Sills MR. Medication Adherence PROM Measures Updates and Pilot Results. Slides for teleconference to facilitate discussion of Cardiovascular PRO Measure Selection and Refinement by SAFTINet Stakeholders. 2 July 2012.
2. +
Overview
PEC preference regarding the medication adherence measure
Instrument
Pilot test
Feedback on the instrument
Feedback on the pilot
How would we use the findings in our research?
3. +
Overview
PEC preference regarding the medication adherence measure
Instrument
Pilot test
Feedback on the instrument
Feedback on the pilot
How would we use the findings in our research?
4. +
Proposed Med Adherence Instrument
and Pilot Test
A single medication adherence question (derived from the Gehi
question) and a single checklist of barriers
Pilot test by 1-2 providers in each organization for a few weeks
5. +
Proposed Med Adherence Instrument:
Adherence Question
Patient Instructions:
It can be difficult to take all of our medications as the doctor has told
us to. Please tell us how often taking your medications is difficult for
you.
In the past month, how often did you take your medications as the
doctor or provider prescribed?1 Please check one (1) answer.
“All of the time” (100%)
“Nearly all of the time” (90%)
“Most of the time” (75%)
“About half the time” (50%)
“Less than half the time” (<50%)
“None of the time” (0%)
6. +
Proposed Med Adherence Instrument:
Barriers Checklist
In the past month, why have you not taken your medicine as
your doctor prescribed? Check all that apply.
My medicine makes me feel bad (I have “side effects”). Please
describe: ________________
I don’t feel like my medicine is working
I feel like taking my medicine will not improve my health
There are too many doses of medicine to take each day
I cannot afford my medicine
I forget to take my medicine
7. +
Proposed Med Adherence
Instrument: Barriers Checklist
Domains for Barriers:
Side effects
No improvement in symptoms
Belief medication won’t change outcomes
Complexity of regimen
Financial cost
Forgetting
Some options for wording on next slides
8. +
Proposed Med Adherence
Instrument: Barriers Checklist
Domain for Barriers: Side effects
Options
proposed: My medicine makes me feel bad (I have “side effects”).
Please describe: ________________
ASK-12: Have you skipped or stopped taking a medicine because it
made you feel bad?
Morisky-8: Have you ever cut back or stopped taking your medicine
without telling your doctor because you felt worse when you took it?
Morisky-4: At times, if you feel worse if you take your medicines, do
you stop taking them?
9. +
Proposed Med Adherence
Instrument: Barriers Checklist
Domain for Barriers: No improvement in symptoms
Options
proposed: I don’t feel like my medicine is working
ASK-12:
I feel confident that each one of my medicines will help me
Have you skipped or stopped taking a medicine because you did
not think it was working?
10. +
Proposed Med Adherence
Instrument: Barriers Checklist
Domain for Barriers: Belief medication won’t change outcomes
Options
proposed: I feel like taking my medicine will not improve my health
ASK-12:
I feel confident that each one of my medicines will help me
Have you skipped or stopped taking a medicine because you did
not think it was working?
11. +
Proposed Med Adherence Instrument:
Barriers Checklist
Domain for Barriers: Complexity of regimen
Options
proposed: There are too many doses of medicine to take each day
ASK-12: Taking medicines more than once a day is inconvenient
12. +
Proposed Med Adherence Instrument:
Barriers Checklist
Domain for Barriers: Financial cost
Options
proposed: I cannot afford my medicine
ASK-12:
I feel confident that each one of my medicines will help me
Have you skipped, stopped, not refilled, or taken less medicine
because of the cost?
13. +
Proposed Med Adherence Instrument:
Barriers Checklist
Domain for Barriers: Forgetting
Options
proposed: I forget to take my medicine
ASK-12:
I just forget to take my medicines some of the time
I run out of my medicine because I don’t get refills on time
Morisky-8:
Do you sometimes forget to take your pills?
How often do you have difficulty remembering to take all your
medications?
When you travel or leave home do you sometimes forget to bring
your medicine?
Morisky-4: Have you ever forgotten to take your medicine?
14. +
Med Adherence Instrument: Provider
Guidance, 1st slide
Provider Instructions: Please review the patient’s responses and
considering adjusting the treatment plan if patients exhibit difficulty
taking their medications. Encouraging adherence to medications is
one of the best ways to improve outcomes! Some ideas for helping
patients take their medications include:
Side effects: Switch medications, adjust the dose, or recommend
other mitigation strategies (e.g., taking the medication with food,
reducing salt intake)
Feeling as though the medication does not or will not improve their
health: indicate a range of time before seeing results, encourage
logging or home monitoring (e.g., blood pressure) so patients can
see change
15. +
Med Adherence Instrument: Provider
Guidance, 2nd slide
Complex regimens: Consider reducing medications, use
combination therapies, design a treatment plan that is easier to
follow (e.g., all medications should be taken in the morning),
use organizing systems (pillboxes)
Cost: Switch to lower cost medications, facilitate sign-up for
prescription assistance plans
Forgetting: Encourage routines, pairing medications with other
daily activities, use of memory aids (alarms, pillboxes,
calendars), use health IT tools to remind patients to proactively
refill prescriptions
16. +
Pilot Timeline
July 10, 2012: Feedback from PEC partners on summary of the
instrument
July 20, 2102: Spanish translation of instrument completed
July 20, 2012: Partners’ providers for Pilot Test identified
Aug 1, 2012: PEC and providers participating in Pilot meet at
regularly scheduled PEC meeting
Aug 1, 2012: Feedback questionnaires provided to PEC
partners
Aug 13, 2012: Feedback questionnaires returned to SAFTINet
research team
17. +
Pilot Survey, 1st slide
Is the information in the survey useful to you as a clinical
provider? Are there questions that are not useful? Are there
questions that would be really useful to you that are missing?
Do the respondents feel comfortable answering the questions?
Is the wording of the survey clear? Are there questions that
respondents consistently misunderstand? Is there some
wording that needs to be changed? Do you have suggestions
for better wording?
How long does this survey take to administer?
18. +
Pilot Survey, 2nd slide
Is the survey too long? If so, what question(s) do you suggest we
drop? Is there a question we are missing?
Are the “provider instructions” about how to adjust the treatment
plan helpful to you? Are they too common-sense? Are they too
context-dependent (would be different at different practice sites)?
Did it make sense to administer this survey at the patient’s visit to
the clinic? Would it be better administered by phone or by other
strategies? If so, how do you suggest we administer it?
Do you prefer to administer the survey to all patients? To only
patients with hyperlipidemia or hypertension?
19. +
Overview
PEC preference regarding the medication adherence measure
Instrument
Pilot test
Feedback on the instrument
Feedback on the pilot
How would we use the findings in our research?
20. +
Overview
PEC preference regarding the medication adherence measure
Instrument
Pilot test
Feedback on the instrument
Feedback on the pilot
How would we use the findings in our research?
21. +
Research Utility
Which domains would we use?
medication adherence scale
barriers measure total count, or focus on specific barrier(s)
How would we use these in an analytic model?
PCMH
Medication adherence
Barriers
Disease control
Editor's Notes
data completeness—how many will fill this out?
If we look at med adherence as an outcome of PCMH we could just look at those with med adherence data
To look at the whole framework here is very complicated—this is a path analysis. Not sure there’s a good way to do it to account for clustering.
you would need to use average med adherence on the practice level