geriatric assessment

A total of 17 pharmacists and 3 pharmacy students agreed to participate. The interview groups varied in size: 1 group of 5 persons, 1 group of 3 persons, 4 groups of 2 persons each, and 4 interviews with individual participants. The majority of pharmacists (13/17) had more than 5 years of experience. Eleven pharmacists and 1 student were working in a hospital setting, and 5 pharmacists and 2 students were working in a community setting. One pharmacist reported the work setting as “other”. The majority of pharmacists spent more than 50% of their time providing direct patient care.

Main Themes

Participants commented on various components of the instrument during the structured interviews. Examples are reported verbatim in Table 1, and the themes are summarized below. These comments prompted modifications to the SMAT, which are described in the Discussion section of this article.

Functional Assessment

Participants’ comments on the tasks used to measure functional ability (Table 1) drew attention to the following issues. The hands-on nature of the assessment was deemed beneficial for effectively assessing difficulties with medication Toolmanagement. The use of different types of vial closures and various font sizes for the printing on labels was appreciated, as was the use of various medication organizers to identify manipulation or vision issues. Concern was expressed that the 10-point font for label printing was too small and would lead to frustration on the part of elderly patients. Some participants recommended that the assessment kit include medications dispensed in manufacturer’s boxes or blister packages, as well as commonly used auxiliary labels. Concerns were expressed about scoring for the colour identification task (e.g., whether the word “purple” would be acceptable as a descriptor for the colour lavender and what background and pill size would be used for the test). Finally, although participants saw the value of questions pertaining to pharmacists’ assessments of hearing difficulty, visual impairment, and ability to swallow pills, some were not comfortable assigning a score to these capabilities. levitra plus

table1

Cognitive Assessment

Participants’ comments on the tasks used to assess patients’ cognitive ability (Table 1) drew attention to the following issues. There was general agreement that the tasks of filling a weekly pill organizer and locating medications in the blister packages were appropriate. It was felt that these tasks would allow a pharmacist to identify patients experiencing difficulty with a pill organizer at home and would provide information that the pharmacist would find helpful for making appropriate recommendations. Participants expressed concern about the label directions, which consisted of only the number of tablets and the number of times per day that the medication should be taken. They anticipated that patients would want to have more specific instructions, such as “take with food”, for completing this task. Participants were also concerned that a patient’s request for additional information would constitute cueing and would affect the score. Feedback from one focus group inter­view concerned the use of 3 vials for the question “If you were prescribed all three of these medications, describe when you would take the tablets and how many you would take for a typical day.” These participants were of the opinion that the use of 3 medication vials would be too complex for many patients. However, participants in another focus group commented that using more than 3 vials for this question would be appropriate. Finally, some participants proposed a change to the scoring scheme for the medication organization task. For this task, the original tool specified that the patient be asked to make a plan of action for 3 medications to be taken in a typical day, with scoring on a single 3-point scale (ease, difficulty, unable). Interviewees felt that it would be difficult to assess performance using only a single score for the 3 medications.
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Reference Drug List

Participants commented on the use of a “reference drug list” as the basis for the recall, self-reported adherence, and purposeful nonadherence scores. Participants were generally unsure of the origin of the reference drug list and whether the medications on the list would be verified with the patient’s community pharmacy (Table 1). It was also noted that patients’ interpretation of the terms “drugs” and “medications” might affect their recall of nonprescription medications and non-oral dosage forms such as inhalers.

Patient Recall Score

Participants’ comments on the descriptors used to assess recall (Table 1) drew attention to the following issues. There was general agreement that the 4 descriptors used for each drug were important; however, it was anticipated that patients would not obtain high scores on this section of the tool. Some participants were unsure how much prompting would be required from the tester and how prompted responses would be scored.

Self-Reported Adherence

Participants had few comments on the questions about self-reported adherence (Table 1). The only issue of concern dealt with the possibility of redundancy between the questions in this section and the questions for either the recall score or the purposeful nonadherence score. tadacip 20