Med Wise: A theory-based program to improve older adults' communication with pharmacists about their medicines.

BACKGROUND: The health and economic toll of medication errors by older adults is well documented. Poor communication and medication coordination problems increase the likelihood of adverse drug events (ADEs). Older adults have difficulty communicating with health care professionals, including pharmacists. As such, the theory-based Med Wise program was designed. Building on the Self-efficacy Framework and the Chronic Care Model, this program was tested with community-dwelling older adults. OBJECTIVES: This study and its resultant paper: (1) describe the theory-based design of the Med Wise program; (2) describe the collaboration of multiple community partners to develop a sustainable model for implementing Med Wise; and (3) present findings from the Med Wise course evaluation. METHODS: Med Wise was designed to be a sustainable, skill-based educational and behavior change program consisting of two, 2-h interactive classes to enhance participants' medication communication skills and self-efficacy. To explore the potential to disseminate Med Wise throughout the state, a partnership was formed between the pharmacy team and the statewide Aging & Disability Resource Centers (ADRCs), as well as the Community-Academic Aging Research Network (CAARN). Over 30 lay volunteer leaders in 8 Wisconsin (U.S. State) counties were trained, and they delivered Med Wise through ADRC community centers. The CAARN staff evaluated the fidelity of the course delivery by leaders. To evaluate Med Wise, a quasi-experimental design using pre/post surveys assessed knowledge, worry and self-efficacy. A telephone follow-up three months later assessed self-efficacy and translation of medication management skills and behaviors. RESULTS: Med Wise programs were presented to 198 community-dwelling older adults while maintaining program fidelity. This evaluation found significant increases in older adults' knowledge about pharmacists' roles and responsibilities, likelihood of talking with a pharmacist about medication concerns, and self-efficacy for communicating with pharmacists. At the 3 month follow-up, participants reported increased interactions with pharmacists, with 29.2% of participants reported seeking medication reviews and 28.5% medication schedule reviews. CONCLUSIONS: The two-class Med Wise program showed sustained impact at 3 months on key outcomes. Further, the community partners successfully implemented the program with fidelity across 8 counties suggesting its ability to be disseminated and sustained. Future directions include expanding the program to examine wider adoption, and measuring program impact on regimen safety and health outcomes linked to increases in patient engagement.

The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence.

Self-report tools for monitoring adherence can be useful in identifying patients who need assistance with their medications, assessing patient concerns, and evaluating new programs. The aim of this study is to test the validity of the Brief Medication Questionnaire (BMQ), a new self-report tool for screening adherence and barriers to adherence. The tool includes a 5-item Regimen Screen that asks patients how they took each medication in the past week, a 2-item Belief Screen that asks about drug effects and bothersome features, and a 2-item Recall Screen about potential difficulties remembering. Validity was assessed in 20 patients using the Medication Events Monitoring System (MEMS). Results varied by type of non-adherence, with the Regimen and Belief Screens having 80-100% sensitivity for "repeat" non-adherence and the Recall Screen having 90% sensitivity for "sporadic" non-adherence. The BMQ appears more sensitive than existing tools and may be useful in identifying and diagnosing adherence problems.