INDICATORS OF THE APPROPRIATENESS OF LONG-TERM PRESCRIBING IN GENERAL-PRACTICE IN THE UNITED-KINGDOM - CONSENSUS DEVELOPMENT, FACE AND CONTENT VALIDITY, FEASIBILITY, AND RELIABILITY

Objectives-To develop valid, reliable indicators of the appropriatenes s of long term prescribing in general practice medical records in the United Kingdom. Design-A nominal group was used to identify potential indicators of appropriateness of prescribing. Their face and content v alidity were subsequently assessed in a two round Delphi exercise. Fea sibility and reliability between raters were evaluated for the indicat ors for which consensus was reached and were suitable for application. Participants-The nominal group comprised a disciplinary mix of nine o pinion leaders and prominent academics in the field of prescribing. Th e Delphi panel was composed of 100 general practitioners and 100 commu nity pharmacists. Results-The nominal group resulted in 20 items which were refined to produce 34 statements for the Delphi exercise. Consen sus was reached on 30, from which 13 indicators suitable for applicati on were produced. These were applied by two independent raters to the records of 49 purposively sampled patients in one general practice. Ni ne indicators showed acceptable reliability between raters. Conclusion s-9 indicators of prescribing appropriateness were produced suitable f or application to the medical record of any patient on long term medic ation in United Kingdom general practice. Although the use of the medi cal record has limitations, this is currently the only available metho d to assess a patient's drug regimen in its entirety.