Prescribing-Assessment Tools for Long-Term Care Pharmacy Practice: Reaching Consensus through a Modified RAND/UCLA Appropriateness Method

Abstract

Medicines are the most used health technology in Long-Term Care. The prevalence of potentially inappropriate medicines amongst Long-Term Care patients is high. Pharmacists, assisted by prescribing-assessment tools, can play an important role in optimizing medication use at this level of care. Through a modified RAND/UCLA Appropriateness Method, 13 long-term care and hospital pharmacists assessed as ‘appropriate’, ‘uncertain’, or ‘inappropriate’ a collection of commonly used prescribing-assessment tools as to its suitability in assisting pharmacy practice in institutional long-term care settings. A qualitative analysis of written or transcribed comments of participants was pursued to identify relevant characteristics of prescribing-assessment tools and potential hinders in their use. From 24 different tools, pharmacists classified 9 as ‘appropriate’ for pharmacy practice targeted to long-term care patients, while 3 were classified as ‘inappropriate’. The tools feature most appreciated by study participants was the indication of alternatives to potentially inappropriate medication. Lack of time and/or pharmacists and limited access to clinical information seems to be the most relevant hinders for prescribing-assessment tools used in daily practice.

Long-term care professionals’ views on pharmacists: a qualitative study using Role Theory

“…Compared to other traditional pharmacists' roles clearly identified in role identity sub-themes (e.g., logistics), clinical pharmacy services represent a relatively new field of practice for pharmacists, contributing to explanation of this overall perception [30]. On the other hand, multicentred work with simultaneous assistance to several different LTC units and the related lack of time were mentioned by pharmacists as barriers to LTC pharmacy practice in Portugal [31]. These barriers might explain the emerging of role overqualification, given the little time spent in each LTC facility and the limited interactions with prescribers, who also mostly work parttime at LTC facilities [11].…”

Development of a medication review tool for residents in Korean long-term care facilities

“…They rated the appropriateness of each item using a 9-point Likert-type scale (9 = very strongly agree, 1 = very strongly disagree) by applying RAND/UCLA appropriateness method. 35 'Consensus' among panelists was defined as a median journals.sagepub.com/home/taj TherapeuTic advances in chronic disease score higher than seven without 'disagreement' (⩾ 4 panelists rating 1-6 points, or more than one panelist rating 1-3 points) or not 'uncertain'(median of 4-6 or any median with 'disagreement'). 36 In the second round, expert panels were given lists of modifications, including a summary of the first round as well as information, such as the proportion of those who responded 'appropriate' (7-9 points), 'inappropriate' (1-3 points), the median score, and previous responses.…”