Medication Appropriateness Index: Reliability and Recommendations for Future Use

Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

“…This measure has also previously been used by others [20,28]. By using that measure we could avoid summing or subtracting scores, which is generally not recommended when dealing with ordered categorical data (i.e.…”

“…Finally, instead of performing two or more independent outcome assessments for each patient, a single rater or a single group of raters assessed the patient data. We decided to use only one rater for the MAI assessments, as previous studies of MAI have shown a good or very good agreement within raters [13,[19][20][21][22] and the main purpose of this study was to quantify changes in MAI (where intra-rater agreement was more important [21]). The group of reviewers evaluating the drugrelated revisits to hospital was chosen to provide varied backgrounds and expert knowledge in order to minimize the risk of misclassifying the revisits.…”

“…According to a weighting scheme, a summed MAI score of between 0 and 18 can be produced for each medication [19] and a patient MAI score can be calculated by summing the scores of all medications for each patient. The literature indicates that the overall inter-rater reliability of this index is moderate to very good and the overall intra-rater reliability is good to very good [13,[19][20][21][22]. The content validity has also been shown to be good [18].…”

“…The content validity has also been shown to be good [18]. In some cases, however, the reliability of a few specific individual MAI items has been fair to poor [20]. Clinical judgment is needed to assess some items, although the rating process has been standardised by including explicit instructions on how to interpret each of the 10 items [13].…”

Impact of a Geriatric Nursing Home Palliative Care Service on Unnecessary Medication Prescribing (766)

“…(11)(12)(13)(14)(15) A clinical pharmacist (Dr. Suhrie) was trained in the proper use of this instrument by its developer (Dr. Hanlon). Dr. Suhrie reviewed the chart abstracts, applied the three items from the MAI to the chronic medications for each patient, and rated each item as appropriate (A), marginal (B), or inappropriate (C).…”