Validation of the Antifungal National Antimicrobial Prescribing Survey (AF-NAPS) quality assessment tool

Khanina, A; Douglas, AP; Yeoh, DK; So, M; Abbotsford, J; Spelman, T; Kong, DCM; Slavin, MA; Thursky, KA

Author(s): Khanina, A; Douglas, AP; Yeoh, DK; So, M; Abbotsford, J; Spelman, T; Kong, DCM; Slavin, MA; Thursky, KA;
Details: Publication Year 2023-06-01,Volume 78,Issue #6,Page 1367-1377
Journal Title: Journal of Antimicrobial Chemotherapy
Publication Type: Research article
Abstract: BACKGROUND: The Antifungal National Antimicrobial Prescribing Survey (AF-NAPS) was developed to undertake streamlined quality audits of antifungal prescribing. The validity and reliability of such tools is not characterized. OBJECTIVES: To assess the validity and reliability of the AF-NAPS quality assessment tool. METHODS: Case vignettes describing antifungal prescribing were prepared. A steering group was assembled to determine gold-standard classifications for appropriateness and guideline compliance. Infectious diseases physicians, antimicrobial stewardship (AMS) and specialist pharmacists undertook a survey to classify appropriateness and guideline compliance of prescriptions utilizing the AF-NAPS tool. Validity was measured as accuracy, sensitivity and specificity compared with gold standard. Inter-rater reliability was measured using Fleiss' kappa statistics. Assessors' responses and comments were thematically analysed to determine reasons for incorrect classification. RESULTS: Twenty-eight clinicians assessed 59 antifungal prescriptions. Overall accuracy of appropriateness assessment was 77.0% (sensitivity 85.3%, specificity 68.0%). Highest accuracy was seen amongst specialist (81%) and AMS pharmacists (79%). Prescriptions with lowest accuracy were in the haematology setting (69%), use of echinocandins (73%), mould-active azoles (75%) and for prophylaxis (71%). Inter-rater reliability was fair overall (0.3906), with moderate reliability amongst specialist pharmacists (0.5304). Barriers to accurate classification were incorrect use of the appropriateness matrix, knowledge gaps and lack of guidelines for some indications. CONCLUSIONS: The AF-NAPS is a valid tool, assisting assessors to correctly classify appropriate prescriptions more accurately than inappropriate prescriptions. Specialist and AMS pharmacists had similar performance, providing confidence that both can undertake AF-NAPS audits to a high standard. Identified reasons for incorrect classification will be targeted in the online tool and educational materials.
Publisher: Oxford University Press
Keywords: Humans; *Antifungal Agents/therapeutic use; Reproducibility of Results; *Anti-Infective Agents/therapeutic use; Prescriptions; Surveys and Questionnaires; Inappropriate Prescribing
Department(s): Infectious Diseases
PubMed ID: 37038993
Publisher's Version: https://doi.org/10.1093/jac/dkad085
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-09-05 07:38:07

Last Modified: 2024-07-09 04:50:54