medication therapy management

INTRODUCTION

For more than a decade, pharmacists have used screening tools to identify patients eligible for institution-based self- medication programs. Many of these tools have been derived from an instrument that focused on older patients’ functional ability to take medication. Evaluations have included assess­ment of motor skills for opening and closing vials or removing tablets, as well as the ability to read prescription labels and identify tablet colours. Other aspects of screening have included questions about daily routine, adverse effects or allergies with previous medications, recall of the preadmission medication regimen, and medication self-management practices (storage, use of compliance aids, and methods of handling missed doses). Several deficiencies have been identified with this approach, including the inability to score or otherwise quantify the results, poor inter-rater reliability, and undetermined reproducibility of the results. Furthermore, cognitive capacity for self-medication is not directly addressed by these tools. As a result, recommen­dations for patient self-care are often based largely on the clinical skill and experience of the pharmacist who administers the screening tool.

To address the issue of cognitive capacity for self-medication, several researchers have employed various tests in an attempt to predict success in medication self-administration. Two of these tests specifically attempted to measure capacity for medication self-management. The Drug Regimen Unassisted Grading Scale (DRUGS) incorporated a stepwise progression of 4 tasks: identification, access, dosage, and timing. This scale allows the assessor to calculate a score that has been found to be useful in identifying early deficits that can increase risk in medication self-management. However, the DRUGS was evaluated in only a small cohort of well-educated, highly functioning older adults, and the power of the study was insuf­ficient to detect differences in clinical outcomes. The Brief Medication Questionnaire (BMQ) was designed as a self-report tool for screening medication adherence and identifying barriers to adherence; upon completion of the questionnaire, the patient’s rating on an Adherence Risk Scale can be determined. The BMQ successfully predicted adherence levels, although it was tested in only a small cohort of highly educated middle-aged adults. cialis 20 mg

Clearly, there is a need for a comprehensive, evidence- based, self-medication assessment instrument that incorporates not only functional ability, but also tests of cognitive capacity, medication recall, and beliefs about medication use. The instru­ment needs to be not only reliable and valid for measuring older adults’ capacity for medication self-care, but also acceptable to pharmacists working with older patients. The first phase in the development and testing of the Self-Medication Assessment Tool (SMAT) is described in the present report.
The goals of this study were to determine the face validity of the SMAT and its acceptability among pharmacists. The study involved structured individual and focus group interviews with pharmacists who had been asked to examine the SMAT, as well as a short questionnaire in which the respondents were asked to rate the SMAT on a series of dimensions. It was hypothesized that pharmacists’ ratings of the SMAT would be positive.