APPROPRIATENESS IN HEALTH-CARE - APPLICATION TO PRESCRIBING

To help account for and address observed variations in medical practic e, evaluations of ''appropriateness'' have sought to supplement incomp lete evidence with professional opinion. This article contributes to a n understanding and refinement of the construct of appropriateness by discussing how it has been defined and applied in studies of health ca re in general and prescribing in particular. We suggest that appropria teness is the outcome of a process of decision-making that maximises n et individual health gains within society's available resources. This definition distinguishes between (in)appropriate prescribing, as an ou tcome, and (ir)rational prescribing as a process. To assess appropriat eness, we advocate combining explicit criteria with independent review in cases of uncertainty and disagreement. Refinements based on review s using implicit criteria should draw on shared professional knowledge and post hoc state the process followed as explicitly as possible. Th e Medication Appropriateness Index is shown to provide a solid foundat ion for identifying dimensions of prescribing appropriateness. (C) 199 7 Elsevier Science Ltd.