Antimicrobial Prescription Assessment Tool (AmPAT) development and validation for assessing the rationality of antimicrobial prescriptions in primary and secondary healthcare settings in India

Adarsh Bansal; Madhu Gupta; Nusrat Shafiq; Atul Saroch; Tanvi Kiran; Jayashree Muralidharan

doi:10.1016/j.puhe.2024.11.009

Antimicrobial Prescription Assessment Tool (AmPAT) development and validation for assessing the rationality of antimicrobial prescriptions in primary and secondary healthcare settings in India

Public Health. 2024 Nov 20:238:7-15. doi: 10.1016/j.puhe.2024.11.009. Online ahead of print.

Authors

Adarsh Bansal¹, Madhu Gupta², Nusrat Shafiq³, Atul Saroch⁴, Tanvi Kiran⁵, Jayashree Muralidharan⁶

Affiliations

¹ Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India. Electronic address: dradarsh_bansal@yahoo.com.
² Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India. Electronic address: madhugupta21@gmail.com.
³ Clinical Pharmacology Unit, Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. Electronic address: nusrat.shafiq.pgi@gmail.com.
⁴ Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. Electronic address: atulsaroch@gmail.com.
⁵ Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India. Electronic address: tanvikiran3@gmail.com.
⁶ Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. Electronic address: mjshree@hotmail.com.

PMID: 39577330
DOI: 10.1016/j.puhe.2024.11.009

Abstract

Objectives: Antimicrobials prescribed without indications can lead to antimicrobial resistance (AMR). This study aimed to develop a validated support and audit antimicrobial prescription assessment tool (AmPAT) to assess the rationality of prescriptions by generalist medical doctors in outpatient settings at primary and secondary healthcare facilities.

Study design: Multiphase content validity study.

Methods: AmPAT was developed in four phases. Phase 1 involved item identification and development based on literature and expert suggestions. In phase 2, the face and content validity were assessed using the Delphi technique in two rounds (16 experts in round 1 and 19 in round 2). The content validity ratio (CVR) and content validity index (CVI) were calculated. A pilot study was conducted in Phase 3 in primary and secondary-level healthcare facilities (n = 92 prescriptions) in Chandigarh, India. Five experts assessed the rationality of 30 prescriptions for inter-rater reliability. The inter-rater agreement and internal consistency were calculated using Fleiss-Kappa statistics and Cronbach's alpha, respectively. Phase 4 included a large cross-sectional study (n = 945 prescriptions) for estimating the internal consistency of AmPAT.

Results: AmPAT was developed with 19 items under three sections (patient, clinical, and treatment details). The mean CVR was 0.91 (range 0.16-1.00), and mean CVI was 0.96 (range 0.58-1.00). The kappa value was 0.91 (range 0.59-1.00) for inter-rater agreement. The Cronbach's alpha was 0.75 (95%CI 0.66-0.82) and 0.76 (0.68-0.82) in phases 3 and 4, respectively.

Conclusion: AmPAT, with good reliability, inter-rater agreement, and internal consistency, was developed to assess the rationality of antimicrobials prescribed in outpatient departments at primary and secondary-level healthcare settings.

Keywords: AmPAT; Antimicrobial prescriptions; Antimicrobial resistance; Prescription assessment; Rationality.