Samsa G P, Hanlon J T, Schmader K E, Weinberger M, Clipp E C, Uttech K M, Lewis I K, Landsman P B, Cohen H J
Center for Health Services Research in Primary Care, Department of Veterans Affairs Medical Center, Durham, NC 27705, USA.
J Clin Epidemiol. 1994 Aug;47(8):891-6. doi: 10.1016/0895-4356(94)90192-9.
Inappropriate medication prescribing is an important problem in the elderly, but is difficult to measure. As part of a randomized controlled trial to evaluate the effectiveness of a pharmacist intervention among elderly veterans using many medications, we developed the Medication Appropriateness Index (MAI), which uses implicit criteria to measure elements of appropriate prescribing. This paper describes the development and validation of a weighting scheme used to produce a single summated MAI score per medication. Using this weighting scheme, two clinical pharmacists rated 105 medications prescribed to 10 elderly veterans from a general medicine clinic. The summated score demonstrated acceptable reliability (intraclass correlation co-efficient = 0.74). In addition, the summated MAI adequately reflected the putative heterogeneity in prescribing appropriateness among 1644 medications prescribed to 208 elderly veterans in the same general medicine clinic. These data support the content validity of the summated MAI. The MAI appears to be a relatively reliable, valid measure of prescribing appropriateness and may be useful for research studies, quality improvement programs, and patient care.
不适当的药物处方是老年人面临的一个重要问题，但难以衡量。作为一项随机对照试验的一部分，旨在评估药剂师干预对使用多种药物的老年退伍军人的有效性，我们开发了药物适宜性指数（MAI），该指数使用隐含标准来衡量适当处方的要素。本文描述了一种加权方案的开发和验证，该方案用于为每种药物生成一个单一的汇总MAI分数。使用该加权方案，两名临床药剂师对一家普通内科诊所为10名老年退伍军人开出的105种药物进行了评分。汇总分数显示出可接受的可靠性（组内相关系数=0.74）。此外，汇总的MAI充分反映了同一家普通内科诊所为208名老年退伍军人开出的1644种药物在处方适宜性方面假定的异质性。这些数据支持汇总MAI的内容效度。MAI似乎是一种相对可靠、有效的处方适宜性衡量指标，可能对研究、质量改进项目和患者护理有用。
