Date Presented 04/22/2023

This poster explores the predictive validity and diagnostic performance of the Executive Function Performance Test-Enhanced (EFPT–E) and the Performance Assessment of Self-Care Skills (PASS) medication management subtests on real-world medication adherence at home.

Primary Author and Speaker: Jaclyn K. Schwartz

Additional Authors and Speakers: Katherine Aylmer, Samara Green

PURPOSE: Half of people fail to take their medication as prescribed. The Executive Function Performance Test-Enhanced (EFPT-E) and the Performance Assessment of Self Care Skills (PASS) are two commonly- used, reliable, and valid assessments designed to describe performance of medication management skills. The purpose of this study is to understand if the use of these tools can be expanded to predict poor medication adherence.

DESIGN: 49 adults with hypertension completed this exploratory measurement study.

METHOD: Participants completed the EFPT-E and PASS (clinic version) medication management subtest. Researchers then monitored participants’ medication adherence to anti-hypertensive medication using electronic medication caps on their pill bottles. Data were analyized using Pearson’s correlations (predictive validity) and receiver operating characteristic curves, where values of the area under the cure (AUC) with AUC>.9 being excellent and AUC<.6 being poor (diagnostic performance).

RESULTS: The EFPT-E and PASS total scores and subscores were not related to medication adherence (r<.r, p>.05) and were also not correlated to each other. For the EFPT-E, we evaluated the AUC for the total score (AUC=.44), judgement score (AUC=.44), and time to complete in seconds (AUC=.53). For the PASS, we evaluated the AUC for the independence score (AUC=.53), safety score (AUC=.50), and adequacy score (AUC=.55).

CONCLUSION: The EFPT-E and PASS demonstrate poor predictive validity and diagnostic performance to real world medication adherence at home. These tools should not be used alone to screen for poor adherence. These findings also suggest that the performance of a medication task in a lab setting is a different construct than the performance of that task at home over time. Occupational therapy scholars have an opportunity to use their expertise in environment, habit, and performance factors to advance measurement in medication management.


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