Development and validation of medication assessment tools to evaluate prescribing adherence to evidence-based guidelines for secondary prevention of coronary heart disease in post-acute coronary syndromes patients in Kuwait

摘要

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 (MAT STEMI and MAT NSTEACS ). 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 CVR0.54 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 MAT STEMI and MAT NSTEACS consisted of eighteen and twelve medication-related criteria, respectively. Face validity resulted in dividing each MAT into five dimensions. In the MAT STEMI , 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 MAT NSTEACS , 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 MAT STEMI and MAT NSTEACS 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. MAT STEMI and MAT NSTEACS were developed and validated to be utilized for optimizing medication therapy management and improving therapeutic interventions.