Development and validation of a new Prescription Quality Index

作者：Hassan Norul Badriah^*; Ismail Hasanah Che; Naing Lin; Conroy Ronan M; Rahman Abdul Rashid Abdul

来源：British Journal of Clinical Pharmacology, 2010, 70(4): 500-513.

DOI：10.1111/j.1365-2125.2009.03597.x

• chronic diseases
• Medication Appropriateness Index
• prescription
• Prescription Quality Index

center dot Many studies raise serious questions about the prescribing appropriateness and prescription quality. However, there is a lack of a single measure that will capture all facets of prescription quality.
center dot Evaluation of prescriptions was usually based on expert judgement of practitioners.
center dot Definition of prescription quality, reference model, validity and reliability of the measurement tools, and other data such as the number, type and severity of diagnosis of patients were usually insufficient or lacking.
WHAT THIS STUDY ADDS
center dot The Prescription Quality Index (PQI) was developed with a strong structural foundation and was able to capture the clinical, clerical and legal requirement of a prescription.
center dot Extensive psychometric testing was performed on the PQI and the new tool demonstrated acceptable validity and reliability.
center dot The PQI has been shown to be a valid, reliable and responsive tool to measure quality of prescriptions in chronic diseases.
AIMS
The aims were to develop and validate a new Prescription Quality Index (PQI) for the measurement of prescription quality in chronic diseases.
METHODS
The PQI were developed and validated based on three separate surveys and one pilot study. Criteria were developed based on literature search, discussions and brainstorming sessions. Validity of the criteria was examined using modified Delphi method. Pre-testing was performed on 30 patients suffering from chronic diseases. The modified version was then subjected to reviews by pharmacists and clinicians in two separate surveys. The rater-based PQI with 22 criteria was then piloted in 120 patients with chronic illnesses. Results were analysed using SPSS version 12.0.1
RESULTS
Exploratory principal components analysis revealed multiple factors contributing to prescription quality. Cronbach's alpha for the entire 22 criteria was 0.60. The average intra-rater and inter-rater reliability showed good to moderate stability (intraclass correlation coefficient 0.76 and 0.52, respectively). The PQI was significantly and negatively correlated with age (correlation coefficient -0.34, P < 0.001), number of drugs in prescriptions (correlation coefficient -0.51, P < 0.001) and number of chronic diseases/conditions (correlation coefficient -0.35, P < 0.001).
CONCLUSIONS
The PQI is a promising new instrument for measuring prescription quality. It has been shown that the PQI is a valid, reliable and responsive tool to measure quality of prescription in chronic diseases.

• 出版日期2010-10