medication adherence

In considering the recall section, participants stated that asking patients to describe their medications is an important aspect of the SMAT. Indeed, patients who understand their disease, the need for treatment, and the role of their medications are generally more likely to adhere to medication regimens. Evidence is also available that the ability to recall one’s own medication regimen is associated with the Mini Mental State Examination (MMSE) score and that a decline may predict the need for future assistance with medication self-management, as well as other aspects of daily living. As shown with the BMQ tool, recall screening can be highly sensitive to sporadic noncompliance. The issue of how to phrase recall questions was addressed by many interviewees in the present study. In the SMAT, recall is scored on the basis of a description of the medication, its name, and the relevant indication.

A fourth identifier, “drug strength”, was changed to “dosage” in the modified version of the tool, such that patients receive a point for reporting the number of tablets used.
In general, participants in this study judged that the SMAT provided a thorough assessment of a patient’s ability to manage oral medications. This view, coming from a diverse group that included both pharmacists and students, seems particularly compelling. However, participants in all focus groups suggested that a complete picture of medication management abilities would require assessment of inhaled, injectable, and topical medications. Unfortunately, the inclu­sion of more complex medication systems would reduce the general usability of the instrument. Nonetheless, the dexterity tasks in the functional section of the SMAT may provide information that is applicable to multiple dosage forms. For example, reduced hand strength (as well as male sex and MMSE score < 24) has been identified as a predictor of non- adherence in older adults with chronic obstructive pulmonary disease who use metered dose inhalers. In phase 2 of this project, measures of manual dexterity and cognitive ability in older adults, as well as scores on the Medication Complexity Index, will be related to SMAT scores. viagra uk online

Despite the lack of statistical power with the small sample used in this study, the results of the survey support the findings of the content analysis. Specifically, respondents were overall very satisfied with the SMAT and rated it highly in terms of usefulness and thoroughness; they also expressed strong willingness to use the instrument. Exploratory analyses (which admittedly also had small samples) revealed that pharmacists working in hospital settings may be more willing to use the SMAT than those working in community settings. This preliminary finding must be replicated with a larger sample before firm conclusions can be drawn. However, if replicated, this finding may be related to concerns expressed in the interviews about the anticipated amount of time needed to administer the tool. Specifically, these differences between groups may be related to multiple factors such as staffing, the role of pharmacy technicians, the availability of private areas for patient interviews, and access to patients’ diagnostic and laboratory information.

CONCLUSIONS

The results from focus group and individual interviews confirmed adequate levels of face validity and usability for the new SMAT. This evaluation by practising pharmacists allowed the researchers to modify the tool for use in phase 2 of this project, which will determine concurrent validity, test—retest reliability, and inter-rater reliability in a geriatric population. Widespread adoption of this comprehensive self-medication assessment instrument has the potential to identify elderly patients at risk of problems in self-management of medications. It would allow hospital and community pharmacists, physicians, and other health care providers to implement interventions that would reduce the risk of medication misad­ventures. The usefulness of the SMAT as perceived by other health professionals such as home care nurses would be an interesting avenue for future research.  cialis professional