Use of a Medication Access and Adherence Tool (MAAT) to identify patients at high risk for medication-related problems

Purpose: To develop and evaluate a tool that effectively identifies patients at risk for medication access and adherence problems.

Methods: A 5-item questionnaire (MAAT) was developed to aid clinicians in identifying patients at risk for medication access or adherence problems at home.  This tool’s items included beliefs about treatment (n=1), medication adherence (n=2), medication access/affordability (n=1), and adverse drug events (n=1).  Inpatients on a medicine unit were administered the tool, assessed for medication access/adherence problems, and followed up within 72 hours of discharge by their hospital pharmacist.  Correlations between MAAT scores and medication access/adherence problems and additional post-discharge problems were assessed.

Results: There were 206 inpatients that completed the MAAT: median age 57 years; 53% female.  MAAT items: 22% were not always certain they needed medications to treat their health problems; 10% were not always sure they could take their medications as prescribed; 35% sometimes stopped taking or skipped doses of their medications; 28% found it difficult to pay for their medications; and 35% experienced adverse effects from their medications.  During the inpatient stay, pharmacists identified 71(35%) patients with medication access/adherence problems. There was a moderate correlation (r²=0.46, p<0.001) between MAAT score and the number of medication access/adherence problems identified.  There were 149 patients who were eligible for post-discharge follow-up and 107 (72%) of these were contacted.  Medication problems were identified in 66% of these patients. There were no correlations between number of post-discharge medication problems and age, number of discharge medications, or comorbidities. There was a slight correlation (r²=0.22, p<0.02) with the MAAT score and the number of post-discharge medication problems.

Conclusion: The MAAT is an effective tool to identify patients at risk for medication access and adherence problems and can also help determine which patients would benefit most from a pharmacist intervention after hospital discharge.