物的总暴露量，这可能会损害老年人的功能。此前尚未开发或评估用于DBI的计算机化临床决策支持系统（CCDSS）。

目的

（a）开发一个计算并生成DBI报告的CCDSS；（b）验证CCDSS的准确性；（c）评估CCDSS在临床实践中的应用。

方法

基于已发表的公式和澳大利亚注册处方信息，使用Microsoft Access 2010构建并设计了DBI计算器应用程序。准确性测试包括将25个已发表的药物审查案例研究中手动计算的DBI分数（金标准）与使用DBI计算器计算的分数进行比较。使用Cohen's Kappa统计量来衡量一致性。为了评估CCDSS在实践中的应用，十名药剂师完成了一项性能测试和可用性调查。参与者对一个虚拟患者案例使用该应用程序进行DBI计算的时间进行了记录。使用5点李克特量表对该应用程序的界面、功能、临床应用和用户满意度进行评分。