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Cognitive and literacy screening as predictors of ability to fill a pillbox using two pillbox assessment scoring methods.

OBJECTIVE
To compare patient cognition measured by Medi-Cog, a tool to assess cognitive literacy and pillbox skills, with pillbox concordance using two scoring methods, Pillbox Fill (PBF) and Prospective Pill Count (PPC).


DESIGN
Prospective, descriptive, cross-sectional study.


SETTING
Primary care.


PARTICIPANTS
Multiethnic participants with type 2 diabetes with sufficient vision and dexterity to load a pillbox.


INTERVENTION
Medi-Cog scores were correlated with ability to fill a pillbox based on both the PPC and the PBF scoring methods. Variables were analyzed by multivariate linear and logistic regression.


MAIN OUTCOME MEASURES
To determine whether there is a difference between PBF and PPC scoring methods relative to Medi-Cog prediction of pillbox concordance.


RESULTS
Sixty-four participants loaded an average of 5.2 medications. Mean Medi-Cog score for five patients who failed PBF but passed PPC were lower than the entire cohort (5.6 compared with 6.2). Correlation between PBF and PPC methods was 0.978; P = 0.01. Regression values for Medi-Cog's ability to predict PBF and PPC scores were r = 0.668 and r2 = 0.446, and r = 0.660 and r2 = 0.436; P < 0.01 for all.


CONCLUSION
Compared with PPC, PBF proved to be a more conservative scoring method and captured an additional five patients who scored less-well on the Medi-Cog. Future studies are needed to explore the value of using pillbox assessments as well as cognitive screening prior to recommending pillbox use.