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The Medication Appropriateness Index at 20: Where It Started, Where It Has Been, and Where It May Be Going

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Abstract

Potentially inappropriate prescribing for older adults is a major public health concern. While there are multiple measures of potentially inappropriate prescribing, the medication appropriateness index (MAI) is one of the most common implicit approaches published in the scientific literature. The objective of this narrative review is to describe findings regarding the MAI’s reliability, comparison of the MAI with other quality measures of potentially inappropriate prescribing, its predictive validity with important health outcomes, and its responsiveness to change within the framework of randomized controlled trials. A search restricted to English-language literature involving humans aged 65+ years from January 1992 to June 2013 was conducted using MEDLINE and EMBASE databases using the search term ‘medication appropriateness index’. A manual search of the reference lists from identified articles and the authors’ article files, book chapters, and recent reviews was conducted to identify additional articles. A total of 26 articles were identified for inclusion in this narrative review. The main findings were that the MAI has acceptable inter- and intra-rater reliability, it more frequently detects potentially inappropriate prescribing than a commonly used set of explicit criteria, it predicts adverse health outcomes, and it is able to demonstrate the positive impact of interventions to improve this public health problem. We conclude that the MAI may serve as a valuable tool for measuring potentially inappropriate prescribing in older adults.

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Acknowledgments

Supported in part by the National Institute on Aging Grants (R01-AG 027017, P30-AG024827, K07-AG033174, P30-AG028716), and an Agency for Healthcare Research and Quality Grant (R01-HS018721). The authors report no potential conflicts of interest.

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Authors and Affiliations

  1. Division of Geriatrics, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Joseph T. Hanlon

  2. Geriatric Pharmaceutical Outcomes and Gero-Informatics Research and Training Program, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Joseph T. Hanlon

  3. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Joseph T. Hanlon

  4. Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Joseph T. Hanlon

  5. Division of Geriatrics, Department of Medicine, School of Medicine, Duke University Medical Center, Durham, NC, USA

    Kenneth E. Schmader

  6. Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA

    Kenneth E. Schmader

  7. Department of Medicine (Geriatrics), University of Pittsburgh, Kaufman Medical Building-Suite 514, 3471 5th Ave, Pittsburgh, PA, 15213, USA

    Joseph T. Hanlon

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  1. Joseph T. Hanlon
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Correspondence to Joseph T. Hanlon.

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Hanlon, J.T., Schmader, K.E. The Medication Appropriateness Index at 20: Where It Started, Where It Has Been, and Where It May Be Going. Drugs Aging 30, 893–900 (2013). https://doi.org/10.1007/s40266-013-0118-4

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