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Assistant Professor, Pharmacy Practice; Director, Structured Pharmacy Education Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
at time of writing, PharmD Student, Creighton University, Omaha, NE; now, Assistant Professor of Social and Administrative Pharmacy, School of Pharmacy, University of Wyoming, Laramie, WY
at time of writing, Assistant Professor, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta; now, Associate Professor, College of Pharmacy, University of Iowa, Iowa City, IA
Reprints: Rosemin Kassam BScPharm PharmD, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, V6T 1Z3, British Columbia, Canada, FAX 604/822-3035, E-mail rokassam{at}unixg.ubc.ca
BACKGROUND: The medication appropriateness index (MAI) has demonstrated reliability in selected outpatient clinics where medical data were easily accessible from medical charts. However, its use in the community setting where patient data may be limited has not been examined.
OBJECTIVE: To evaluate the usefulness of a modified MAI for use in the community pharmacy setting by testing interrater reliability using 3 different rating schemes.
METHODS: Two raters evaluated 160 medications for 32
elderly ambulatory patients. Patient information was acquired using community
pharmacist–collected medication histories. A summated MAI score, percent
agreement, 
, positive agreement, negative agreement, and intraclass
correlation coefficient were calculated for each criterion using 3 scoring
schemes. A paired samples t-test (95% CI) was used to test interrater
reliability.
RESULTS: The statistics were >0.75 for
indication and effectiveness, but good (0.41–0.66) for the remaining
criteria using the Hanlon scoring scheme. The intraclass coefficients (0.82,
0.86, 0.87) and overall (0.65, 0.66, 0.61) were similar for the 3
schemes.
CONCLUSIONS: This study suggests that the modified MAI has the potential to detect medication appropriateness and inappropriateness in the community pharmacy setting; however, it is not without limitations. Because the MAI has the most clinimetric and psychometric data available, the instrument should be studied further to increase its reliability and generalizability.
Key Words: community pharmacy, medication appropriateness, reliability
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  J. F. van Mil, L. T. Westerlund, K. E Hersberger, and M. A Schaefer Drug-Related Problem Classification Systems Ann. Pharmacother., May 1, 2004; 38(5): 859 - 867. [Abstract] [Full Text] [PDF]
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