PHILADELPHIA -- Asking patients a single question is a good way to measure their engagement in their own care, a speaker said here at the annual Population Health Colloquium sponsored by Thomas Jefferson University.
Joey Mattingly, PharmD, MBA, of the University of Maryland School of Pharmacy in Baltimore, reported on his experience with "," a one-question instrument that begins with the words "How confident are you ..."
Originally developed by John Wasson, MD, of Dartmouth College in Hanover, New Hampshire, and colleagues, the question then allows providers to ask about a particular area of interest. Mattingly and his team worked with staff members at the University of Maryland Medical Center to see whether they could determine, in patients about to be discharged, their confidence in managing their medications. Answers were given on a 0-10 scale, with zero being not at all confident and 10 being very confident.
The effort began after the hospital pharmacy introduced a bedside medication delivery program for patients about to be discharged, Mattingly explained.
"As we were launching this bedside delivery program, we [wondered] what other ways can we evaluate getting more out of the pharmacy?" he said. "We were an underutilized resource, and we have an ambulatory pharmacy director who doesn't see the pharmacy as just a place to count pills and send you on your way -- can we do more?"
The group decided to have pharmacy technicians ask the confidence question when they came up to deliver the patients' medications shortly before to discharge, Mattingly said. "Pharmacy technicians who are selected to do discharge service are often our best pharmacy technicians," he said. "They're the ones that can fix any insurance situation with their eyes closed while calling a doctor's office and juggling 10 other things; those are your rock stars." The fact that these technicians were already a familiar sight on the hospital floors made it a little easier to implement, he added.
Getting management to buy into the health-confidence tool wasn't that difficult, Mattingly said. "All I'm gathering is data from one question ... [We explained] to the pharmacy director that this isn't impacting your labor budget; we're not going to spend an extra 20 minutes with the patient at discharge."
Mattingly and his pharmacy team summarized in the journal The Patient: Patient-Centered Outcomes Research, who were followed up by phone at 30-45 days post-discharge to see how they were doing with their medications.
The group ran into some problems in this effort. One was simply getting respondents to answer the phone. "About half the calls in the country now are robocalls," Mattingly said. "Can we expect a lot of our patients to answer 30 days out via phone?"
In the end, the team was only able to reach 56% of patients that way. Mattingly said future studies should examine the best ways to make contact post-discharge.
Another bump was that fewer patients than expected self-rated their confidence as low. Mattingly and colleagues hoped to find 20-40 patients who rated themselves less than 7 on the scale, the threshold for low confidence; the literature suggested that 20% of respondents would assess themselves in that category.
Out of the original 200 patients, 141 responded, which should have been plenty. But 128 rated themselves as 7 or higher, while only 13 rated themselves below 7.
That limited the group's ability to answer one of their research questions: whether low confidence in medication management was associated with risk for readmission. They found that 9.6% of those who weren't readmitted had rated themselves at less than 7, versus 7.4% of those who were readmitted, a non-significant difference. However, when the definition of low confidence was changed to less than 8 on the 10-point scale, the difference did become significant (20.2% of those who weren't readmitted had low confidence vs 44.0% of those who were, P=0.009).
Limitations included the fact that the study was done at a single center and that patients may have had a higher-than-expected confidence level because the question was asked immediately after they had received post-discharge counseling. In addition, Mattingly said, patients may worry about giving the "wrong" answer. Perhaps they wonder "if they get that question wrong, are you going to keep them there?" he said. "So you have to think about that."
"I would really love to take [the study] further," Mattingly said. "If you're not confident, can we help? And how do we support family members and caregivers?"
Speaking with ľֱ, he said, "If I were to put together a proposal for a randomized trial, I would ... want to take 20 pharmacies in a control group and 20 in an active group and test the differences in terms of engagement and outcomes ... My initial proposal to do a randomized controlled trial would have been a 6-month followup and intervention in patients who were not confident. Can we have the pharmacist or someone work with you to bring the confidence up?"
Disclosures
The session at which Mattingly spoke was sponsored by Bristol-Myers Squibb, which also funded his study.