Development and validation of a revised instrument to measure burden of long-term medicines use: the Living with Medicines Questionnaire version 3

Abstract

ObjectivesTo revise the Living with Medicines Questionnaire version 2 (LMQ-2), which measures the burden of using prescribed medicines, to include cost and expand side effects and social issues.MethodsNew statements were developed and validated through cognitive interviews with medicine users, and these and a global visual analog scale (VAS) were added to the 42-item LMQ-2. Construct validity was assessed through exploratory and confirmatory factor analyses using an online public survey. Criterion-related validity was measured against the Treatment Satisfaction Questionnaire with Medication (TSQM-II) and the EuroQoL 5-level quality of life measure (EQ-5D-5L), in patients using community pharmacies, general practices, and outpatient clinics. Reliability was assessed by test–retest using online public distribution.ResultsThe 58-item interim instrument (n=729) was reduced to 41 items after factor analysis, which confirmed an eight-domain structure: relationships with health professionals, practicalities, interferences, effectiveness, side effects, concerns, cost, and autonomy, constructed as medicine burden. All subscales, except autonomy, were loaded onto this construct and showed acceptable internal consistency. LMQ-VAS correlated with total LMQ scores (r=0.571). Criterion validation (n=422) demonstrated total LMQ scores negatively correlated with TSQM scores for global satisfaction (r=–0.616); domain scores showed similar correlations: effectiveness (r=–0.628), side effects (r=–0.597), and practicalities (r=–0.529). Total LMQ score was negatively correlated with EQ VAS (r=–0.383) and showed weak/moderate relationships with individual EQ-5D-5L dimensions. Test–retest (n=30) reliability showed intra-class correlation coefficients of 0.954 (total LMQ score), 0.733–0.929 (domain scores), and 0.789 (global item).ConclusionThe LMQ version 3 (LMQ-3) instrument has acceptable construct, criterion-related and known-groups validity, and is internally consistent as a measure of medicine burden, although reliability requires further confirmation. It could be used to measure the outcome of interventions designed to reduce the burden of polypharmacy.

Medication-Related Burden and Medication Adherence Among Geriatric Patients in Kuwait: A Cross-Sectional Study

“…than those aged 65-74 years old. This finding is in contrast to the Qatari and English studies, which reported that LMQ overall scores were not strongly related to age (Katusiime et al, 2018;Zidan et al, 2018), and another English study that showed a significantly lower mean LMQ overall scores among elderly patients (≥ 65 years) compared with adult patients (18-64 years) and a nonsignificant difference among the older patient groups, 65-79 years vs. ≥ 80 years (Krska et al, 2018). The possible explanation for the high burden among respondents aged ≥75 years may be due to their significantly higher scores in two domains related to communication/relationships with healthcare professionals about medicines and perceived effectiveness of medicines, which revealed their poorer quality relationships with healthcare professionals and less satisfaction with medication effectiveness.…”

Patient experiences of the burden of using medicines for long-term conditions and factors affecting burden: A cross-sectional survey

“…Several instruments measure satisfaction with medicines (Katusiime, Corlett, Reeve, & Krska, ) which we have found is negatively correlated with medicines burden (Katusiime et al, ). Few other instruments measure burden; one measures overall treatment burden (Tran et al, ), others focus on burden in specific medical conditions (Eton et al, ) but cover limited aspects of medicines use.…”

“…The LMQ‐3 is a self‐completion questionnaire which includes 41 Likert‐type statements rated on a 5‐point scale (strongly agree to strongly disagree), within eight domains (Katusiime et al, ). Domain scores are summed to produce a total scale score (total LMQ‐3 score) depicting the overall level of medicine burden (range 41–205), with higher scores reflecting higher medicine burden.…”

“…The Living with Medicines Questionnaire (LMQ) (Krska, Katusiime, & Corlett, ), developed from the patient perspective, covers eight domains of medicine burden: relationships with health professionals, practical difficulties, interference with daily life, lack of effectiveness, side effects, general concerns, cost and lack of autonomy (Katusiime, Corlett, & Krska, ). The LMQ version 3 (LMQ‐3) has undergone psychometric testing, has been translated into several languages (Zidan, Awaisu, Hasan, & Kheir, ) and is being used in both cross‐sectional and intervention studies in a number of countries.…”

Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis

“…Analysis confirmed older people's medication management workload (17,18,56), highlighting the influence of diagnoses, symptoms and illness trajectories that overlay ageing processes (11)(12)(13)55); the medications they take, including high risk drugs, doses and complex regimes (7,10,20,56); and their relationship with the prescriber (56,58,60). These factors affected behavioural responses such as self-efficacy, coping styles and control: 'personalised, contingent and contextually situated… highly individualised routines and strategies' (52).Tentative links between 'the overburdened patient', poorer adherence and worse outcomes began to emerge (13)(14)(15)(76)(77)(78)(79)(80)(81).…”