Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
Clinical Pharmacy, Solothurner Spitaler AG, Olten, Switzerland.
BMJ Open. 2018 Jun 27;8(6):e021284. doi: 10.1136/bmjopen-2017-021284.
The Drug-Associated Risk Tool (DART) has been developed as a self-administered questionnaire for patients with the aim of stratifying patients according to their risk of drug-related problems (DRPs). We aimed to validate the ability of the questionnaire to distinguish between hospitalised patients showing lower and higher numbers of DRPs.
Cross-sectional study assessing the questionnaire's concurrent criterion validity.
Five geriatric and the associated physical and neurological rehabilitation wards of a Swiss regional secondary care hospital with 617 beds.
We recruited 110 patients from a total of 437 admissions. Exclusion criteria were insufficient knowledge in spoken or written German, medical conditions preventing meaningful conversations and already receiving pharmacy services.
Comprehensive pharmacist-led clinical medication reviews were performed, including patient interviews, to identify potential and manifest DRPs. A cluster analysis was conducted to assess the discriminatory potential of the DART to group patients according to number (low and high) of identified DRPs. A subsequent discriminatory function analysis was performed to reduce the number of items. We determined which DART items may be used to trigger what type of medication review.
Recruited patients had a median age of 79 years and were prescribed a median of 11 drugs. Patients with a median DART score of 10 and a median of 3 DRPs represented one cluster, whereas patients with a median DART score of 15 and a median of 8 DRPs represented another cluster. Discriminatory function analysis reduced the questionnaire to five items with a moderate to strong correlation with the number of DRPs per patient (Spearman's rank correlation ρ=0.44). Additional items were associated with patients benefiting from interviews.
As a self-administered questionnaire for patients, the DART may be used to stratify hospitalised non-acute older patients in groups of having low and high likelihood of DRPs. The analyses showed that a short form of the DART can be used instead of the full tool to identify older inpatients at risk for DRPs. Additional eight items from the DART may be used to initiate additional clinical pharmacy services. The linkage between certain DART questions and type of medication review enables pharmacist resource allocation.
药物相关风险工具（DART）已被开发为一种供患者使用的自我管理问卷，旨在根据患者发生药物相关问题（DRP）的风险对其进行分层。我们旨在验证该问卷区分住院患者中 DRP 数量较低和较高的能力。
评估问卷同时效标准效度的横断面研究。
瑞士一家拥有 617 张床位的地区二级保健医院的五间老年病房和相关的物理与神经康复病房。
我们从总共 437 例入院中招募了 110 名患者。排除标准为：口语或书面德语知识不足、妨碍有意义对话的医疗状况以及已接受药学服务。
全面的药师主导的临床药物审查，包括对患者进行访谈，以确定潜在和显性的 DRP。进行聚类分析以评估 DART 将患者按识别出的 DRP 数量（低和高）分组的区分潜力。随后进行判别函数分析以减少项目数量。我们确定了哪些 DART 项目可用于触发哪种类型的药物审查。
招募的患者中位年龄为 79 岁，中位处方药物为 11 种。中位 DART 评分为 10 分且 DRP 中位数为 3 分的患者构成一个聚类，而中位 DART 评分为 15 分且 DRP 中位数为 8 分的患者构成另一个聚类。判别函数分析将问卷简化为五个项目，与每位患者的 DRP 数量具有中度至强相关性（Spearman 等级相关 ρ=0.44）。其他项目与需要接受访谈的患者相关。
作为一种供患者使用的自我管理问卷，DART 可用于将住院非急性老年患者分为发生 DRP 可能性低和高的两组。分析表明，可使用 DART 的简短形式代替完整工具来识别有发生 DRP 风险的老年住院患者。DART 的另外 8 个项目可用于启动额外的临床药学服务。某些 DART 问题与药物审查类型之间的联系使药剂师能够分配资源。
