ABSTRACT
BACKGROUND: Quality of health performance is of increasing international importance. The potential value of the implementation of a guideline-based medication assessment tool (MAT) has been evaluated in order to measure and improve adherence to guideline recommendations in secondary prevention of coronary heart disease (CHD). METHOD: An existing MAT developed in the UK based on internationally recognised clinical evidence has been further developed [with criteria extended to secondary prevention of CHD only] for application in Norway. Content validity was demonstrated using a two round Delphi process among an expert group (12 reviewers, consensus threshold 75%). Inter- and intra-observer reliability testing was conducted with agreement expressed by Cohen's kappa (κ). The designed MAT was applied in a pilot study and application time was measured to inform clinical utility of the tool in real world settings. A total of 85 patients (69% male) undergoing coronary angiography were included. Mean age was 65.4 years (SD 11.6). RESULTS: The new MAT is named MAT-CHDSP and comprises 21 review criteria. Consensus among the expert group (n = 12) was obtained for all final criteria. Reliability testing showed κ in the range (0.79-0.90). Applicability in the pilot study was 63% (n = 1106) and adherence was 65%, 95% CI (64-66) (n = 791). The mean application time for the experienced user was 1.5 minutes (SD 0.3). CONCLUSION: MAT methodology might merge the increasing demand for continuous assessment of quality of health performance with the clinical pharmacist's need for a standardised and explicit working tool.
