Design of Instrument

To address identified gaps in existing tools for assessing capacity for self-medication, the researchers designed an instrument with 5 assessment scales to measure function, cognition, medication recall, self-reported adherence, and intentional or purposeful nonadherence. Most of the items in these assessment scales were developed by the authors, although some items were adapted from the BMQ and the DRUGS. The version of the SMAT used in this study included a standardized kit with the required items for testing functional and cognitive capacity (e.g., a medication organizer) and administration instructions for testers.

With the SMAT, the patient’s sensory, perceptual, and physical abilities are measured using the 22-item Functional Scale. Each item is scored on either a 2-point scale (able or unable) or a 3-point scale (ease, difficulty, unable). Tasks that are included are opening 3 types of prescription vial closures (align arrows, push and turn, flip open); reading prescription labels in 10-, 12-, and 14-point type; filling a standard weekly pill box; using a blister package filled by a pharmacist; and identifying certain colours. The patient’s hearing, vision, and swallowing ability are also evaluated. suhagra

The patient’s ability to make judgements, manipulate information, and interpret instructions is determined using the 22-item Cognitive Scale. It is scored with a 3-point scoring system (ease, difficulty, unable). Tasks that are included are interpreting information on labels, organizing 3 test medica­tions for daily use, organizing 3 test medications in a weekly pill organizer, and accurately locating medications in blister packages filled by a pharmacist.

The patient’s ability to remember his or her own medica­tion regimen is measured with the Recall Scale. The patient is asked to recall any or all of 4 items per drug: medication name, indication, dose regimen, and description (colour, shape, strength, and/or dosage form). A reference drug list obtained from the patient’s labelled prescription containers or from computerized pharmacy records is used to determine the max­imum score (number of reference drugs multiplied by 4). The patient’s ability to recall each item for each drug is scored as “able” or “unable”. The total of the “able” results is expressed as a percentage of the maximum possible score.

The patient’s assessment of compliance with his or her own medication regimen is determined with the Self-Reported Adherence Scale, which is scored by the same method as the Recall Scale. viagra 10 mg

The Purposeful Nonadherence Scale measures the patient’s experiences with adverse effects of medications, belief in the value of medication, and history of stopping a medication without medical advice. For each drug, the patient is asked to choose a ranking for each item (e.g., “Did this medication ever bother you in any way?”). The rankings range from 0 (not at all) to 3 (a lot). The final score for this scale is calculated as the sum of the ranks for the 3 questions divided by the maximum possible score and expressed as a percentage.