7‐Minute Medi‐Cog...the VA and is public domain. It has not been validated. •Medi‐Cog...

7‐MinuteMedi‐Cog

KatherineAnderson,PharmD,CGP,FASCPPharmacistsInternationalConsultingSpecialists

[email protected]

Professional Resources & Business Development

LearningObjectives

• Articulatethevalueofabriefcognitive/pillboxskillsscreentoidentifypatientsatriskformedicationmisadventures.

• Administerandscoreabriefcognitivescreenthatidentifiesclinicallysignificantcognitiveimpairment.

• Administerapillboxskillsscreendesignedtoidentifypatientswhowouldbenefitfrompillboxeducation.

• Applyclinicaljudgmenttotheinterpretationofapatient’sperformanceontheMedi‐Cog.

• EvaluatetheMedi‐Cogforapplicabilityinvariouspracticesettings.

Self‐AssessmentQuestions

1.HowmanypointsareawardedtoaClockDrawTest(CDT)intheMini‐Cog©scoringrubric?

A.0point

B.1point

C.2points

D.EitherAorC


2.IntheMini‐Cog©scoringrubric,howmanypointsareawardedforthecorrectrecallofthreewordsintheThreeItemRecall(TIR)?

A.1point

B.2points

C.3points


3.TheMedi‐Cogiscomprisedofwhichofthefollowingscreens?

A.ClockDrawTest(CDT)B.ThreeItemRecall(TIR)C.MedicationTransferScreen(MTS)D.Alloftheabove


4.Whichofthefollowingscreenshavebeenvalidated?Whichscreenisapartofthepublicdomain?

A.Medi‐Cog/Mini‐Cog

B.Mini‐Cog/MedicationTransferScreen

C.Mini‐Cog/Medi‐Cog

D.MedicationTransferScreen/Medi‐Cog


5.Apatientscores1of5pointsontheMedicationTransferScreen(MTS).Otherthancognitiveimpairment,selectareasonwhythepatientmayhavefailedthescreen.

A.Thepatientwastiredwhenhewasscreened.B.Thepatientisunabletoread.C.Thepatienthadneverdoneatasklikethisbeforeanddidn’tunderstandtheinstructions.D.Thepatientwasnotwearinghisglasses.E.Alloftheabove

MedSafetyScreeningStrategyNeededfor77Boomers+

• Medicationerrorsinjureover1.5millionpeopleayear.1

• Regimennon‐adherenceisassociatedwithinjury,higherhealthcareexpenditures,lossofqualityoflife.

• Healthoutcomeshavebeenshowntoimproveformanypatientswhoutilizeapillbox.2

• Ourgoal:useproactivepreventionstrategies.• Implementswiftandaccuratewaystoidentifypatientsatriskformedicationmismanagement.

1.http//www8nationalacademies.org/onpinews/newsitem.aspx?RecordID+11623.Accessed3/1/20102.ZelikovskyN,etal.Perceivedbarrierstoadherenceamongadolescentrenaltransplantcandidates.PediatrTransplant.2008May;12(3):300‐8.

SafeMedicationManagement

• Limitedvalidatedscreenstopredictmedadherence.• Mini‐Cog©isvalidatedasacognitivescreen.• Medi‐Coghasnotyetbeenvalidated.(Mini‐Cog©+MTS)

• MedicationTransferScreen(MTS)wasdevelopedintheVAandispublicdomain.Ithasnotbeenvalidated.

• Medi‐Cogdevelopedasabriefassessmentofcognition,literacy,pillboxskillsto:– Identifypatientswhohavecognitivedeficit– Alertforliteracydeficits– Flagpatientswhowouldbenefitfrompillboxeducation

1010

Mini‐CogMini‐Cog©©MethodMethod

• Threeitemrecall(TIR)‐screenernames3unrelatedobjects(banana/sunrise/chair);patientrepeatsthemback.Patientistoldtheywillbeaskedtorecallthewordsintwominutes.

• Clockdrawingtest(CDT)‐subjectisaskedtodrawthefaceofaclock,thentodrawthehandsoftheclockdepicting11:10.“Tenminutesaftereleven.”

• AfterperformingtheCDT,thesubjectisaskedtorecallthe3words.

Borsonetal.JAmGeriatrSoc2005;53:871‐4.

1111

Mini‐CogMini‐Cog©©ScoringScoring

• Mini‐Cog©–5points– ThreeItemRecall(TIR)‐1pointforeachitemrecalled(0‐3possible)

– ClockDrawTask‐2pointsforacorrectclock;ifallnumbersarenotpresent,ornotincorrectsequenceorposition,thescoreiszero

• Passingscore:>3– All3wordsofTIROR

– Correctclockandrecallofatleastoneword

Mini‐Cog©Administration&Scoring

AudienceParticipation

MedicationTransferScreen• Onthetablewritethenumberofpillsas

instructedintothecorrectcompartments:

• Example:TAKEONETABLETEVERYDAYATBEDTIME(Patientfillsinremainingslots).

• 1.TAKEONETABLETEVERYDAYINTHEMORNING

• 2.TAKEONETABLET3TIMESDAILYWITHMEALS

• 3.TAKETWOTABLETSM‐W‐FINTHEEVENING

• 4.TAKEONE‐HALFTABLETONSATURDAYATBEDTIME

• 5.HowmanypillstotalareinthepillboxfortheentiredayofSaturday?__

S M T W Th F S

Morn

Noon

Eve

Bed 1 1 1 1 1* 1* 1*

Score:1pointforeachMTSquestion(0to5points)

Reprinted with permission of the American Society of Consultant Pharmacists, Alexandria, Virginia, www.ascp.com. All rights reserved.

Reprinted with permission of the American Society of Consultant Pharmacists, Alexandria, Virginia, www.ascp.com. All rights reserved.

MedicationTransfer(MTS)Administration&Scoring

AudienceParticipation

Medi‐Cog

• StudyresultsdemonstratedthatMedi‐Cogscreenscorescorrelated0.72withpatientaccuracyinloadingmedicationsinapillbox.

• Screenutilizedinvariouspracticesettings– Attimeofdischargefromhospitals,LTC,SNF.– ALFadmitandroutinescreenforselfadministeredmeds.

– Communitypharmacy– Seniorcentersscreenings

• AndersonK,JueSG,Madaras‐KellyKJ.IdentifyingPatientsatRiskforMedicationMismanagement:UsingCognitiveScreenstoPredictaPatient’sAccuracyinFillingaPillbox.ConsultPharm2008;June;23(6):259‐72.



A.0point

B.1point

C.2points

D.EitherAorC



A.0point

B.1point

C.2points

D.EitherAorC



A.1point

B.2points

C.3points



A.1point

B.2points

C.3points

























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7‐Minute Medi‐Cog...the VA and is public domain. It has not been validated. •Medi‐Cog...

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