255572 Improving medication management in home hospice patients: A pilot study of the MedCoach intervention for informal caregivers

Wednesday, October 31, 2012 : 8:30 AM - 8:42 AM

Denys T. Lau, PhD , Department of Pharmacy Administration, University of Illinois at Chicago, College of Pharmacy, Chicago, IL
Linda Ehrlich-Jones, PhD, RN , Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
Nathaniel Mercaldo, MS , Department of Biostatistics, Vanderbilt University, Nashville, TN
Brian Joyce, BA , Division of Epidemiology and Biostatistics, University of Illinois at Chicago, School of Public Health, Chicago, IL
Marla L. Clayman, PhD, MPH , Robert H. Lurie Comprehensive Cancer Center of Northwestern University &, Division of General Internal Medicine, Northwestern University, Chicago, IL
Sydney Dy, MD , Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
Linda Emanuel, MD, PhD , Buehler Center on Aging, Health & Society, Northwestern University, Chicago, IL
Judith Paice, PhD, RN , Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
Joseph Shega, MD , Section of Geriatrics and Palliative Medicine, University of Chicago, Department of Medicine, Chicago, IL
Janie Urbanic, MA , Department of Pharmacy Administration, University of Illinois at Chicago, College of Pharmacy, Chicago, IL
OBJECTIVES: Many informal caregivers report feeling under-prepared about managing medications for patients near the end-of-life. This pilot study evaluates a novel intervention Ė MedCoach Ė that combines video and written materials to better equip caregivers in effectively managing medications for home hospice patients. METHODS: A convenience sample of 20 caregivers participating in MedCoach during 2 home visits within 5 days (cases) and 20 caregivers selected from a larger study receiving usual care (controls) was recruited from 5 Chicago-based hospice agencies. Cases and controls were matched on age (+/-10 years), sex, and race. Baseline and follow-up computer-assisted telephone surveys, conducted approximately 7 days apart, collected data on sociodemographic factors, caregiver's knowledge/attitudes toward medication management; caregiver's stress, preparedness, and locus of control; and caregiver-reported patient's symptom severity and health-related quality of life. RESULTS: Cases and controls were well matched. The mean caregiver's age was 57. Most were female offspring, White, and had no college degree. Most were managing >7 medications and caring for a patient with dementia or cancer. Compared to controls, changes among cases between baseline and follow-up were significantly greater with improved knowledge/attitudes toward overall medication management (p<0.001) and internal locus of control (p<0.05). However, caregiver-reported patient's symptom severity scores appeared to increase more significantly among cases than among controls (p<0.05). No detectable differences were observed for the other measures between study arms. DISCUSSION: MedCoach may be a promising hospice intervention but needs further investigation. Higher symptom severity scores suggest that MedCoach may increase caregivers' awareness of patient symptom severity.

Learning Areas:
Public health or related research
Social and behavioral sciences

Learning Objectives:
1) Describe a novel intervention, MedCoach, which uses videos and written materials to better equip caregivers to effectively manage medications for home hospice patients 2) Discuss the potential impact that MedCoach can have on caregiverís knowledge/attitudes toward medication management; caregiverís stress, preparedness, and locus of control; and caregiver-reported patientís symptom severity and health-related quality of life.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Mr. Joyce collected the data and provided support in interpreting the data for this study. He is the lead research assistant for this project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.