Development and validation of quality indicators for improving and evaluating geriatric pharmacotherapy in primary care in Japan

Abstract

Primary care services are becoming increasingly important for older people with multi-morbidity and multiple medications. Despite the increasing demand for measuring quality of geriatric pharmacotherapy for patients with polypharmacy, few studies on the development and validation of quality indicators (QIs) have been conducted. The overall aim of the research described in this thesis was to develop a set of QIs for medicine use in geriatric pharmacotherapy in Japan and validate QIs in terms of their measurement properties. A 4-step process for the development of QIs was employed. The first step was to determine the elements of quality for community pharmacy services. The second step was to prepare a preliminary set of QIs based on guidelines about geriatric care. The preliminary set comprised 143 QIs. The third step was to use the RAND/UCLA appropriateness method to assess face and content validity of 143 QIs. A total of 134 QIs were judged as valid by the expert panel. The final step involved a pilot study to evaluate the measurement properties of the 121 of 134 QIs developed the third step. Specifically, a 6-month observational study was conducted to evaluate applicability, improvement potential and sensitivity to change. For this study, a web application was developed by our research team. After an observational study, in-depth semi-structured interviews were conducted to evaluate acceptability and implementation issues. As a result, 17 QIs met all measurement properties. The QI set developed in this research can be used to identify patients who may benefit from further assessment of their medication regimen. Future studies should assess the impact of an increase in quality improvement processes as measured by QIs on patient clinical, humanistic and economic outcomes, at different levels within healthcare systems.