Identifying Patients at Risk for Medication Mismanagement: Using Cognitive Screens to Predict a Patient's Accuracy in Filling a Pillbox

Abstract

Objective: To study the relationship between four cognitive screens (Mini-Mental State Examination [MMSE], Mini-Cog, Medication Transfer Screen [MTS], and Medi-Cog [Mini-Cog + MTS]) and pillbox concordance. Design: Prospective cross-sectional pilot study. Setting: Primary care federal health care system. Participants: English literate inpatients not previously diagnosed or treated for dementia and without physical handicap preventing use of a pillbox. Main Outcome Measure: Correlation between cognitive screens and prospective pill-count scores (PPCS). Interventions: Mini-Cog, MTS, and MMSE screening was followed by a 28-compartment pillbox skills assessment. A passing PPCS was defined as correctly loading 80% of the medications in the pillbox. A PPCS of < 80% identified patients for pillbox-organization education or supportive intervention. Variables associated with total and passing PPCS were analyzed by multivariate linear and logistic regression, respectively. Results: Fifty-three patients discharged on > 1 medication completed all screenings. Other than cognitive screening, only age was associated with total and passing PPCS. After adjustment for age, Medi-Cog had the highest correlation with total PPCS [r² = 0.53; P < 0.001), whereas Mini-Cog was the single cognitive assessment that remained significantly associated with a passing PPCS (r² = 0.23; P = 0.023). Age-adjusted models, including MMSE, had relatively poor association with total PPCS (r² = 0.23; P = 0.046) and no association with passing PPCS (r² = 0.15; P = 0.46). The Medi-Cog exhibited modest highest overall sensitivity (72%) and specificity (61%) to detect a passing PPCS. Conclusion: MMSE is a relatively poor measure of the ability of patients to fill a pillbox. The Medi-Cog and Mini-Cog may have value for assessing pillbox concordance for patients who load their own pillboxes. Abbreviations: DRUGS = Drug Regimen Unassisted Grading Scale; HMS = Hopkins Medication Schedule; MedMaIDE = Medication Management Instrument for Deficiencies in the Elderly; MMAA = Medication Management Ability Assessment; MMSE = Mini-Mental State Examination; MMT = Medication Management Treatment in HIV; MTM = Medication Therapy Management; MTS = Medication Transfer Screen; PPCS = Prospective Pill Count Score; SAM = Self- Administration of Medication. Consult Pharm 2008;23:459-72.