Medication non-adherence is common and a serious threat to patient safety, individual health and well-being. Currently, healthcare professionals lack evidence-based guidelines regarding the relative efficacy of medication management strategies (including devices and technologies). Further, most medication management and adherence tasks are performed at home, however, the role of the home environment in supporting medication management is poorly understood. A better understanding of the current medication practices of visually impaired persons served by VA Healthcare, and the relative efficacy of these practices as they are employed in the home context, will allow greater specificity in targeting real-world interventions. OBJECTIVE: The overarching objective of this study is to investigate the efficacy of medication management strategies currently employed in the home environments of visually impaired veterans relative to age and regimen matched non-visually impaired veterans.
The specific aims of this proposal are to 1) identify the number and types of medication management strategies used in the home-environment, and 2) compare the extent to which these strategy-types and strategy-combinations predict adequate medication management and adherence among visually impaired and matched non-visually impaired veterans. We hypothesize that greater frequency of strategy use supported by the home-environment will predict greater likelihood of adequate medication management (DRUGS score >95%) and adherence (Morisky >6;CMG <20%) among the visually impaired participants (n=40) than non-visually impaired matched comparisons (n=40). RESEARCH PLAN &METHODS: We will evaluate the efficacy of medication management strategies via multiple indicators of medication adherence using both performance-based assessment and administrative data analysis with interview and self-report measures. These measures will allow us to capture capacity (i.e., skills for managing medications), actual adherence behavior (i.e., refill adherence) and self-reported adherence as outcomes. In addition we will assess strategy use in the home environment by recording strategy types (what is used), their implementation (how used), locations in the home in which they are applied (where used) and routine and time based links to location (when used). We will measure demographic, psychosocial, visual and cognitive predictors of adherence to identify important covariates of strategy use and efficacy. Veterans with visual impairment (n=40) and age and regimen matched Veterans without visual impairment (n=40) will be enrolled to complete 2 study visits of approximately 2 hours each. Potentially interested participants will respond to posted flyers or a letter by phone. CLINICAL
Interventions that promote adherence are likely to increase the overall effectiveness and efficiency of the health system. The multivariate approach in this study, will allow us to collect the efficacy data needed to inform an evidence-based medication management toolkit comprised of patient-centered strategies that are targeted to users based on individual, interpersonal and environmental characteristics and will be tested in a subsequent controlled trial proposal with veterans newly diagnosed with vision loss. Targeted interventions to support the health self-management of veterans with visual impairment, particularly medication management and adherence, will optimize health, independence and ensure the best possible quality of life.
