Measuring Medication Self-Management Capacity: A Scoping Review of Available Instruments

Badawoud, Amal M; Salgado, Teresa M.; Lü, Juan; Parsons, Pamela; Peron, Emily P.; Slattum, Patricia W.

doi:10.1007/s40266-020-00764-z

Cited by 12 publications

(21 citation statements)

References 30 publications

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“…These domains brings a more detailed perspective with respect to the patient work process involved in medication management, previously described as complex, cognitive, and collaborative [6]. These findings highlight that the previously developed Drug Regimen Unassisted Grading Scale as well as the Medication Management Instrument for Deficiencies in the Elderly, which focus on functional skills [32], would not be sufficient to estimate the medication literacy skills in older patients.…”

Section: Discussionmentioning

confidence: 87%

Conceptualization and content validation of the MEDication literacy assessment of geriatric patients and informal caregivers (MED-fLAG)

Gentizon

Fleury

Pilet

et al. 2022

J Patient Rep Outcomes

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Background The assessment of patients’ medication literacy skills (i.e., abilities to access, comprehend and interact with medication-related information) is an important step in assisting clinicians to plan for appropriate care. Despite several attempts by researchers to develop measures of medication literacy, an instrument tailored to the specific needs of older adults remains a significant shortfall. Therefore, an interprofessional team that included a citizen co-researcher conceptualized a new standardised measure of medication literacy—the MEDedication Literacy Assessment of Geriatric patients and informal caregivers (MED-fLAG). MED-fLAG was designed as a three-dimensional self-reported measure of functional, interactive and critical skills. This study describes the conceptualization process and provides the results of an evaluation of MED-fLAG’s content validity, acceptability, and feasibility during a hospital stay. Methods MED-fLAG was developed in accordance with the guidance on scale development and standards for good content validity, by using the following steps: (I) conceptualization of a provisional version of MED-fLAG; (II) iterative qualitative evaluation of its content validity by older adults, informal caregivers and healthcare professionals. Results The qualitative assessment of the initial 54-item MED-fLAG was conducted in 36 participants, namely 13 home-dwelling older adults and/or informal caregivers and 23 healthcare professionals. Six rounds of revisions were performed to achieve content validity and to propose a 56-item revised MED-fLAG. Participants reported benefits of using a standardized assessment of medication literacy during a hospital stay but warned about certain limitations and prerequisites. The extent to which MED-fLAG could be integrated into discharge planning needs to be further investigated. Conclusions MED-fLAG is the first medication literacy measure tailored to the specific needs of older patients and informal caregivers. A unique feature of this measure is that it includes prescribed and non-prescribed medications, irrespective of the galenic form. Additional studies are required to evaluate the other measurement properties of MED-fLAG, and to reduce the number of items before considering its clinical application.

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Section: Discussionmentioning

confidence: 87%

Conceptualization and content validation of the MEDication literacy assessment of geriatric patients and informal caregivers (MED-fLAG)

Gentizon

Fleury

Pilet

et al. 2022

J Patient Rep Outcomes

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“…Insufficient medication management performance leads to impairments in the ability to engage in self-care and live independently ( 9 ). Thus, preserved medication performance skills are important for patients’ quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, most previous studies describe handling errors only of one selected dosage form such as inhalers, eye drops or pills. In addition, there is no instrument recommended for use in clinical practice which objectively measures medication self-management capacity ( 9 ). Furthermore, most findings were based on single person judgements or patients’ self-reports ( 10 – 13 ).…”

Section: Introductionmentioning

confidence: 99%

Developing a novel tool to assess the ability to self-administer medication – A systematic evaluation of patients’ video recordings in the ABLYMED study

et al. 2023

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BackgroundOlder people often experience medication management problems due to multimorbidity, polypharmacy and medication complexity. There is often a large gap between patients’ self-reported and actual abilities to handle the self-administration of their medication. Here we report on the development and evaluation of a new tool to assess the ability of non-demented hospitalized patients to self-administer medication in different dosage forms. To this end, we video-recorded the patients’ medication management performance and implemented a novel assessment scheme, which was applied by several independent raters.MethodsSixty-seven in-patients ≥70 years of age and regularly taking ≥5 different drugs autonomously of the ABLYMED study agreed to the video recording of their medication management performance with five different dosage forms. All raters underwent a training and applied a standardized assessment form and written guide with rating rules for evaluation. In a pilot phase, video recordings of three patients were rated by 19 raters (15 medical students, two expert raters to determine a reference standard, and two main raters who later rated the total sample). In the rating phase, based on the ratings obtained from the two main raters, we determined interrater (assessed every section of 20 patients as agreement between the raters at one point of time) and intrarater (assessed as consistency within each rater across three points of time) agreement by intraclass correlation analysis.ResultsIn the pilot phase we obtained an overall sufficient agreement pattern, with an adjustment of the rating rules for patches. In the rating phase we achieved satisfactory agreement between the two raters (interrater reliability) and across different points of time (intrarater reliability). For two dosage forms (eye-drops and pen), rater training needed to be repeated to reach satisfactory levels.DiscussionOur novel rating procedure was found to be objective, valid and reproducible, given appropriate training of the raters. Our findings are an important part of a larger research project to implement a novel assessment for the ability to self-administer medication in different dosage forms. Further, they can support the development of patient trainings to improve medication management and secure independent living.

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“…The decline in an older adult’s ability to self-manage medications and increase in risk of medication errors, adverse drug events, placement in assisted living and hospitalization are well recognized in published literature [ 25 , 26 , 27 , 28 ]. Therefore, several instruments have been developed to examine a patient’s functional and cognitive capacity to manage medications, using the patient’s own medications or simulated medication regimen and tasks [ 29 , 30 , 31 , 32 ]. These instruments enable clinicians to examine both physical and cognitive skills in their older adults.…”

Section: Introductionmentioning

confidence: 99%

“…However, many vary in their validity and reliability and none of these instruments are gold standard measures [ 29 , 32 ]. Furthermore, there is significant variability in the comprehensiveness of their assessments, in both the physical and cognitive skills [ 29 , 32 , 33 ]. For example, while 96% of the instruments assess skill in opening medication packaging, only 18% examine the ability to split a tablet.…”

Section: Introductionmentioning

confidence: 99%

Development and Content Validation of an Instrument to Measure Medication Self-Management in Older Adults

et al. 2021

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Background: For older adults, the capacity to self-manage medications may be limited by several factors. However, currently available tools do not permit a comprehensive assessment of such limitations. The Domain Specific Limitation in Medication Management Capacity (DSL-MMC) was developed to address this need. This study aimed to establish the face and content validity of the DSL-MMC. Methods: The DSL-MMC tool consisted of 4 domains and 12 sub-domains with 42 items including: 1. physical abilities (vision, dexterity, hearing); 2. cognition (comprehension, memory, executive functioning); 3. medication regimen complexity (dosing regimen, non-oral administration, polypharmacy); and 4. access/caregiver (prescription refill, new prescription, caregiver). Pharmacists assessed each item for relevance, importance, readability, understandability, and representation. Items with content validity index (CVI) scores of <0.80 for relevance were examined for revision or removal. Results: Twelve pharmacists participated in the study. CVI scores for relevance and importance of domains were 1.0; of the sub-domains, two were below 0.80. Among the 42 items, 35 (83%) and 30 (71%) maintained CVI scores above 0.80 for relevance and importance, respectively. Five items were removed, three were merged and seven were modified due to low CVI scores and/or feedback. Conclusion: The DSL-MMC has been validated for content.

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Measuring Medication Self-Management Capacity: A Scoping Review of Available Instruments

Cited by 12 publications

References 30 publications

Conceptualization and content validation of the MEDication literacy assessment of geriatric patients and informal caregivers (MED-fLAG)

Conceptualization and content validation of the MEDication literacy assessment of geriatric patients and informal caregivers (MED-fLAG)

Developing a novel tool to assess the ability to self-administer medication – A systematic evaluation of patients’ video recordings in the ABLYMED study

Development and Content Validation of an Instrument to Measure Medication Self-Management in Older Adults

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