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Letters to the Editor
Numbers do not add up
From Mrs P. K. Sandhu, MRPharmS
I refer to the news item “Trigger questions useful to identify medicines support need” (PJ, 16 October, p549). First, I commend the attempt to develop a single assessment process (SAP) with only four questions because this has the potential to simplify the process enough to be used in wider practice.
Would the project managers please clarify a few issues on the methodology and results stated in the article since I have been left a little perplexed.
Question 3: “Can you swallow and use all of your medicines and get all of your medicines out of their containers?” contains three questions. Does the patient have to say “yes” to all three parts to qualify? If all three parts are relevant and important, which they seem to be, then surely it should be split into three questions producing an SAP that consists of six questions.
The inclusion criteria of responding “yes” to any of the questions is also puzzling. Surely, saying “yes” to “Do you always take all of your medicines the way the doctor wants you to?” seems to be the perfect response. Am I to understand that by saying “yes” a patient is actually demonstrating non-compliance as, after all, none of us is perfect so he or she must be lying?
Finally, with regards to the results, could you please explain where the 88 per cent of older people needing an alteration to their medicines was derived from. I understand we have limited data in the story but the figures just do not add up (or divide).
Since supporting older people is such a key area in medicines management, an initiative such as this has great potential value. It would help if we could be assured of the robustness of the methodology before it receives wider adoption.
LELLY OBOH, project co-ordinator, replies:
First, I must correct the statement in the press release: “A response of ‘yes’ to any of the four questions indicates a potential pharmaceutical care need.” It should state: “A response that indicates a problem in any of these areas shows that the older person may have a potential pharmaceutical care need.” The confusion is because the four trigger questions were originally statements where a “yes” response would indicate a need. However they were rephrased as questions in the final report, which changes this. I hope this clarifies Pam Sandhu’s next two questions.
One of the eight objectives of the project was to test the four trigger questions to determine if they can identify older people with a potential pharmaceutical care need within the single assessment process. They were asked as part of the overview assessments (or case finding process) along with other non-pharmacy questions (with or without prompts) to trigger a referral for further assessment for support. All of those, for whom the trigger questions highlighted a need, were subsequently found to have a pharmaceutical care need in the in-depth assessment. The project was not geared to validate the questions and further work will be needed to do this.
In 88 per cent of the older people who were part of the evaluation, there was an alteration made to at least one medication, and in many cases, more than one. Although the sample size is relatively small (n=32) we feel this observed outcome remains important and representative of reality. The reported proportion refers to the number of cases (patients) not the number of medicines observed.
The three pilot sites employed different methods to case find their project population. However each site was limited to 17 patients for the in-depth medication assessment irrespective of the numbers found. For the explanation about the numbers see Table D-1 and footnote on p26 of the final report ().