Background Patients have medicines reviews conducted by different health care professionals in different settings. Introducing a clinical panel to drug related problems (DRPs) to evaluate their clinical significance is common practice. The clinical panel discuss the potential consequences and come to a mutual agreement on the level of clinical significance. However, to what degree does the panel agree?
Purpose To compare the agreement between different health care professionals who have evaluated the clinical significance of DRPs.
Materials and methods DRPs were identified in 30 comprehensive medicines reviews conducted by a clinical pharmacist. Two hospital pharmacists, a general practitioner and two specialists in pain management from hospital care (the Panel) evaluated each DRP considering the potential clinical outcome for the patient. The DRPs were rated either nil, low, minor, moderate or highly clinically significant. Agreement was analysed using Kappa statistics. A Kappa value of 0.8 to 1.0 indicated nearly perfect agreement between ratings of the Panel members.
Results The Panel rated 45 percent of the total 162 DRPs as of moderate clinical significance. However, the overall kappa score was 0.12 showing nil agreement when comparing the ratings of clinical significance. The Panel disagreed on which DRPs were of minor or moderate clinical significance. Further analysis of the interrelationship of the five Panel members described fair agreement between one specialist and the two pharmacists. In two types of DRPs, sub-therapeutic dosing and side effects, the Panel agreed fairly well on moderate clinical significance.
Conclusions Each profession rates the clinical significance of DRPs differently, especially in cases of intervention by pharmacist versus practitioner, and opinion also varies within each profession. Take into account the profession and setting when clinical relevance of DRPs is discussed in the literature and when choosing a method for evaluating the clinical significance of DRPs.
Acknowledgement Many thanks to Grünenthalfonden and Actavisfonden, participants in the project ‘Drug Related Problems in the Frontier between Primary and Secondary Health Care’.
No conflict of interest.
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