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Rheumatology Advance Access published online on March 1, 2005
Rheumatology, doi:10.1093/rheumatology/keh566
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© British Society for Rheumatology 2005; all rights reserved
Received November 19, 2004
Accepted January 11, 2005

Original Papers

Quality of care for NSAID users: development of an assessment tool

P. Jobanputra 1*, V. Arthur 1, M. Pugh 2, F. Spannuth 3, P. Griffiths 4, E. Thomas 5, and T. Sheeran 6

1 Department of Rheumatology, Selly Oak Hospital, University Hospital Birmingham Foundation Trust, Birmingham, UK
2 St Mary's Hospital, Newport, Isle of Wight, UK
3 Kingsfield Medical Centre, Birmingham, UK
4 Harborne Medical Practice, Birmingham, UK
5 Pharmacy, Selly Oak Hospital, University Hospital Birmingham Foundation Trust, Birmingham, UK
6 Cannock Chase Hospital NHS Trust, Cannock, UK

* To whom correspondence should be addressed.
P. Jobanputra, E-mail: P.Jobanputra{at}bham.ac.uk


  Abstract

Objective. Assessments of NSAID use based on authoritative guidelines typically overlook patients' views and nuances of medical history. Our objective was to develop an assessment tool that incorporates these aspects, and technical items, for quality of care assessments in NSAID users.

Methods. Patients newly referred to a university hospital were interviewed by a nurse using an agreed template. A multidisciplinary group of rheumatologists, nurse specialists, primary care physicians and a pharmacist reviewed current guidance and systematic reviews on NSAID use, and a series of interview transcripts. The group agreed, by informal consensus, important determinants of effective and safe NSAID use. Technical aspects of medical care and items that reflected interpersonal care were included in an index for assessing quality of care for individual patients. Interview transcripts of 100 patients were scored by panel members and reliability of scores was tested by calculating weighted percentage agreement and the {kappa} statistic.

Results. Our final index had five domains: medical risk factors; steps taken to reduce risk; knowledge of adverse effects; NSAID dose; and cost efficiency. Each item was scored 0, 1 or 2. Scores were summed, giving a maximum of 10 (low scores indicating low quality). Intra-rater agreement was >90%; {kappa} was 0.47-0.87 for individual domains and 0.59 for overall score. Inter-rater agreement for overall score was 95%; {kappa} was 0.25-0.78 for domains and 0.48 for overall score. Patients with especially low scores were identified using the mode of scores for five assessors; obvious clinical concerns were identified, supporting index face validity.

Conclusions. A simple index to evaluate quality of care for NSAID users based on a patient interview is described. This may be used by one or more assessors to examine care standards and highlight deficiencies in relation to NSAID use in practice.

Keywords: Quality of care; NSAIDs; Assessment; Rheumatic diseases.
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