Instruments assessing capacity to manage medications.

OBJECTIVE: To review literature on instruments available for assessing the physical and cognitive ability to take medications as prescribed, which serve as a way to rule out reasons for nonadherence. DATA SOURCES: A PubMed search (1950-February 2008) was conducted to identify relevant articles. Additional references were obtained from cross-referencing the bibliographies of selected articles. Only journals containing English-language articles were selected for review. STUDY SELECTION AND DATA EXTRACTION: Articles that described a simulated assessment of medication management were obtained, irrespective of whether the assessment also contained data about medication adherence or was focused on older adults. DATA SYNTHESIS: Fifteen instruments were identified. Six instruments required 5 minutes or less to administer, 5 required 6-30 minutes, and 4 had no administration time data reported. A possible advantage of 3 of the instruments is that they use a subject's own medications and may therefore provide a more authentic assessment. Only 2 instruments have been tested by subjects other than the drug developers and only one has been used in 2 different populations, thereby affording some insight into generalizability. These studies have used a variety of other validated surveys/assessments to provide an indication of construct validity, including neuropsychological batteries, caregiver reports, prospective outcomes, instrumental activities of daily living, and levels of care. One instrument determined whether individuals could tell if refills existed, whom to contact, and resources to obtain medications. Three assessed numeracy literacy.
CONCLUSIONS: Five instruments that measure medication management capacity should be compared for potential further use, including Beckman's tasks, due to their brevity and assessment of numeracy literacy; the Medication Management Ability Assessment, Drug Regimen Unassisted Grading Scale, and Hopkins Medication Schedule because of the evidence supporting their use; and the Medication Management Instrument for Deficiencies in the Elderly because it includes an assessment of the patient's knowledge of how to obtain more medications. No brief tool is available for the primary care setting to identify individuals with medication management problems or to guide the type and amount of support required to manage medications.