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      Development and validation of a revised instrument to measure burden of long-term medicines use: the Living with Medicines Questionnaire version 3

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          Abstract

          Objectives

          To revise the Living with Medicines Questionnaire version 2 (LMQ-2), which measures the burden of using prescribed medicines, to include cost and expand side effects and social issues.

          Methods

          New statements were developed and validated through cognitive interviews with medicine users, and these and a global visual analog scale (VAS) were added to the 42-item LMQ-2. Construct validity was assessed through exploratory and confirmatory factor analyses using an online public survey. Criterion-related validity was measured against the Treatment Satisfaction Questionnaire with Medication (TSQM-II) and the EuroQoL 5-level quality of life measure (EQ-5D-5L), in patients using community pharmacies, general practices, and outpatient clinics. Reliability was assessed by test–retest using online public distribution.

          Results

          The 58-item interim instrument (n=729) was reduced to 41 items after factor analysis, which confirmed an eight-domain structure: relationships with health professionals, practicalities, interferences, effectiveness, side effects, concerns, cost, and autonomy, constructed as medicine burden. All subscales, except autonomy, were loaded onto this construct and showed acceptable internal consistency. LMQ-VAS correlated with total LMQ scores ( r=0.571). Criterion validation (n=422) demonstrated total LMQ scores negatively correlated with TSQM scores for global satisfaction ( r=–0.616); domain scores showed similar correlations: effectiveness ( r=–0.628), side effects ( r=–0.597), and practicalities ( r=–0.529). Total LMQ score was negatively correlated with EQ VAS ( r=–0.383) and showed weak/moderate relationships with individual EQ-5D-5L dimensions. Test–retest (n=30) reliability showed intra-class correlation coefficients of 0.954 (total LMQ score), 0.733–0.929 (domain scores), and 0.789 (global item).

          Conclusion

          The LMQ version 3 (LMQ-3) instrument has acceptable construct, criterion-related and known-groups validity, and is internally consistent as a measure of medicine burden, although reliability requires further confirmation. It could be used to measure the outcome of interventions designed to reduce the burden of polypharmacy.

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          Most cited references21

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          Factor Analysis in Counseling Psychology Research, Training, and Practice: Principles, Advances, and Applications

          J. Kahn (2006)
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            Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review

            Objective To summarise the findings of an updated Cochrane review of interventions aimed at improving the appropriate use of polypharmacy in older people. Design Cochrane systematic review. Multiple electronic databases were searched including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (from inception to November 2013). Hand searching of references was also performed. Randomised controlled trials (RCTs), controlled clinical trials, controlled before-and-after studies and interrupted time series analyses reporting on interventions targeting appropriate polypharmacy in older people in any healthcare setting were included if they used a validated measure of prescribing appropriateness. Evidence quality was assessed using the Cochrane risk of bias tool and GRADE (Grades of Recommendation, Assessment, Development and Evaluation). Setting All healthcare settings. Participants Older people (≥65 years) with ≥1 long-term condition who were receiving polypharmacy (≥4 regular medicines). Primary and secondary outcome measures Primary outcomes were the change in prevalence of appropriate polypharmacy and hospital admissions. Medication-related problems (eg, adverse drug reactions), medication adherence and quality of life were included as secondary outcomes. Results 12 studies were included: 8 RCTs, 2 cluster RCTs and 2 controlled before-and-after studies. 1 study involved computerised decision support and 11 comprised pharmaceutical care approaches across various settings. Appropriateness was measured using validated tools, including the Medication Appropriateness Index, Beers’ criteria and Screening Tool of Older Person's Prescriptions (STOPP)/ Screening Tool to Alert doctors to Right Treatment (START). The interventions demonstrated a reduction in inappropriate prescribing. Evidence of effect on hospital admissions and medication-related problems was conflicting. No differences in health-related quality of life were reported. Conclusions The included interventions demonstrated improvements in appropriate polypharmacy based on reductions in inappropriate prescribing. However, it remains unclear if interventions resulted in clinically significant improvements (eg, in terms of hospital admissions). Future intervention studies would benefit from available guidance on intervention development, evaluation and reporting to facilitate replication in clinical practice.
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              Development and description of measurement properties of an instrument to assess treatment burden among patients with multiple chronic conditions

              Background Patients experience an increasing treatment burden related to everything they do to take care of their health: visits to the doctor, medical tests, treatment management and lifestyle changes. This treatment burden could affect treatment adherence, quality of life and outcomes. We aimed to develop and validate an instrument for measuring treatment burden for patients with multiple chronic conditions. Methods Items were derived from a literature review and qualitative semistructured interviews with patients. The instrument was then validated in a sample of patients with chronic conditions recruited in hospitals and general practitioner clinics in France. Factor analysis was used to examine the questionnaire structure. Construct validity was studied by the relationships between the instrument's global score, the Treatment Satisfaction Questionnaire for Medication (TSQM) scores and the complexity of treatment as assessed by patients and physicians. Agreement between patients and physicians was appraised. Reliability was determined by a test-retest method. Results A sample of 502 patients completed the Treatment Burden Questionnaire (TBQ), which consisted of 7 items (2 of which had 4 subitems) defined after 22 interviews with patients. The questionnaire showed a unidimensional structure. The Cronbach's α was 0.89. The instrument's global score was negatively correlated with TSQM scores (rs = -0.41 to -0.53) and positively correlated with the complexity of treatment (rs = 0.16 to 0.40). Agreement between patients and physicians (n = 396) was weak (intraclass correlation coefficient 0.38 (95% confidence interval 0.29 to 0.47)). Reliability of the retest (n = 211 patients) was 0.76 (0.67 to 0.83). Conclusions This study provides the first valid and reliable instrument assessing the treatment burden for patients across any disease or treatment context. This instrument could help in the development of treatment strategies that are both efficient and acceptable for patients.
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                Author and article information

                Journal
                Patient Relat Outcome Meas
                Patient Relat Outcome Meas
                Patient Related Outcome Measures
                Patient Related Outcome Measures
                Dove Medical Press
                1179-271X
                2018
                28 May 2018
                : 9
                : 155-168
                Affiliations
                Medway School of Pharmacy, The Universities of Greenwich and Kent, Chatham Maritime, UK
                Author notes
                Correspondence: Janet Krska, Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Anson Building, Central Avenue, Chatham Maritime, Chatham, Kent ME4 4TB, UK, Tel +44 16 3420 2950, Email j.krska@ 123456kent.ac.uk
                Article
                prom-9-155
                10.2147/PROM.S151143
                5978458
                29881317
                a93e8d02-0c28-4fba-89ad-f0eb18c0b452
                © 2018 Katusiime et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Original Research

                Medicine
                medicine burden,patient experience,polypharmacy,long-term conditions
                Medicine
                medicine burden, patient experience, polypharmacy, long-term conditions

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