Research Article
Issue Date: March 13, 2019
Published Online: March 14, 2019
Updated: March 14, 2019
Scoring, Clinical Utility, and Psychometric Properties of the In-Home Medication Management Performance Evaluation (HOME–Rx)
Author Affiliations
  • Emily Somerville, OTD, OTR/L, is Occupational Therapist, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO; somervillee@wustl.edu
  • Kayla Massey, MS, OTR/L, is Occupational Therapist, SSM Health Rehabilitation Hospital, St. Louis, MO.
  • Marian Keglovits, OTD, MSCI, OTR/L, is Occupational Therapist, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO.
  • Scott Vouri, PhD, PharmD, BCPG, is Clinical Assistant Professor of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville.
  • Yi-Ling Hu, MS, is Doctoral Student, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO.
  • David Carr, MD, is Alan A. and Edith L. Wolff Distinguished Professor of Geriatric Medicine, Division of Geriatrics and Nutritional Science, Washington University in St. Louis, St. Louis, MO.
  • Susan Stark, PhD, OTR/L, FAOTA, is Associate Professor of Occupational Therapy, Neurology, and Social Work, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO.
Article Information
Assessment Development and Testing / Geriatrics/Productive Aging / Research Articles
Research Article   |   March 13, 2019
Scoring, Clinical Utility, and Psychometric Properties of the In-Home Medication Management Performance Evaluation (HOME–Rx)
American Journal of Occupational Therapy, 03 2019, Vol. 73, 7302205060. https://doi.org/10.5014/ajot.2019.029793
American Journal of Occupational Therapy, 03 2019, Vol. 73, 7302205060. https://doi.org/10.5014/ajot.2019.029793
Abstract

Importance: Forty percent to 75% of community-dwelling older adults are not able to adhere to their medication routine. A medication management assessment can correctly identify the reasons for nonadherence and the barriers contributing to it.

Objective: To further develop the HOME–Rx, an in-home medication management assessment, by modifying scoring metrics, improving clinical utility, and establishing psychometric properties.

Design: In Phase 1, the scoring metrics were modified, and the clinical procedures were evaluated. In Phase 2, the psychometric properties were established.

Setting: The homes of older adults.

Participants: Older adults who took three or more medications, managed their own medications, and lived in their own home were eligible. Older adults with cognitive impairment were ineligible.

Outcomes and Measures: We assessed concurrent validity with the Performance Assessment for Self-Care Skills (PASS) and Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) and established interrater reliability.

Results: The PASS was positively correlated with the HOME–Rx Performance and Safety subscales; the MedMaIDE was negatively correlated with the HOME–Rx Performance subscale and positively correlated with the Barriers subscale. Interrater reliability was excellent (ICCs = .87–1.00).

Conclusions and Relevance: All relationships were as predicted: The HOME–Rx is a valid and reliable performance-based assessment that provides clinicians and researchers with a measure of older adults’ actual medication management ability in the home using their medications. The results can potentially be used to guide treatment planning and improve medication management.

What This Article Adds: Occupational therapy practitioners can use the HOME–Rx to adequately determine performance problems, safety concerns, and environmental barriers and potentially to guide treatment planning and improve medication management for older adults.