A Medication Assessment Tool to Evaluate Prescribers' Adherence to Practice Guidelines in Bipolar Disorder: Development and Psychometric Properties

Background: In the last decades, bipolar disorder treatments have undergone a gradual shift away from relying on clinical expertise to adopting evidence-based practice guidelines and expert consensus, leading to an improvement in medical care safety, patient performance, and quality of life. Nonetheless, suboptimal prescribing has remained an issue, and there is an excellent opportunity for improving the care standards to reduce symptoms' recurrence, frequent hospitalizations, and costs. Objectives: This study aimed to develop and validate a medication assessment tool for evaluating prescribers' adherence to pharmacotherapy recommendations outlined in practice guidelines during the acute phase of bipolar disorder in Iran (MATAPBD). Methods: This mixed-method study was conducted from August 2021 to May 2022. A 54-item pool was developed based on the results from the literature review and research group discussion. The validity (i.e., face, content, and construct) and reliability (i.e., stability and internal consistency) of the tool were evaluated. Results: Four items were rewritten in qualitative content validity. Then, eleven and five items were excluded from the scale in terms of having low content validity ratios and corrected item-total correlation, respectively. The construct validity of the MATAPBD was assessed by adopting the maximum-likelihood exploratory factor analysis method and Promax rotation. The number of latent factors was calculated by performing Horn's parallel analysis. In exploratory factor analysis, the remaining 17 items were categorized into four factors which explained 57.97% of the total extracted variance. Cronbach's alpha and McDonald's omega of all factors were > 0.7, and the intraclass correlation coefficient was 0.914 revealing the strong reliability of MATAPBD. Conclusions: The MATAPBD had good psychometric properties and may have been a valuable tool to evaluate prescribers' adherence to practice guideline recommendations during the acute phase of bipolar disorder.