Reliability Testing of the Clinical Pharmacist Recommendation Taxonomy
Study Objective: To evaluate the reliability of a newly developed taxonomy—the Clinical Pharmacist Recommendation (CPR) taxonomy—to classify clinical pharmacy interventions.
Design: The CPR taxonomy was developed and refined in three phases. In each phase, reviewers independently reviewed recommendations made by a clinical pharmacist–physician team and categorized them into mutually exclusive categories: priority, problem, and response. Interrater reliability was assessed for all categories during each development phase.
Setting: Primary care clinics of a Veterans Affairs Medical Center.
Patients: Fifty-three patients enrolled in the Veterans Affairs Enhanced Pharmacy Outpatient Clinic (EPOC) trial.
Measurements and Main Results: Interrater reliability was assessed using the k statistic. A total of 423 recommendations were evaluated during the three testing phases. In the final testing phase, agreement was moderate for pharmacotherapy problem subcategories (κ = 0.57), substantial for pharmacotherapy problem primary categories (κ = 0.64), and almost perfect for response categories (κ = 0.85). Taxonomy completion time/patient averaged 4.6 minutes (range 1-11 min).
Conclusion: The CPR taxonomy provides a reliable method to systematically evaluate clinical pharmacy recommendations based on the therapeutic problem identified and specific action recommended to resolve the problem.
The role of clinical pharmacists has evolved considerably over the past 2 decades to include an expanded and more explicit scope of practice. In addition, clinical services rendered have gone well beyond dispensing to include numerous cognitive services. Having explicit descriptions of these services is essential for documenting the services provided. Because reimbursement for cognitive services is limited, associated documentation has not been necessary. However, as pharmacy budgets are stretched and the potential for billing and associated documentation expands, validated methods of classifying cognitive services are needed.
Another important role for the classification of cognitive services lies in the realm of clinical interventions involving pharmacists. Although numerous studies have demonstrated the value of clinical pharmacists in both outpatient and inpatient settings, systematically comparing the interventions and applying them to practice is difficult.
Previous efforts to categorize recommendations have been limited and not systematically developed and tested for reliability and validity. Some studies simply created lists of categories of services; others developed more extensive and unwieldy lists. Predictive validity of the categories has not been employed, even for relationships with outcome measures such as health-related quality of life, morbidity, mortality, and reduced actual or potential adverse drug events.
We describe the development of a systematic measure to categorize cognitive services provided by clinical pharmacists as priority, pharmaco-therapy problem category, and the specific therapeutic response recommended. The instrument was developed for both clinical use and pharmacy intervention trials. Our objective was to evaluate the reliability of this instrument.
Abstract and Introduction
Abstract
Study Objective: To evaluate the reliability of a newly developed taxonomy—the Clinical Pharmacist Recommendation (CPR) taxonomy—to classify clinical pharmacy interventions.
Design: The CPR taxonomy was developed and refined in three phases. In each phase, reviewers independently reviewed recommendations made by a clinical pharmacist–physician team and categorized them into mutually exclusive categories: priority, problem, and response. Interrater reliability was assessed for all categories during each development phase.
Setting: Primary care clinics of a Veterans Affairs Medical Center.
Patients: Fifty-three patients enrolled in the Veterans Affairs Enhanced Pharmacy Outpatient Clinic (EPOC) trial.
Measurements and Main Results: Interrater reliability was assessed using the k statistic. A total of 423 recommendations were evaluated during the three testing phases. In the final testing phase, agreement was moderate for pharmacotherapy problem subcategories (κ = 0.57), substantial for pharmacotherapy problem primary categories (κ = 0.64), and almost perfect for response categories (κ = 0.85). Taxonomy completion time/patient averaged 4.6 minutes (range 1-11 min).
Conclusion: The CPR taxonomy provides a reliable method to systematically evaluate clinical pharmacy recommendations based on the therapeutic problem identified and specific action recommended to resolve the problem.
Introduction
The role of clinical pharmacists has evolved considerably over the past 2 decades to include an expanded and more explicit scope of practice. In addition, clinical services rendered have gone well beyond dispensing to include numerous cognitive services. Having explicit descriptions of these services is essential for documenting the services provided. Because reimbursement for cognitive services is limited, associated documentation has not been necessary. However, as pharmacy budgets are stretched and the potential for billing and associated documentation expands, validated methods of classifying cognitive services are needed.
Another important role for the classification of cognitive services lies in the realm of clinical interventions involving pharmacists. Although numerous studies have demonstrated the value of clinical pharmacists in both outpatient and inpatient settings, systematically comparing the interventions and applying them to practice is difficult.
Previous efforts to categorize recommendations have been limited and not systematically developed and tested for reliability and validity. Some studies simply created lists of categories of services; others developed more extensive and unwieldy lists. Predictive validity of the categories has not been employed, even for relationships with outcome measures such as health-related quality of life, morbidity, mortality, and reduced actual or potential adverse drug events.
We describe the development of a systematic measure to categorize cognitive services provided by clinical pharmacists as priority, pharmaco-therapy problem category, and the specific therapeutic response recommended. The instrument was developed for both clinical use and pharmacy intervention trials. Our objective was to evaluate the reliability of this instrument.
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