Evaluation of Medication Appropriateness Index in Cardiovascular
Outpatient Clinic: A Cross-Sectional Study
Abstract
Background: Older adults often have polypharmacy and multiple
comorbidities. Cardiovascular diseases (CVDs) are the most common
morbidities in older adults and are linked to many adverse drug effects
and drug-related issues. Several patient settings use the medication
appropriateness index (MAI) to assess older adults’ Potentially
Inappropriate Medication (PIM) prescribing. Aim: This study estimated
CVDs outpatient clinic PIM prescribing. It also tested the MAI’s ability
to detect and quantify PIMs in CVD outpatient clinics. Methods: It is a
cross-sectional, single-center, cardiovascular outpatient clinic study.
Demographic, medical, and drug data from 65 years or older patients were
retrospectively reviewed. Two clinical pharmacists randomly selected 70
patients and assessed medication appropriateness using the MAI.
Statistical Package for the Social Sciences (SPSS) descriptive and
logistic regression analyses calculated the number of potentially
inappropriate medications, the percentage of patients with inappropriate
medication prescribing, and factors associated with inappropriate
medication prescribing. Results: Total of 87.14% of participants had
PIMs. Two clinical pharmacists evaluated 539 prescriptions, and 59.9%
had an MAI weighted score of zero (no prescription error). Drug-drug
interaction, duplication, and drug-disease interaction almost perfectly
agreed among raters. The two raters’ MAI criteria kappa coefficient was
0.44, indicating moderate agreement. The results showed that only some
medications significantly affected MAI-defined inappropriate
prescribing. Conclusion: The MAI is a reliable and valid tool in CVD
outpatient clinics. A relatively high prevalence of PIMs was found in
the studied population. It mandates implementing specific measures to
reduce PIMs.