Development and Pilot-Testing of Key Questions to Identify Patients' Difficulties in Medication Administration

Viktoria S Wurmbach; Steffen J Schmidt; Anette Lampert; Simone Bernard; Christine K Faller; Petra A Thürmann; Walter E Haefeli; Hanna M Seidling; HIOPP-6 Consortium

doi:10.2147/PPA.S328380

Development and Pilot-Testing of Key Questions to Identify Patients' Difficulties in Medication Administration

Patient Prefer Adherence. 2021 Nov 6:15:2479-2488. doi: 10.2147/PPA.S328380. eCollection 2021.

Authors

Viktoria S Wurmbach^{1

2}, Steffen J Schmidt³, Anette Lampert^{1

2}, Simone Bernard³, Christine K Faller^{1

2}, Petra A Thürmann^{3

4}, Walter E Haefeli^{1

2}, Hanna M Seidling^{1

2}; HIOPP-6 Consortium

Affiliations

¹ Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany.
² Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany.
³ Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
⁴ Philipp Klee-Institute for Clinical Pharmacology, HELIOS University Clinic Wuppertal, Wuppertal, Germany.

Abstract

Purpose: The development and testing of key questions suitable to identify patients' difficulties with medication administration.

Materials and methods: We used a consecutive five-step process to draft key questions regarding 43 aspects of medication administration that can be difficult for patients who manage a complex drug treatment: Step 1) Identification of potentially error-prone characteristics of drug treatment (such as certain dosage forms) and initial draft of key questions. Step 2) Assessment of how comprehensible the questions are for patients. Step 3) Pre-testing of exemplary key questions with patients and monitoring of patient's actual medication administration behavior. Step 4) Evaluation by general practitioners of how well the questions may be integrated into actual patient visits. Step 5) Final approval of the questions in an expert panel. Thereafter, we pilot-tested exemplary questions with 36 patients (43 tests). In the course of this pilot-testing, the patients' answers to the key questions were tested against both their actual behavior during medication administration and against their answers to more general questions regarding potential difficulties with medication administration.

Results: More than half of the key questions (N = 24/43) were revised at least once during the development process. During the pilot-testing, 55.8% of the pilot-tests (N = 24/43) revealed medication administration difficulties. It was observed that the key questions identified significantly more difficulties (N = 17) than the general questions (N = 8; P = 0.021, positive predictive value = 94.4% vs 88.9%). In one case, both a key question and a general question identified difficulties, which, however, was not confirmed during the drug administration demonstration, indicating a false positive rate of 5.3% in both cases.

Conclusion: We developed key questions aimed at detecting administration errors with a high specificity and a significantly higher sensitivity than general questions, suggesting that the resource-intensive demonstration of medication administration can be reserved for the detection of rarer and uncommon administration errors.

Keywords: medication adherence; medication errors; patient preference; quality of health care.

Grants and funding

This work was funded by the Innovation Fund of The Federal Joint Committee (grant number 01VSF16019). The funding had no influence on the design of the development process, interpretation of data, and on the writing of the manuscript.