Hanlon et al developed the Medication Appropriateness Index (MAI) for evaluating the appropriateness of drug therapy. The authors are from Duke University and the University of North Carolina.
Questions relate to:
(1) indication for the drug (indicated vs not indicated)
(2) effectiveness for the condition (effective vs ineffective)
(3) correct dosage (correct vs incorrect)
(4) correct directions (correct vs incorrect)
(5) directions practical (practical vs impractical)
(6) drug-drug interactions (insignificant vs significant)
(7) drug-disease/condition interactions (insignificant vs significant)
(8) duplication with other drugs (necessary vs unnecessary)
(9) duration of therapy (acceptable vs unacceptable)
(10) expense relative to alternative drugs of equal utility? (least expensive vs most expensive)
Definitions:
(1) effectiveness: producing beneficial result; the question assesses whether the drug prescribed is efficacious for the indication in a population of patients.
(2) indication: the sign, symptom, disease or condition for which the medication is prescribed.
(3) directions: instructions to the patient for the proper use of the medication
(4) practicality: capability of being used or being put into practice
(5) drug-drug interaction: the effect that the administration of one medication has on another drug; clinical significance connotes a harmful interaction
(6) drug-disease interaction: the effect that the drug has on a pre-existing disease or condition; clinical significance connotes a harmful interaction.
(7) unnecessary duplication: non-beneficial or risky prescribing of 2 or more drugs from the same chemical or pharmacological class
(8) duration: length of therapy
(9) expensiveness: cost of the drug in comparison to other agents of equal efficacy and safety
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Responses
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Points in Study
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appropriate
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1
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marginal
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2
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inappropriate
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3
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don't know
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9
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The authors also report using a 5 point modified Likert scale for grading responses.
Performance:
• overall inter-rater kappa for 2 observers (1 physician, 1 pharmacist) of 10 patients: 0.83
• overall intra-rater kappa for 2 observers (1 physician, 1 pharmacist) of 10 patients: 0.92
