Reliability testing of a case-leveling framework for assigning level of difficulty of pharmacist's initial patient medication assessments
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OBJECTIVE: To develop and test the reliability of a case-leveling framework for assigning level of difficulty of the pharmacist's task for initial medication assessments conducted by pharmacists integrated into family physician offices. DESIGN: Descriptive study. SETTING: Seven family practice sites in Ontario from June 2004 to July 2006. PATIENTS: Patients referred by their family physician for pharmacist assessment. INTERVENTION: Individual medication assessments, monitoring, and follow-up by pharmacists. A case-leveling framework was developed with three levels of complexity (graded as I, II, or III) including specific descriptors and practice-based examples. Reliability was assessed between two standardized assessors and between one assessor and project pharmacists. Project pharmacist feedback was elicited through an e-mail survey. Reliability is reported using the kappa statistic. MAIN OUTCOME MEASURES: Reliability of a case-leveling framework and helpfulness of the framework as reported by pharmacists. RESULTS: 53 patient cases were evaluated for interrater reliability between standardized assessors. The mean (+/- SD) case level assigned was 1.8 +/- 0.68, and the kappa was 0.62 (95% CI 0.44-0.79), indicating a substantial strength of agreement between raters. For the second reliability test, 52 cases were rated, with a level of agreement between project pharmacists and the external assessor of 0.46 (95% CI 0.27-0.65), indicating moderate agreement. Feedback resulted in slight revisions to the original framework. CONCLUSION: The case-leveling framework was a reliable method and can be used to determine the level of difficulty of patient cases in primary care.
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