Lubinga Solomon J, Millar Ian, Babigumira Joseph B
Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.
BMC Res Notes. 2011 Oct 11;4:398. doi: 10.1186/1756-0500-4-398.
Although community pharmacists in the United Kingdom are expected to assess elderly patients' needs for additional support in managing their medicines, there is limited data on potentially useful assessment tools. We sought to evaluate a 13-item assessment instrument among community dwelling elderly patients, 65 years and above. The instrument is composed of a cognitive risk sub-scale of 6 items and a physical risk sub-scale of 7 items.
The instrument was administered to elderly patients in a survey performed in a community to the west of Glasgow, Scotland. The survey recruited 37 participants, 31 from 4 community pharmacies and 6 patients whose medication management tasks were managed by the West Glasgow Community Health and Care Partnership (managed patients). Community pharmacists independently rated 29 of the 37 participants' comprehension of, and dexterity in handling their medicines. We assessed scale reliability, convergent validity and criterion validity. In sub-analyses, we assessed differences in scores between the managed patients and those recruited from the community pharmacies, and between multi-compartment compliance aid users and non-users. The instrument showed satisfactory internal consistency (Cronbach's alpha of 0.792 for 13-item scale). There was significant strong negative correlation between the cognitive risk sub-scores and community pharmacists' assessment of comprehension (ρ = -0.546, p = 0.0038); and physical risk sub-scores and community pharmacists' assessment of dexterity (ρ = -0.491, p = 0.0093). The Area Under the Receiver Operator Characteristic Curve (AUC ± SE; 95%CI) showed that the instrument had good discriminatory capacity (0.86 ± 0.07; 0.68, 0.96). The best cut-off (sensitivity, specificity) was ≥4 (65%, 100%). In the sub-analyses, managed patients had significantly higher cognitive risk sub-scores (6.5 versus 4.0, p = 0.0461) compared to non-managed patients. There was a significant difference in total risk score (4 versus 2, p = 0.0135) and cognitive risk sub-score (4 versus 1.5, p = 0.0029) between users and non-users of multi-compartment compliance aids.
This instrument shows potential for use in identifying elderly patients who may have problems managing their own medicines in the community setting. However, more robust validity and reliability assessments are needed prior to introduction of the tool into routine practice.
尽管英国的社区药剂师需要评估老年患者在药物管理方面对额外支持的需求，但关于潜在有用的评估工具的数据有限。我们试图在65岁及以上的社区居住老年患者中评估一种包含13个条目的评估工具。该工具由一个包含6个条目的认知风险子量表和一个包含7个条目的身体风险子量表组成。
在苏格兰格拉斯哥以西的一个社区进行的一项调查中，该工具被应用于老年患者。该调查招募了37名参与者，其中31名来自4家社区药房，6名患者的药物管理任务由西格拉斯哥社区健康与护理伙伴关系负责（受管理患者）。社区药剂师独立对37名参与者中的29名对药物的理解和操作灵活性进行了评分。我们评估了量表的信度、收敛效度和效标效度。在亚分析中，我们评估了受管理患者与从社区药房招募的患者之间，以及多格依从性辅助工具使用者与非使用者之间的得分差异。该工具显示出令人满意的内部一致性（13个条目量表的Cronbach's alpha为0.792）。认知风险子得分与社区药剂师对理解能力的评估之间存在显著的强负相关（ρ = -0.546，p = 0.0038）；身体风险子得分与社区药剂师对操作灵活性的评估之间存在显著的强负相关（ρ = -0.491，p = 0.0093）。受试者工作特征曲线下面积（AUC ± SE；95%CI）表明该工具具有良好的区分能力（0.86 ± 0.07；0.68，0.96）。最佳截断值（敏感性，特异性）为≥4（65%，100%）。在亚分析中，与非受管理患者相比，受管理患者的认知风险子得分显著更高（6.5对4.0，p = 0.0461）。多格依从性辅助工具使用者与非使用者之间的总风险得分（4对2，p = 0.0135）和认知风险子得分（4对1.5，p = 0.0029）存在显著差异。
该工具显示出在识别社区环境中可能在自我药物管理方面存在问题的老年患者方面的应用潜力。然而，在将该工具引入常规实践之前，需要进行更有力的效度和信度评估。
