A reliable and valid index was developed to measure appropriate psychotropic drug use in dementia

Objectives: The aim of this study was to develop an index derived from the Medication Appropriateness Index (MAT) items that is suited for clinical studies evaluating appropriateness of psychotropic drug use (PDU) for neuropsychiatric symptoms (NPS) in patients with dementia in nursing homes and to test its reliability and validity. Study Design and Setting: An expert panel reviewed the MAT items to develop items for appropriateness of PDU; a second, independent, expert panel determined content validity of the items. An interrater reliability study was conducted (N = 54), and a summated index score, based on weighted item scores, was developed to enhance the use in clinical studies. Construct validity was explored using a representative sample of 560 medical records. Results: Five existing MAT items were used, the MAI item "indication" was adjusted, a new item "evaluation" was added, and scoring rules were based on guideline recommendations, to create the Appropriate Psychotropic drugs use In Dementia (APID) index. The second expert panel concluded that all items contributed to the construct "appropriateness." All items and the summated index score had moderate to almost perfect interrater reliability (intraclass correlation coefficient for agreement, 0.577-1). The summated index score showed promising construct validity, for example, no multicollinearity issues were found. Conclusion: The results of this study show that the AHD index is reliable and valid for measuring appropriateness of PDU for NPS in dementia in nursing homes in clinical studies. (C) 2015 Elsevier Inc. All rights reserved.