Development and validation of explicit criteria to identify potentially inappropriate prescribing for adults with type 2 diabetes mellitus

BackgroundEarly detection and timely resolution of potentially inappropriate prescribing (PIP) prevents adverse outcomes and improves patient care. An explicit tool specifically designed to detect PIP among people with Type 2 Diabetes Mellitus (T2DM) has not been published.ObjectivesThis study aims to develop and validate the Inappropriate Medication Prescribing Assessment Criteria for Type 2 Diabetes Mellitus (IMPACT2DM); an explicit tool that can be used to identify PIP for adults with T2DM.MethodsCurrent national and international guidelines for the management of T2DM and drug information software programs were used to generate potential items. The content of the IMPACT2DM was validated by 2 consecutive rounds of Delphi method. Physicians and clinical pharmacists experienced in providing care for people with diabetes and authors of selected diabetes guidelines were invited to participate in the Delphi panel. Consensus was assumed if 90% (first round) and 85% (second round) of expert panelists showed agreement to include or exclude an item.ResultsA total of 95 potential items were generated from selected diabetes guidelines and drug information software programs. After the first Delphi round 27 items had ≥90% agreement and were included in the tool; 19 items were considered not PIP and were excluded from the tool. The second round contained 49 items; of these 43 were included and 6 were excluded from the tool. The final IMPACT2DM contains 70 items categorized by type of PIP and arranged in terms of medical conditions and medication classes. IMPACT2DM can be applied using information on medical charts and requires minimal or no clinical knowledge to assess quality of diabetes care and improve medication selection.ConclusionsIMPACT2DM has been developed from current quality evidence and undergone content validation. It is the first explicit tool specifically designed to identify PIP for adults with T2DM.     

我院抗菌药物在线分析系统的开发与应用

目的:加强我院抗菌药物的管理,促进临床合理用药。方法:利用医院信息系统(HIS)数据资源和Power Builder开发工具,依据《医疗机构合理用药指标》的计算方法,开发了抗菌药物在线分析系统。结果:该系统分为"基础数据查询"、"统计指标查询"、"数据输出"3大功能模块,可方便快捷地查询某时间段内门诊、住院各临床科室抗菌药物应用指标。结论:本系统界面直观、操作简单、所列数据图表简明易懂,提高了工作人员的统计效率,促进了抗菌药物的合理应用。     

Development and validation of key performance indicators for medication management services provided for outpatients

BackgroundOne of the elements of quality improvement of medication management services is measuring the quality of care and key performance indicators (KPIs) can be used in this assessment. There has been no publishing yet about a KPI instrument developed for ambulatory setting.ObjectivesTo develop and validate KPI instrument for medication management services provided for outpatients in Brazilian context.MethodsA working group established 7 possible KPIs for assessment of the expert panel. For content validity, 16 experts were invited to participate in an internet based 2-round Delphi approach. Expert panel rated 7 possible KPIs using 7 attributes on a 5-point Likert scale for consensus. In order to construct validity and reliability, an internet questionnaire was developed for pharmacists that work in primary care to understand their views. In addition, a comparison between expert and pharmacist views about the indicators relevance was performed.ResultsEleven (68.8%) experts participated in the Delphi round 1 and nine (81.8%) experts completed the 2 Delphi rounds. A new KPI was develop after expert panel assessment in the first round. Overall, content and construct validity were reached for 6 KPIs: pharmaceutical consultation provided (I₁), pharmacist interventions accepted by the prescriber (I₂), drug therapy problems resolved (I₃), patient clinical status (I₄), patient satisfaction (I₅), and patient quality of life (I₆).ConclusionsA set of 6 KPIs was developed for medication management services provided for outpatients. The instrument presented a good reliability and validity evidence. It is expected that these KPIs will improve the quality of medication management services.