Abstract
Cardiovascular diseases are estimated to cause 46% of all mortalities in Kuwait. The aim of evidence-based clinical practice has led to an increased interest in the design of medication assessment tools (MATs) to identify deviations from evidence-based practice, and eventually provide the basis of consistent standardized prescribing. This study was designed to develop and validate MATs using quality standards extracted from international guidelines to evaluate prescribing practices in secondary prevention of coronary heart disease in patients with post-acute coronary syndrome (STEMI or NSTEACS]. International guidelines were reviewed to develop two MATs (MATSTEMI and MATNSTEACS). Face and content validity of the developed tools was performed with three MAT experts and thirteen cardiologists. Two quantitative approaches were used to determine content validity: (i) Content Validity Ratio (CVR) and the average of CVR values; and (ii) Content validity index at item level (I-CVI) and scale-level of the tool (S-CVI/Ave) with the average approach. Criteria with a CVR<0.54 and I-CVI <70% were eliminated. Ultimately, feasibility testing of both MATs was performed on 66 patients’ records as a pilot study. The initial developed MATSTEMI and MATNSTEACS consisted of eighteen and twelve medication-related criteria, respectively. Face validity resulted in dividing each MAT into five dimensions. In the MATSTEMI, three criteria had CVR values < 0.54 and I-CVIs < 70%. Two criteria were eliminated and one was retained. This resulted in sixteen criteria with average CVR 0.85 and S-CVI/Ave 92.3%. In the MATNSTEACS, one criterion was eliminated. This resulted in eleven criteria with average CVR 0.93 and S-CVI/Ave 96.5%. The overall adherence scores to the MATSTEMI and MATNSTEACS were 64.1% (95% CI: 57.8–69.9%) and 62.0% (95% CI: 53.4–69.9%), respectively. It was judged as intermediate adherence for both MATs. MATSTEMI and MATNSTEACS were developed and validated to be utilized for optimizing medication therapy management and improving therapeutic interventions.
Highlights
The definition of clinical guidelines has been stated as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” [1]
Following discussion with the research group, it was agreed that criteria 10 and 18 were to be eliminated; as criteria 15 is classified as Class I (Level of Evidence A) in ESC and ACC/AHA guidelines, it was decided to be retained in the Medication assessment tools (MATs)
To the best of our knowledge, this is the first study in the Middle East and North Africa (MENA) region to develop and validate MATs using medication standards extracted from international clinical guidelines to evaluate prescribing practices in secondary prevention of coronary heart disease (CHD) in post-STEMI and post-NSTEACS patients
Summary
The definition of clinical guidelines has been stated as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” [1]. MATs are developed using clear, defined standards endorsed by clinical guidelines and are designed to measure prescribing practices of clinicians to defined clinical guidelines by applying them to patients’ medical records. They have the advantage of quantifying adherence to guidelines and ensuring more equal care at a low cost of application and a higher degree of fairness [12]. In the Gulf Cooperation Council (GCC) region, healthcare managers have expressed an increased interest in the improvement of the quality of prescribing, and this can be implemented by the development of tools that identify and quantify deviations in prescribing practices to specific patient groups by using explicit standards extracted from published evidencebased clinical guidelines [11, 13, 14]
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