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  • Title: Inter- and intrarater reliability of retrospective drug utilization reviewers.
    Author: Zuckerman IH, Mulhearn DM, Metge CJ.
    Journal: J Am Pharm Assoc (Wash); 1999; 39(1):45-9. PubMed ID: 9990187.
    Abstract:
    OBJECTIVE: To assess inter- and intrarater reliability among 23 pharmacist and physician retrospective drug utilization reviewers and to assess interrater reliability after a reviewer training session. DESIGN: Exploratory study. SETTING: Maryland Medicaid's retrospective drug utilization review (DUR) program. PARTICIPANTS: 23 physician and pharmacist retrospective drug utilization reviewers. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Profiles rated as "intervention indicated" or "intervention not indicated." Cochran's Q test, overall percent agreement, and the unweighted kappa statistic were used in the analysis of review consistency. RESULTS: Intrarater reliability showed substantial consistency among the 23 reviewers; the percent agreement was 82.9% with kappa = 0.66. Interrater reliability, however, was poor, with an overall agreement of 69.6% and kappa = 0.16. Interrater reliability was also poor after a one-hour reviewer training session (agreement 81.8%, kappa = -0.19). CONCLUSION: The implicit review process used in the retrospective DUR program that we evaluated was unreliable. Since reliability is a necessary but not sufficient condition for validity of an indicator of inappropriate drug use, the validity of the DUR implicit review process is in question.
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