MRM identified 506 DRPs which were mapped to 492 classifications representing 80 different types of classification. MRX identified 1265 DRPs which were mapped to 880 classifications representing 17 different types of classification. Pharmacists identified 303 DRPs which were mapped to 297 classifications representing 79 different types of classification.
All 100 cases which were entered into MRX and aged 65 years old or over were used in this section. Classifications were summed and compared with pharmacist and MRM classifications, shown in Tables 23, 24 and 25.
Sixty of the same types of classifications were identified by both MRM and pharmacists. Five of the same types of classifications were identified by both MRX and pharmacists.
Figure 32: Frequency and variety of classifications for each DRP source
Descriptive classifications
Table 23: Classifications found by each source and classifications in common with MRM findings (test cases)
Beers03 Beers12 MRX Pharmacist PIEA STOPP/START
Total other source
classifications 53 68 880 297 241 156
Number of different classification types identified by each source
10 16 17 79 27 32 Classifications in common with MRM 19 21 22 69 51 54 Total MRM classifications 492 492 492 492 492 492 Percent in common MRM classifications 4% 4% 4% 14% 10% 11% Percent of prescribing criteria classifications found in common by MRM 36% 31% 21% 35%
Table 24: Classifications found by each source and classifications in common with pharmacists findings (test cases)
Beers03 Beers12 MRM MRX PIEA STOPP/START
Total other source
classifications 53 68 492 880 241 156
Number of different classification types identified by each source
10 16 80 17 27 32
Classifications in common
with pharmacists 9 15 69 11 24 20
Total Pharmacist
classifications 297 297 297 297 297 297
Percent in common with
pharmacist classifications 3% 5% 23% 4% 8% 7% Percent of prescribing criteria classifications found in common by pharmacists 17% 22% 10% 13%
Descriptive classifications
Table 25: Classifications found by each source and classifications found in common with MRX findings (test cases)
Beers03 Beers12 MRM Pharmacist PIEA STOPP/START
Total other source
classifications 53 68 492 297 241 156
Number of different classification types identified by each source
10 16 80 79 27 32
Classifications in common with MRX
25 28 22 11 18 14
Total MRX classifications 880 880 880 880 880 880
Percent in common with MRX classifications 3% 3% 3% 1% 2% 2% Percent of prescribing criteria classifications found in common by MRX 47% 41% 7% 9%
As a percentage of the pharmacist classifications, MRM found 23%, PIEA 8%, STOPP 7%, Beers12 5%, MRX 4%, Beers03 3%. MRX identified the greatest number of classifications overall with minimal overlap of pharmacist classifications. Unlike MRX, MRM identified a smaller number of classifications yet a much greater proportion of classifications overlapped with pharmacist classifications. MRX identified the largest proportions of classifications identified by both sets of Beers criteria and the smallest proportions of PIEA and STOPP/START. MRM identified the largest proportions of the classifications found by PIEA and STOPP/START. The proportions of Beers03 and Beers12 classifications identified by pharmacists were lower than MRX and similar to MRM. Pharmacists identified more PIEA and STOPP/START classifications than MRX but less than MRM. Figure 33 displays the overlap of classifications identified by software and prescribing criteria with pharmacist classification findings.
Descriptive classifications
There was a low similarity between MRM and pharmacists with the identification of the same types of problems in the same patients calculated using the Jaccard index. The Jaccard index ranged from 0 (no similarity) to 0.375 (partial similarity) with a mean of 0.09 ± 0.11 across the 100 patients indicating low overlap overall. There was very low similarity between MRX and pharmacists with the identification of the same types of problems in the same patients calculated using the Jaccard index. The Jaccard index ranged from 0 (no similarity) to 0.125 (partial similarity) with a mean of 0.008 ± 0.03 across the 100 patients indicating very low overlap overall.
Classification categories in common and unique to MRX or pharmacists are shown in Table 26 and Figure 34, ordered by most to least findings. MRX identified a small scope of 20 types of potential DRP found in the elderly, these are listed in Appendix 19. However, only a small number of DRP types overlapped with pharmacist findings.
Figure 33: Classifications unique to the pharmacist or computer source and classification in common (100 test cases)
Descriptive classifications
Table 26: Overlap of common classification categories between MRX and pharmacists (100 test cases)
Classification category Total cases
MRM found pharmacists foundTotal cases Total cases found in common Total cases percent of Overlap total cases
Other 160 3 3 160 1.9%
Anticholinergic 75 6 6 75 8.0%
Sedative 6 2 2 6 33.3%
Classifications in common between MRX and pharmacists are shown in Table 27 and Figure 35. The most common classification identified was: Anticholinergic use not elsewhere specified (6). This is perhaps not surprising, since anticholinergic and sedative classifications were the predominant findings by MRX. These classifications are prominent in the Beers03 criteria which were incorporated into MRX. MRX overlapped with every instance of a descriptive classifications pharmacists found in the four classifications listed in Table 27, as it based DRP detection solely on presence of specific medications. However, MRX appeared to be unrefined, or excessive, in the frequency of descriptive classifications found.
Descriptive classifications
Table 27: Overlap of common classifications between MRX and pharmacists (100 test cases)
Classification Total cases
MRX found pharmacists Total cases found
Total cases found in common
Total cases Overlap percent of total cases Falls risk/history and
sedatives/antihypertensives/ other
100 1 1 100 1.0%
Anticholinergic use not
elsewhere specified 75 6 6 75 8.0%
Other drug disease
contraindication 60 2 2 60 3.3%
Sedatives long-acting or
sedative long term 6 2 2 6 33.3%
The scope of DRP detection is shown in Figure 36. It can be seen that MRM identified a wide range of problems approaching the range of problems detectable by pharmacists, yet MRM identified a far greater frequency of problems, but surprisingly still failed to identify many of the problems that pharmacists identified. MRX identified the greatest number of problems yet only identified a narrow range of problem types.
Among this reduced set of cases, the prescribing criteria again identified a smaller variety of problems and in smaller volume. Again, the two sets of Beers criteria identified the least number of problems by both volume and problem type.
Figure 35: Overlap of classification between pharmacists and MRX, count of classifications equals the number of patients (100 test cases)
Descriptive classifications