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Issue Date: July 2015
Published Online: July 01, 2015
Updated: April 30, 2020
Development of the In-Home Medication Management Performance Evaluation (HOME-Rx): A Validity Study
Author Affiliations
  • Washington University School of Medicine
  • Washington University School of Medicine
  • Washington University School of Medicine
  • Washington University School of Medicine
Article Information
Geriatrics/Productive Aging / Vision / Assessment/Measurement
Research Platform   |   July 01, 2015
Development of the In-Home Medication Management Performance Evaluation (HOME-Rx): A Validity Study
American Journal of Occupational Therapy, July 2015, Vol. 69, 6911500085. https://doi.org/10.5014/ajot.2015.69S1-RP204C
American Journal of Occupational Therapy, July 2015, Vol. 69, 6911500085. https://doi.org/10.5014/ajot.2015.69S1-RP204C
Abstract

Date Presented 4/17/2015

Occupational therapists have the expertise to assess cognitive, perceptual, and motor components of medication management in addition to environmental, social, and technological factors. The In-Home Medication Management Performance Evaluation (HOME-Rx) is a performance-based assessment to inform medication management treatment and intervention efficacy.

SIGNIFICANCE: There is limited research supporting the efficacy of occupational therapy in medication management assessment and intervention. Occupational therapists rate medication management as one of the most important instrumental activities of daily living (IADLs) for community independence; yet, they report assessment at a lesser frequency than other common IADLs, such as meal preparation, driving, and shopping. Medication management is thought to be one of the entry points for occupational therapists in primary health care under the Patient Protection and Affordable Care Act (ACA). Instrument development is needed to adequately measure outcomes related to occupational performance in geriatric populations.
INNOVATION: Current preliminary studies of occupational therapy and medication management have cited reliance on self-report data collection methods as limitations. Standardized instruments to inform treatment planning and evaluation of intervention effectiveness are needed. In-home structured assessments are ideal for the older adult population to uncover barriers to medication management that would otherwise go undetected by standard clinical examinations. A validated medication management screening tool for the home is needed to evaluate older adults at risk for nonadherence and to determine appropriate levels of support for continued independence.
In this study, we aimed to assess initial psychometric properties of a 30-min, performance-based instrument conducted in the homes of older adults: the In-Home Medication Management Performance Evaluation (HOME-Rx).
METHOD: Content validity of the instrument was determined through the multistep Content Validity Index (CVI) process. Content experts and older adults provided qualitative and quantitative judgments of the instrument’s ability to measure medication management.
This study was completed remotely using e-mail communication and in the homes of older adult volunteers. Two groups of participants (N = 13) were recruited. Content expert participants (n = 7) with relevant experience in medication management, geriatric populations, and clinical expertise were recruited nationally to determine the content validity of the HOME-Rx. Older adult participants who represent the HOME-Rx’s target population (n = 5) were recruited from a convenience sample. Inclusion criteria included English-speaking, community-dwelling adult aged more than 65 yr, and takes three or more medications on a daily basis.
The content experts evaluated the HOME-Rx as a whole instrument (scale-level CVI [S-CVI]) and the individual items (item-level CVI [I-CVI]) using a 4-point ordinal scale. In addition to the quantitative scores, qualitative feedback was collected using open-ended questions on the score sheet. Older adults were administered the HOME-Rx in their homes and were asked to provide verbal critique and feedback through an approved semistructured interview.
Each item’s agreement scores were calculated by determining the proportion of items rated as 3 (relevant but needs minor alteration) or 4 (very relevant and succinct) on the CVI scale. A minimum I-CVI score of >.80 was considered acceptable for inclusion in the HOME-Rx. A S-CVI score of .90 for the entire assessment is considered to be an acceptable level of agreement. Items that did not meet this minimum calculation were eliminated or further revised per the qualitative feedback from content experts and older adults.
RESULTS AND CONCLUSION: Content experts (n = 7) were in agreement that the overall instrument was valid for measuring medication management (CVI = 1.0). Six items were deleted due to low agreement (CVI > .80). Twenty-nine minor edits were made to the order of questions and language usage. Older adult participants (n = 5) reported that the instrument was relevant, acceptable, and easy to understand. The HOME-Rx appears to be a relevant and valid method to assess performance barriers to medication management in the home.