Abstract
Our study is based on the occupation of medication management in the acute inpatient rehab setting. We examined the use of a tool (the ManageMed Screen, or MMS), primarily based on OT documentation on 100 stroke patients, to determine the correlates of MMS scores. MMS scores were moderately correlated to scores on the Montreal Cognitive Assessment, the discharge portion of the cognitive FIM®, and education level.
Primary Author and Speaker: Sharon Hartl
Additional Authors and Speakers: Additional Speaker
Contributing Authors: Lauren A. Hallberg
The purpose of this research project was to determine the efficacy of using the ManageMed Screen (MMS, Robnett & Bolduc, 2012) with stroke patients on an acute inpatient rehabilitation unit. The MMS is a cost-free, task-based tool designed to assess an individual's ability to complete a moderately difficult medication routine (Robnett et al., 2007). Medication management is one of the four ‘Ms’ of age-friendly health care seen as one of the essential elements which will provide the best care possible for older adults (John Hartford, 2018 [www.johnahartford.org]). Nonadherence to prescribed medication routines can have severe consequences, including hospitalization and death. Kini and Ho (2018) estimate that the cost of nonadherence is 100 billion per year in the USA, including the loss of 125,000 lives, and causing 10% of hospital admissions. The study design was a psychometric, secondary data analysis for Phase 1, reported here, which consisted of analyzing 100 chart reviews of stroke patients at a suburban rehab hospital. These charts contained the results of the MMS and the characteristics of patients in relation to medication management (e.g., age, education level, gender, correlation to established norms of the MMS). We also compared the patient's MMS scores with other related aspects of cognition, to further examine the concurrent validity of the MMS (e.g., scores on the Montreal Cognitive Assessment [MoCA] and the cognitive portion of the Functional Independence Measure [cogFIM]). We reviewed the documentation which was most usually completed by occupational therapy (OT) to learn more about medication management documentation. The results of the chart reviews demonstrated that the average score for the MMS was 30.6 (out of 40) with a standard deviation (SD) = 6.9. This compared to the norms established for the MMS, which was 30.7 (SD = 6.1) for community residing elders. Of the 100 patients, 46 were male and 53 were female. Their scores were not significantly different (p = 0.167). The mean age of the stroke patients was 71.3 (range 29-97). Age was negatively correlated to MMS score (-.383; p = .0001) meaning that the younger patients tended to outperform the older patients. The mean education level was 13.2 years (1 year of college). Education level was correlated with MMS score at a moderate level (0.503; p = .0001) meaning that those with a higher level of education tended to do better than those with less education. When comparing the total discharge cogFIM to the MMS scores we found a positive moderate correlation (Spearman's rho = .557; p = .0001). The scores of the MMS compared to scores on the MoCA were also moderately correlated (n = 86; .546; p = .0001). These results were not surprising, given that moderate correlations indicate that the two measures are related, but only to a modest level, meaning that each tool adds additional information. Phase 2 of this project involved 13 interviews of former rehabilitation patients who had taken the MMS, to determine their views on the medication management protocol at the hospital. These results are also included. Due to the consequences of nonadherence to medication protocols being so dire (Anderson & Birge, 2016), continued research is needed, yet this chart review offered key data.
Anderson, R. E., & Birge, S. J. (2016). Cognitive dysfunction, medication management, and the risk of readmission in hospital inpatients. Journal of the American Geriatrics Society, 64(7), 1464-1468. https://doi-org.une.idm.oclc.org/10.1111/jgs.14200
Kini, V., & Ho, P. M. (2018). Interventions to improve medication adherence: a review. Journal of the American Medical Association, 320(23), 2461-2473.
Robnett, R. & Bolduc, J. (2012). The ManageMed Screen. Retrieved from https://NEATtests.com
Robnett, R. H., Dionne, C., Jacques, R., LaChance, A., & Mailhot, M. (2007). The ManageMed Screening: an interdisciplinary tool for quickly assessing medication management skills. Clinical Gerontologist, 30(4), 1-23. https://doi.org/10.1300/J018v30n04_01