Development and reliability testing of the clinical pharmacist recommendation taxonomy

Abstract

Study Objective. To evaluate the reliability of a newly developed taxonomy-the Clinical Pharmacist Recommendation (CPR) taxonomy-to classify clinical pharmacy interventions. Design. The CPR taxonomy was developed and refined in three phases. In each phase, reviewers independently reviewed recommendations made by a clinical pharmacist-physician team and categorized them into mutually exclusive categories: priority problem, and response. Interrater reliability was assessed for all categories during each development phase. Setting. Primary care clinics of a Veterans Affairs Medical Center. Patients. Fifty-three patients enrolled in the Veterans Affairs Enhanced Pharmacy Outpatient Clinic (EPOC) trial. Measurements and Main Results. Interrater reliability was assessed using the κ statistic. A total of 423 recommendations were evaluated during the three testing phases. In the final testing phase, agreement was moderate for pharmacotherapy problem subcategories (κ=0.57), substantial for pharmacotherapy problem primary categories (κ=0.64), and almost perfect for response categories (κ=0.85). Taxonomy completion time/patient averaged 4.6 minutes (range 1-11 min). Conclusion. The CPR taxonomy provides a reliable method to systematically evaluate clinical pharmacy recommendations based on the therapeutic problem identified and specific action recommended to resolve the problem.