Shelton P S, Hanlon J T, Landsman P B, Scott M A, Lewis I K, Schmader K E, Samsa G P, Weinberger M
School of Pharmacy, Campbell University, Dorothea Dix Hospital, Raleigh, NC 27603, USA.
Ann Pharmacother. 1997 May;31(5):533-42. doi: 10.1177/106002809703100502.
To test the reliability of drug utilization evaluation (DUE) applied to medications commonly used by the ambulatory elderly.
A DUE model was developed for four domains: (1) justification for use, (2) critical process indicators, (3) complications, and (4) clinical outcomes. DUE criteria specific to use in the elderly were developed for angiotensin-converting enzyme (ACE) inhibitors and histamine2 (H2)-antagonists, and consensus was reached by an external expert panel. After pilot testing, two clinical pharmacists independently evaluated these medications, applying the DUE criteria and rating each item as appropriate or inappropriate. Interrater and intrarater reliability was assessed by using kappa statistics.
In a sample of 208 ambulatory elderly veterans, 42 (20.2%) were taking an ACE inhibitor and 56 (26.9%) an H2-antagonist. The interrater agreement for individual domains, represented by kappa statistics, were 0.10-0.58 and 0-0.83 for ACE inhibitors and H2-antagonists, respectively. The kappa statistic for overall agreement, which considered ratings from all criteria across all domains, was 0.24 for ACE inhibitors and 0.18 for H2-antagonists. Intrarater reliability was assessed 3 months later, and kappa statistics were 0.61-0.65 (0.49 overall) and 0-0.96 (0.81 overall) for ACE inhibitors and H2-antagonists, respectively.
Intrarater reliability for DUE was good to excellent. However, interrater reliability exhibited only marginal reproducibility, particularly where evaluators were required to use subjective judgement (i.e., complications, clinical outcomes). DUE may not be a suitable standard for assessing medication appropriateness in ambulatory elderly patients.
检验药物利用评价（DUE）应用于门诊老年患者常用药物的可靠性。
针对四个领域开发了一个DUE模型：（1）用药合理性，（2）关键过程指标，（3）并发症，以及（4）临床结局。为血管紧张素转换酶（ACE）抑制剂和组胺2（H2）拮抗剂制定了适用于老年人的DUE标准，并由一个外部专家小组达成共识。经过预试验后，两名临床药师独立评估这些药物，应用DUE标准并将每个项目评定为适当或不适当。通过kappa统计量评估评分者间和评分者内的可靠性。
在208名门诊老年退伍军人样本中，42人（20.2%）正在服用ACE抑制剂，56人（26.9%）正在服用H2拮抗剂。以kappa统计量表示的各领域评分者间一致性，ACE抑制剂为0.10 - 0.58，H2拮抗剂为0 - 0.83。考虑所有领域所有标准评分的总体一致性kappa统计量，ACE抑制剂为0.24，H2拮抗剂为0.18。3个月后评估评分者内可靠性，ACE抑制剂的kappa统计量为0.61 - 0.65（总体为0.49），H2拮抗剂为0 - 0.96（总体为0.81）。
DUE的评分者内可靠性良好至优秀。然而，评分者间可靠性仅表现出有限的可重复性，特别是在评估者需要使用主观判断的情况下（即并发症和临床结局）。DUE可能不是评估门诊老年患者用药合理性的合适标准。
