Cognitive and literacy screening as predictors of ability to fill a pillbox using two pillbox assessment scoring methods.

OBJECTIVE: To compare patient cognition measured by Medi-Cog, a tool to assess cognitive literacy and pillbox skills, with pillbox concordance using two scoring methods, Pillbox Fill (PBF) and Prospective Pill Count (PPC). DESIGN: Prospective, descriptive, cross-sectional study. SETTING: Primary care. PARTICIPANTS: Multiethnic participants with type 2 diabetes with sufficient vision and dexterity to load a pillbox. INTERVENTION: Medi-Cog scores were correlated with ability to fill a pillbox based on both the PPC and the PBF scoring methods. Variables were analyzed by multivariate linear and logistic regression. MAIN OUTCOME MEASURES: To determine whether there is a difference between PBF and PPC scoring methods relative to Medi-Cog prediction of pillbox concordance. RESULTS: Sixty-four participants loaded an average of 5.2 medications. Mean Medi-Cog score for five patients who failed PBF but passed PPC were lower than the entire cohort (5.6 compared with 6.2). Correlation between PBF and PPC methods was 0.978; P = 0.01. Regression values for Medi-Cog's ability to predict PBF and PPC scores were r = 0.668 and r2 = 0.446, and r = 0.660 and r2 = 0.436; P < 0.01 for all. CONCLUSION: Compared with PPC, PBF proved to be a more conservative scoring method and captured an additional five patients who scored less-well on the Medi-Cog. Future studies are needed to explore the value of using pillbox assessments as well as cognitive screening prior to recommending pillbox use.

A pilot study to assess cognition and pillbox fill accuracy by community-dwelling older adults.

OBJECTIVE: To assess pillbox fill accuracy and cognition among community-dwelling older adults. DESIGN: A descriptive, cross-sectional study. SETTING: Retail pharmacy. PARTICIPANTS: Convenience sample of English-speaking adults older than 60 years of age without dementia, taking more than four medications, and naive to Mediset use. INTERVENTIONS: In face-to-face interviews, subjects provided demographic, medical, and medication information, completed the Mini-Cog and Medi-Cog (combination of Mini-Cog and medication-transfer screen [MTS]), and filled their own medications in a pillbox. Data were analyzed using descriptive statistics and stepwise regression analysis with correctly filled pill count (PC) as the dependent variable and the cognitive screens as independent variables. MAIN OUTCOME MEASURES: Accuracy of the Mini-Cog, MTS, and Medi-Cog in predicting PC. RESULTS: Among 50 subjects (58% female, mean age 76.4 years), only one subject failed to pass the Mini-Cog and two failed to reach the criterion level of correctly filled PC. The mean (standard deviation) Mini-Cog score for the sample was 4.38 (0.81), MTS score was 4.1 (1.31), Medi-Cog score was 8.48 (1.82), and the mean PC was 97% (8%). The Mini-Cog and MTS individually accounted for about 30% of the variance (P < 0.001); the Medi-Cog accounted for 44% of the variance (P < 0.001), indicating strongest PC prediction. CONCLUSION: Nearly all study participants filled pillboxes accurately. The Medi-Cog was the strongest predictor of pillbox fill accuracy. Future studies of medication self-management abilities among community-dwelling older adults should include representative samples of this population, comprehensive assessment of health status, cognitive screening, pillbox fill accuracy, and the utilization of medications in filled pillboxes.

Identifying patients at risk for medication mismanagement: using cognitive screens to predict a patient's accuracy in filling a pillbox.

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.

Quality, labeling accuracy, and cost comparison of purified soy isoflavonoid products.

OBJECTIVES: To evaluate the labeling accuracy and product uniformity of available soy isoflavone products in the eastern Washington State region for 13 products and to perform a cost comparison based on the isoflavone content in milligrams for 11 products. DESIGN: Thirteen (13) isoflavone products (7 tablet and 6 capsule formulations) were randomly obtained from health food, grocery, and pharmacy outlets in eastern Washington State. Four different samples of the same product were extracted using 75% ethanol. Each sample was analyzed for isoflavone content using a gradient high-performance liquid chromatography (HPLC) method. Pure isoflavonoid standards were used to quantify the content of genistein, daidzein, and glycitein and their respective glycosides. The amount of total isoflavonoids per purchased product was then divided into its purchase price in order to make cost comparisons between the products based on a 50 mg/d dose. RESULTS: The weight variation within each product was generally small (<4%). However, there was significant variability in the composition of the products. Only 4 of the 13 products contained at least 90% of the isoflavone content claimed on the label and 2 of products contained impurities in the HPLC chromatogram that exceeded 40%. There was no difference in the total isoflavonoid contents of the 2 identical products made by the same manufacturer, but the percentages of the main components had changed significantly over time. Based on a 50-mg isoflavone per day dose, the cost of a 30-day supply ranged from $3.20 to $65.88. CONCLUSION: There is a lack of uniformity among the products tested and the majority (67%) of the products contained less than 90% of labeled amounts. There is significant variability in the compositions between the products and in the composition of the same product over time. Consumers cannot trust isoflavonoid product labels to represent the product's content accurately or that product pricing is a reflection of isoflavone content.