Development and reliability testing of BRANT-MERQS-2A: A quality assessment tool for medication review type 2a reports.

Abstract

Introduction: Medication reviews (MRs) are increasingly implemented to optimize medication use and address drug-related problems in patients with complex pharmacotherapy, with medication review type 2a (MR2a) representing an intermediate format involving a pharmacist-led structured assessment with patient interview, based on clinical and medication data, without direct prescriber interaction. Despite their widespread implementation, systematic and operational approaches to evaluate the quality of MRs remain limited. In Belgium, Medication Review type 2a (MR2a) has been implemented in routine practice of community pharmacies since 2023, yet no validated instruments exist to evaluate the quality of written MR2a reports.

Aim: This study aimed to adapt the existing BRANT-MERQS framework for the quality evaluation of MR2a reports and to assess the usability, reproducibility and reliability of the resulting tool (BRANT-MERQS-2A).

Method: Relevant criteria were selected from the original BRANT-MERQS and expanded with criterion-specific instructions to form the BRANT-MERQS-2A. Initial testing involved two student assessors independently evaluating 98 MR2a reports, with interrater agreement (IRA) assessed using weighted Cohen's Kappa. In a subsequent extended testing phase, the same reports were assessed by 61 final-year pharmacy students, with three randomly selected students evaluating each MR2A report. Interrater reliability was evaluated using the Intraclass Correlation Coefficient (ICC) and Gwet's AC1. Assessment duration was recorded to evaluate feasibility.

Results: Initial testing demonstrated strong IRA between the two student assessors. In the extended student cohort, agreement at the criterion level ranged from poor to moderate, with an overall ICC of 0.62, indicating moderate reliability. Criteria differed in discriminatory capacity, with some showing high absolute agreement but limited variability. Assessment time decreased over successive rounds, reflecting a learning effect and improved efficiency.

Conclusion: The BRANT-MERQS-2A provides a feasible and structured approach for assessing the quality of MR2a reports. While variability at criterion level reflects the inherent complexity of MR2a, the tool demonstrates potential for self-and peer-assessment and offers a valuable foundation for further refinement and integration into routine quality monitoring.