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

Consult Pharm. 2014;29(5):304-16. doi: 10.4140/TCP.n.2014.304.


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.

Keywords: Adherence; CDT = Clock Draw Test; Cognitive impairment; MTS = Medication Transfer Screen; Medi-Cog; Medication adherence; Medication mismanagement; Mini-Cog; PBA = Pillbox Assessment; PBF = Pillbox Fill; PPC = Prospective Pill Count; Pillbox; TIR = Three-Item Recall; r2 = Multivariate regression.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cognition*
  • Cross-Sectional Studies
  • Female
  • Health Literacy*
  • Humans
  • Male
  • Medication Adherence*
  • Middle Aged
  • Prospective Studies