Inappropriate prescribing: a systematic overview of published assessment tools.

BACKGROUND: Criteria to assess the appropriateness of prescriptions might serve as a helpful guideline during professional training and in daily practice, with the aim to improve a patient's pharmacotherapy. OBJECTIVE: To create a comprehensive and structured overview of existing tools to assess inappropriate prescribing. METHOD: Systematic literature search in Pubmed (1991-2013). The following properties of the tools were extracted and mapped in a structured way: approach (explicit, implicit), development method (consensus technique, expert panel, literature based), focused patient group, health care setting, and covered aspects of inappropriate prescribing. RESULTS: The literature search resulted in 46 tools to assess inappropriate prescribing.Twenty-eight (61%) of 46 tools were explicit, 8 (17%) were implicit and 10 (22%) used a mixed approach. Thirty-six (78%) tools named older people as target patients and 10 (22%) tools did not specify the target age group. Four (8.5%) tools were designed to detect inappropriate prescribing in hospitalised patients, 9 (19.5%) focused on patients in ambulatory care and 6 (13%) were developed for use in long-term care. Twenty-seven (59%) tools did not specify the health care setting. Consensus methods were applied in the development of 19 tools (41%), the others were based on either simple expert panels (13; 28%) or on a literature search (11; 24%). For three tools (7%) the development method was not described. CONCLUSION: This overview reveals the characteristics of 46 assessment tools and can serve as a summary to assist readers in choosing a tool, either for research purposes or for daily practice use.

Demonstrating the clinical pharmacist's activity: validation of an intervention oriented classification system.

BACKGROUND: Clinical pharmacists are increasingly involved in detecting and solving drug-related problems. To document their performance, a convenient tool to code pharmaceutical interventions in daily practice is desirable. The Swiss Society of Public Health Administration and Hospital Pharmacists (GSASA) proposed to implement a new classification system for pharmaceutical interventions. OBJECTIVES: To develop and validate a classification system for pharmaceutical interventions and to compare it with the well-established Pharmaceutical Care Network Europe (PCNE) system. SETTING: Rehabilitation clinic, geriatric and orthopaedic wards of a 427-bed teaching hospital. METHODS: Development of the GSASA classification started with expert panel discussions and the validation of the first version (GSASA V1). To assess appropriateness, interpretability, and validity, clinical pharmacists documented during a 6-week period all interventions using GSASA V1 and PCNE version 6.2 (V6.2). Acceptability and feasibility were tested by an 8-item questionnaire with 5-point Likert scale (1 = strongly disagree, 5 = strongly agree), and inter-rater reliability (Fleiss-Kappa coefficients κ) was determined. After revision, the second version (V2) was assessed again for reliability. MEAN OUTCOME MEASURES: User's agreement/satisfaction, comprehensiveness/reliability of the classification system. RESULTS: The GSASA V1 includes 4 categories and 35 subcategories. Of 115 interventions classified with GSASA V1, 93 (80.9 %) could be completely classified in all categories. This explains that 3 of 6 users could be not satisfied with the comprehensiveness of GSASA V1 (mean user agreement 2.7 ± 0.8). The questionnaire showed that all users could find GSASA V1 (4.0 ± 0.0) easier to use than PCNE V6.2 (3.0 ± 0.9). Users were generally satisfied with the GSASA V1 (3.5 ± 0.8), especially with the adequate time expenditure (4.0 ± 0.7). Inter-rater reliability and acceptability of GSASA V1 were comparable to those of the PCNE V6.2. The agreement among the GSASA V1 users was substantial for the categories 'problem' (κ = 0.66), 'intervention' (κ = 0.74), and 'outcome' (κ = 0.63), while moderate agreement for the category 'cause' was obtained (κ = 0.53). The final system GSASA V2 includes 5 categories (addition of 'type of problem') and 41 subcategories. Total inter-rater reliability was moderate (κ = 0.52). CONCLUSION: The GSASA classification system appeared to be reliable and promising for documentation of pharmaceutical interventions in daily practice (practical and less time-consuming). The system is validated in terms of appropriateness, interpretability, validity, acceptability, feasibility, and reliability.