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Colley A, Broering J, Lee K, Lin JA, Pierce L, Finlayson E, Sudore RL, Wick EC. "It Gives Me Peace of Mind So I Can Focus on Healing": Views on Advance Care Planning for Older Surgical Patients. J Palliat Med 2024; 27:667-674. [PMID: 38386513 DOI: 10.1089/jpm.2023.0589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Introduction: The period of time before an elective operation may be an opportune time to engage older adults in advance care planning (ACP). Past interventions have not been readily incorporated into surgical workflows leaving a need for ACP tools that are generalizable, easy to implement, and effective. Design: This is a qualitative study. Setting and Subjects: Older adults with a history of cancer and a recent major operation were recruited through their surgical oncologist at a tertiary medical center in the United States. Interviews were conducted to determine how to adapt the validated PrepareForYourCare.org ACP program with electronic health record prompts for the perioperative setting and openness to introducing ACP during a presurgical visit. We used qualitative content analysis to determine themes. Results: Eight themes were identified: (1) ACP as static and private, (2) people expected a prompt, (3) family trusted to do the "right" thing, (4) lack of relationship or comfort with providers, (5) a team-based approach can be helpful, (6) surgeon's expertise (e.g., prognosis and surgical risk), (7) ACP belongs on the surgical checklist, and (8) patients would welcome a conversation starter. Discussion: Older surgical patients are interested in engaging with ACP, particularly if prompted, and believe it has a place on the preoperative "checklist." Conclusions: To effectively engage patients with ACP, a combination of routine prompts by the health care team and patient-centered follow-up may be required.
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Affiliation(s)
- Alexis Colley
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jeannette Broering
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Katherine Lee
- Division of Palliative Medicine, University of California, San Francisco, California, USA
| | - Joseph A Lin
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Logan Pierce
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Elizabeth C Wick
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
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Gillan R, Bachtel G, Webber K, Ezzair Y, Myers NE, Bishayee A. Osteopathic manipulative treatment for chronic inflammatory diseases. J Evid Based Med 2024; 17:172-186. [PMID: 38488211 DOI: 10.1111/jebm.12590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 02/25/2024] [Indexed: 04/02/2024]
Abstract
Chronic inflammatory diseases (CIDs) are debilitating and potentially lethal illnesses that affect a large proportion of the global population. Osteopathic manipulative treatment (OMT) is a manual therapy technique developed and performed by osteopathic physicians that facilitates the body's innate healing processes. Therefore, OMT may prove a beneficial anti-inflammatory modality useful in the management and treatment of CIDs. This work aims to objectively evaluate the therapeutic benefits of OMT in patients with various CIDs. In this review, a structured literature search was performed. The included studies involving asthma, chronic obstructive pulmonary disease, irritable bowel syndrome, ankylosing spondylitis, and peripheral arterial disease were selected for this work. Various OMT modalities, including lymphatic, still, counterstain, and muscle energy techniques, were utilized. Control treatments included sham techniques, routine care, or no treatment. OMT utilization led to variable patient outcomes in individuals with pathologies linked to CID.
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Affiliation(s)
- Ross Gillan
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Gabrielle Bachtel
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Kassidy Webber
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Yasmine Ezzair
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Nicole E Myers
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Anupam Bishayee
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
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3
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Zhu Y, Enguidanos S. Impact of Limited English Proficiency on Medication-Related Problems and Emergency Room Visits Among Community-Dwelling Older People. Sr Care Pharm 2024; 39:14-21. [PMID: 38160237 DOI: 10.4140/tcp.n.2024.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Background Older people have higher risk of experiencing medication-related problems (MRPs), leading to increased morbidity, health care use, and mortality. Few studies have examined the pathway between limited English proficiency (LEP) among older people and health service use through MRPs. Objective This study aimed to explore the association of LEP among Latino older people with MRPs and their relationship to emergency room (ER) visits. Methods Researchers used secondary enrollment data from a community medication program for older people (N = 180). Researchers conducted linear regression to examine the relationship between ethnicity/English proficiency and MRPs, and logistic regression to explore the association between MRPs and ER visits. Generalized structural equation modeling (GSEM) with bootstrapping was used to test the indirect effect between LEP Latino through MRPs to ER visits. Results The sample included 70% non-Latino participants, 12% English-speaking Latinos, and 18% LEP Latinos. Analysis LEP Latinos were associated with having 3.4 more MRPs than non-Latino participants, after controlling for covariates. Additionally, each additional MRP was associated with a 10% increased probability of having an ER visit. The GSEM results illustrated there was a significant indirect effect between LEP through MRPs to ER visits (β = 0.27, 95% CI 0.07-0.61). Conclusion Though LEP was not directly related to increased ER visits, it may have inhibited the ability of Latinos to read and understand medication instructions, contributing to their elevated risk of experiencing MRPs, thus indirectly increasing potential risks of having ER visits.
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Affiliation(s)
- Yujun Zhu
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, California
| | - Susan Enguidanos
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, California
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Yang C, Zhu S, Hui Z, Mo Y. Psychosocial factors associated with medication burden among community-dwelling older people with multimorbidity. BMC Geriatr 2023; 23:741. [PMID: 37964196 PMCID: PMC10648314 DOI: 10.1186/s12877-023-04444-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Older people with multimorbidity are often prescribed multiple medication treatments, leading to difficulties in self-managing their medications and negative experiences in medication use. The perceived burden arising from the process of undertaking medication self-management practices has been described as medication burden. Preliminary evidence has suggested that patients' demographic and clinical characteristics may impact their medication burden. Little is known regarding how psychosocial factors affect medication burden in older people with multimorbidity. The aim of this study was to identify psychosocial factors associated with medication burden among community-dwelling older people with multimorbidity. METHODS This is a secondary analysis of a cross-sectional study. A total of 254 older people with three or more chronic conditions were included in the analysis. Participants were assessed for demographics, medication burden, psychosocial variables (depression, medication-related knowledge, beliefs, social support, self-efficacy, and satisfaction), disease burden, and polypharmacy. Medication burden was measured using items from the Treatment Burden Questionnaire. Univariate and multivariate linear regression models explored factors associated with medication burden. RESULTS The mean age of participants was 70.90 years. Participants had an average of 4.40 chronic conditions, and over one-third had polypharmacy. Multivariate analysis showed that the participants' satisfaction with medication treatments (β = -0.32, p < 0.001), disease burden (β = 0.25, p = 0.009), medication self-efficacy (β = -0.21, p < 0.001), polypharmacy (β = 0.15, p = 0.016), and depression (β = 0.14, p = 0.016) were independently associated with medication burden. Other factors, including demographic characteristics, medication knowledge, medication beliefs, medication social support, and the number or specific types of chronic conditions, were not independently associated with medication burden. CONCLUSIONS Poor medication treatment satisfaction, great disease burden, low medication self-efficacy, polypharmacy, and depression may increase individuals' medication burden. Understanding psychosocial aspects associated with medication burden provides an important perspective for identifying older people who are overburdened by their medication treatments and offering individualised treatments to relieve their burden.
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Affiliation(s)
- Chen Yang
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
| | - Song Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhaozhao Hui
- School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
- Shaanxi Health Culture Research Center, Xianyang, China
| | - Yihan Mo
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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Falemban AH. Medication-Related Problems and Their Intervention in the Geriatric Population: A Review of the Literature. Cureus 2023; 15:e44594. [PMID: 37795072 PMCID: PMC10545972 DOI: 10.7759/cureus.44594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
In order to implement the principles of providing clinically and economically effective care, the current state of healthcare must be evaluated, and challenges must be addressed. As part of a physician's role in such a context, one tool consists of identifying medication-related problems (MRPs) and accordingly implementing best practices and innovative strategies to improve patient healthcare outcomes. The geriatric population is expected to have passed through the natural ageing process and experienced several physiological and biological changes that impact their bodies and lives. In the presence of geriatric syndromes and the increased number of medications consumed, the risk of MRPs such as polypharmacy, potentially inappropriate medication (PIM), adverse events, drug-drug interactions, and risk of non-adherence increases. Different interventions that focus on practical and perceptual barriers have been studied, and different tools to define clinically important prescribing problems relating to PIM have been established. The Beers Criteria and STOPP (Screening Tool of Older Persons' Prescriptions)/START (Screening Tool to Alert to Right Treatment) criteria are the most widely used sets of explicit PIM criteria; however, they are still limited in Saudi Arabia. These tools should be considered in clinical settings to improve healthcare outcomes in the geriatric population, and the clinical relevance of enhancing medication should also be explored from the point of view of both the patient and healthcare practitioners.
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Affiliation(s)
- Alaa H Falemban
- Department of Pharmacology and Toxicology, Umm Al-Qura University, Makkah, SAU
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6
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Wang D, Meng X, Liu L, Wang A. Views on Suspected Adverse Drug Events in Older Adults with Chronic Conditions: A Qualitative Study. Patient Prefer Adherence 2023; 17:2051-2061. [PMID: 37614766 PMCID: PMC10443695 DOI: 10.2147/ppa.s420620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
Purpose To explore how elderly patients with chronic conditions identify and cope with suspected adverse drug events (ADEs) in northern China with the aim of encouraging the elderly to participate in medication safety monitoring. Patients and Methods A purposive sampling method was adopted to select 15 elderly patients with chronic conditions from a medical center in northern China for semi-structured-interviews, and the data were collated and analyzed through thematic framework analysis. Results Five major themes and 12 subthemes were refined, namely (1) lack of knowledge: poor awareness of the medications and ambiguous knowledge of ADEs, (2) barriers to identifying suspected ADEs: unawareness and uncertainty, seeking alternative explanations, and limited access to information, (3) the basis for identifying suspected ADEs: time cues and actively seeking communication (4) coping with suspected ADEs: cope with it themselves, not talking to the health care provider on their own initiative and actively seeking communication, and (5) expectations: desire for more reliable information and hope to be safeguarded for medication safety. Conclusion Due to the lack of relevant knowledge and limited access to information, the elderly were limited in identifying suspected ADEs, but they were positive towards participating in medication safety monitoring and hoped to obtain reliable medication information and detailed medication assessment by enhancing communication with medical professionals in order to achieve medication safety.
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Affiliation(s)
- Daqiu Wang
- Liaoning University of Traditional Chinese Medicine, Shenyang, People’s Republic of China
| | - Xin Meng
- The First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Lei Liu
- Liaoning University of Traditional Chinese Medicine, Shenyang, People’s Republic of China
| | - Aiping Wang
- The First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
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7
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Heikkilä JM, Bergman P, Jantunen J, Salimäki J, Pohjanoksa-Mäntylä M, Kauppi P. Are there differences in the patient-reported medication-related problems among asthma and allergy patients? A community pharmacy survey in Finland. BMC Public Health 2023; 23:1570. [PMID: 37596587 PMCID: PMC10436668 DOI: 10.1186/s12889-023-16423-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 07/31/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND A medication-related problem is an event involving medication that interferes with desired health outcomes. Those are largely studied among asthma patients, but little is known about medication-related problems among allergy patients. The objective of this study was to determine the most common patient-reported medication-related problems among asthma patients compared to allergy patients during the self-management of diseases. The other objective was to identify how demographic variables and the received treatment information influence reported problems. METHODS A nationwide survey was conducted in Finnish community pharmacies (n = 785) in September 2016. The survey targeted patients buying prescription medicines for asthma or allergy. RESULTS Responses were received from 46% of targeted pharmacies from 956 respondents. At least one medication problem was reported by 24% of asthma patients and 12% of allergy patients. The most common problems among asthma patients were having problems taking medicines on time (16%), problems in the administration technique (7%) and in the use of the inhaler (4%). Among allergy patients, 10% reported problems remembering to take medicines on time. Severe asthma and allergy increased the risk for medication-related problems (OR 1.20, 95% CI 1.04-1.40 and OR 1.17, 95% CI 1.0-1.37). A higher age and less education were associated with fewer reported medication-related problems among both patient groups. CONCLUSIONS Asthma patients reported more medication-related problems than allergy patients. Among both investigated patient groups, remembering to take medicines on time was the most common. Health care professionals should educate younger patients but also older and less educated asthma and allergy patients to recognize and, to solve medication-related problems. In addition, severe asthma patients still need medication counseling.
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Affiliation(s)
- Juha Markus Heikkilä
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
| | - Paula Bergman
- Biostatistics Unit, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Juha Jantunen
- Allergy, Skin and Asthma Federation, Helsinki, Finland
| | | | - Marika Pohjanoksa-Mäntylä
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Paula Kauppi
- Pulmonary Department, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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8
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Xiao Y, Smith A, Abebe E, Hannum SM, Wessell AM, Gurses AP. Understanding Hazards for Adverse Drug Events Among Older Adults After Hospital Discharge: Insights From Frontline Care Professionals. J Patient Saf 2022; 18:e1174-e1180. [PMID: 35617608 PMCID: PMC9679039 DOI: 10.1097/pts.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Care transitions pose a high risk of adverse drug events (ADEs). We aimed to identify hazards to medication safety for older adults during care transitions using a systems approach. METHODS Hospital-based professionals from 4 hospitals were interviewed about ADE risks after hospital discharge among older adults. Concerns were extracted from the interview transcript, and for each concern, hazard for medication-related harms was coded and grouped by its sources according to a human factors and systems engineering model that views postdischarge ADEs as the outcome of professional and patient home work systems. RESULTS Thirty-eight professionals participated (5 hospitalists, 24 nurses, 4 clinical pharmacists, 3 pharmacy technicians, and 2 social workers). Hazards were classified into 6 groups, ranked by frequencies of hazards coded: (1) medication tasks related at home, (2) patient and caregiver related, (3) hospital work system related, (4) home resource related, (5) hospital professional-patient collaborative work related, and (6) external environment related. Medications most frequently cited when describing concerns included anticoagulants, insulins, and diuretics. Top coded hazard types were complex dosing, patient and caregiver knowledge gaps in medication management, errors in discharge medications, unaffordable cost, inadequate understanding about changes in medications, and gaps in access to care or in sharing medication information. CONCLUSIONS From the perspective of hospital-based frontline health care professionals, hazards for medication-related harms during care transitions were multifactorial and represented those introduced by the hospital work system as well as defects unrecognized and unaddressed in the home work system.
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Affiliation(s)
- Yan Xiao
- From the College of Nursing and Health Innovation, University of Texas at Arlington
| | - Aaliyah Smith
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Ephrem Abebe
- Department of Pharmacy Practice, Purdue University, College of Pharmacy, West Lafayette, Indiana
| | - Susan M Hannum
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrea M Wessell
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Ayse P Gurses
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, Maryland
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Pereira F, Bieri M, Martins MM, del Río Carral M, Verloo H. Safe Medication Management for Polymedicated Home-Dwelling Older Adults after Hospital Discharge: A Qualitative Study of Older Adults, Informal Caregivers and Healthcare Professionals’ Perspectives. NURSING REPORTS 2022; 12:403-423. [PMID: 35736616 PMCID: PMC9230543 DOI: 10.3390/nursrep12020039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Safe medication management is particularly challenging among polymedicated home-dwelling older adults after hospital discharge. This study aimed to identify and categorise the stressors experienced and reconstitution strategies adopted by older adults, their informal caregivers, and healthcare professionals as they manage older adults’ medications after hospital discharge. A primary study collected the perspectives of 28 older adults, 17 informal caregivers, and 13 healthcare professionals using a qualitative descriptive design. The Neuman Systems Model was used as the basis for a secondary deductive content analysis. Findings revealed that post-discharge medication management at home involved numerous stressors, often including dysfunctions in communication, collaboration, and coordination between the multiple stakeholders involved. Reconstitution strategies for safe medication management were not always successful or satisfactory and were sometimes identified as stressors themselves. Older adults, informal caregivers, and healthcare professionals’ perspectives highlighted several potential opportunities for improving safe medication management through nurse-led, interprofessional, patient-centred practices.
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Affiliation(s)
- Filipa Pereira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- School of Health Sciences, HES-SO Valais/Wallis, 1950 Sion, Switzerland; (M.B.); (H.V.)
- Correspondence:
| | - Marion Bieri
- School of Health Sciences, HES-SO Valais/Wallis, 1950 Sion, Switzerland; (M.B.); (H.V.)
| | | | - María del Río Carral
- Research Center for Psychology of Health, Aging and Sport Examination, Institute of Psychology, University of Lausanne, 1015 Lausanne, Switzerland;
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/Wallis, 1950 Sion, Switzerland; (M.B.); (H.V.)
- Service of Old Age Psychiatry, Lausanne University Hospital, 1008 Prilly, Switzerland
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10
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Zonsius MC, Myftari K, Newman M, Emery-Tiburcio EE. Optimizing Older Adults' Medication Use. Am J Nurs 2022; 122:38-43. [PMID: 35200184 DOI: 10.1097/01.naj.0000822976.96210.5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article is the third in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
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Affiliation(s)
- Mary C Zonsius
- Mary C. Zonsius is an associate professor in the College of Nursing at Rush University Medical Center in Chicago, where Klodiana Myftari is a clinical pharmacy specialist in the Department of Ambulatory Care Management, Michelle Newman is a program manager in the Department of Social Work and Community Health, and Erin E. Emery-Tiburcio is an associate professor in the Department of Psychiatry and Behavioral Sciences. Myftari is also an assistant professor of pharmacy practice at Midwestern University College of Pharmacy in Downers Grove, IL. Contact author: Mary C. Zonsius, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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11
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Garrett SB, Nicosia F, Thompson N, Miaskowski C, Ritchie CS. Barriers and facilitators to older adults' use of nonpharmacologic approaches for chronic pain: a person-focused model. Pain 2021; 162:2769-2779. [PMID: 33902095 PMCID: PMC8426428 DOI: 10.1097/j.pain.0000000000002260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT In the context of the opioid epidemic and the growing population of older adults living with chronic pain, clinicians are increasingly recommending nonpharmacologic approaches to patients as complements to or substitutes for pharmacologic treatments for pain. Currently, little is known about the factors that influence older adults' use of these approaches. We aimed to characterize the factors that hinder or support the use of nonpharmacologic approaches for pain management among older adults with multiple morbidities. We collected semistructured qualitative interview data from 25 older adults with multiple morbidities living with chronic pain for 6 months or more. Transcripts were coded to identify factors that hindered or supported participants' use of various nonpharmacologic approaches. We used the constant comparative method to develop a person-focused model of barriers and facilitators to participants' use of these approaches for chronic pain management. Participants described a wide range of factors that influenced their use of nonpharmacologic approaches. We grouped these factors into 3 person-focused domains: awareness of the nonpharmacologic approach as relevant to their chronic pain, appeal of the approach, and access to the approach. We propose and illustrate a conceptual model of barriers and facilitators to guide research and clinical care. This study identifies numerous factors that influence patients' use of nonpharmacologic approaches, some of which are not captured in existing research or routinely addressed in clinical practice. The person-centered model proposed may help to structure and support patient-clinician communication about nonpharmacologic approaches to chronic pain management.
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Affiliation(s)
- Sarah B. Garrett
- Philip R. Lee Institute for Health Policy Studies,
University of California, San Francisco, CA
- Division of Geriatrics, University of California, San
Francisco, San Francisco, CA
| | - Francesca Nicosia
- Division of Geriatrics, University of California, San
Francisco, San Francisco, CA
- Institute for Health & Aging, UCSF
- Integrative Health, San Francisco VA Health Care
System
| | - Nicole Thompson
- Osher Center for Integrative Medicine, University of
California, San Francisco, San Francisco, CA
| | - Christine Miaskowski
- Departments of Physiological Nursing and Anesthesia,
University of California, San Francisco, San Francisco, CA
| | - Christine S. Ritchie
- The Mongan Institute and the Division of Palliative Care
and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
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12
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Taushanov Z, Verloo H, Wernli B, Di Giovanni S, von Gunten A, Pereira F. Transforming a Patient Registry Into a Customized Data Set for the Advanced Statistical Analysis of Health Risk Factors and for Medication-Related Hospitalization Research: Retrospective Hospital Patient Registry Study. JMIR Med Inform 2021; 9:e24205. [PMID: 33973865 PMCID: PMC8150425 DOI: 10.2196/24205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/11/2021] [Accepted: 04/04/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hospital patient registries provide substantial longitudinal data sets describing the clinical and medical health statuses of inpatients and their pharmacological prescriptions. Despite the multiple advantages of routinely collecting multidimensional longitudinal data, those data sets are rarely suitable for advanced statistical analysis and they require customization and synthesis. OBJECTIVE The aim of this study was to describe the methods used to transform and synthesize a raw, multidimensional, hospital patient registry data set into an exploitable database for the further investigation of risk profiles and predictive and survival health outcomes among polymorbid, polymedicated, older inpatients in relation to their medicine prescriptions at hospital discharge. METHODS A raw, multidimensional data set from a public hospital was extracted from the hospital registry in a CSV (.csv) file and imported into the R statistical package for cleaning, customization, and synthesis. Patients fulfilling the criteria for inclusion were home-dwelling, polymedicated, older adults with multiple chronic conditions aged ≥65 who became hospitalized. The patient data set covered 140 variables from 20,422 hospitalizations of polymedicated, home-dwelling older adults from 2015 to 2018. Each variable, according to type, was explored and computed to describe distributions, missing values, and associations. Different clustering methods, expert opinion, recoding, and missing-value techniques were used to customize and synthesize these multidimensional data sets. RESULTS Sociodemographic data showed no missing values. Average age, hospital length of stay, and frequency of hospitalization were computed. Discharge details were recoded and summarized. Clinical data were cleaned up and best practices for managing missing values were applied. Seven clusters of medical diagnoses, surgical interventions, somatic, cognitive, and medicines data were extracted using empirical and statistical best practices, with each presenting the health status of the patients included in it as accurately as possible. Medical, comorbidity, and drug data were recoded and summarized. CONCLUSIONS A cleaner, better-structured data set was obtained, combining empirical and best-practice statistical approaches. The overall strategy delivered an exploitable, population-based database suitable for an advanced analysis of the descriptive, predictive, and survival statistics relating to polymedicated, home-dwelling older adults admitted as inpatients. More research is needed to develop best practices for customizing and synthesizing large, multidimensional, population-based registries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2019-030030.
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Affiliation(s)
- Zhivko Taushanov
- Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland.,Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland.,Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Boris Wernli
- FORS, Swiss Centre of Expertise in the Social Sciences, University of Lausanne, Lausanne, Switzerland
| | - Saviana Di Giovanni
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland.,Pharmacy Benu Tavil-Chatton, Morges, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Filipa Pereira
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland.,Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
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13
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Chang S, Stebbins M, Witt EA, Kirkham H, Santos T, Cocohoba J. Medication‐related problems in chronic inflammatory conditions: A pharmacy claims and electronic health record analysis. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Susan Chang
- University of California San Francisco School of Pharmacy San Francisco California USA
- Global Access & Health Economics Roche Molecular Systems Pleasanton California USA
| | - Marilyn Stebbins
- University of California San Francisco School of Pharmacy San Francisco California USA
| | - Edward A. Witt
- Health Analytics, Research, and Reporting, Walgreen Co Deerfield Illinois USA
| | - Heather Kirkham
- Health Analytics, Research, and Reporting, Walgreen Co Deerfield Illinois USA
| | - Troy Santos
- University of California San Francisco School of Pharmacy San Francisco California USA
| | - Jennifer Cocohoba
- University of California San Francisco School of Pharmacy San Francisco California USA
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14
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Tool development to improve medication information transfer to patients during transitions of care: A participatory action research and design thinking methodology approach. Res Social Adm Pharm 2021; 18:2170-2177. [PMID: 33926826 DOI: 10.1016/j.sapharm.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Medication changes during transitions of care is a recognized challenge that has been linked to adverse events. The delivery of medication instructions during transition from hospital to home is a priority area for improvement. OBJECTIVE The goals of this work were to 1) understand the current experiences of patients and families; and 2) co-design tools to improve medication information transfer during transitions of care together with patients, families, and providers. METHODS A participatory action approach, using mixed methods within a design thinking framework was used. Participants were chosen from patient groups at higher risk of adverse events, guided by extreme user design, which posits that needs of extreme users can also fit the majority. Providers, patients and family (users) were interviewed to understand current experiences with medication information transfer during transitions of care and to solicit input on potential elements to inform tool design. Users were engaged in iterative creation of prototypes. RESULTS A total of 116 patients, family caregivers, and providers were engaged throughout this project. Findings highlighted challenges currently experienced, strengthening the case for tools that engage the patient and family in medication information transfer. Important information included why medications were prescribed, how to take them, side effects, and an explanation of the role of community pharmacists. Displaying information in a grid format was preferred. Two tools were prototyped: (1) A Medication Whiteboard for engaging patients and families in creating their medication routine, and (2) A Patient Oriented Medication List for providing medication instructions and as a reference once patients are home. CONCLUSIONS Through the use of mixed methods within a design thinking framework, the team was able to understand the challenges and design prototypes of tools that both engage patients and families in developing their medication routine and improve medication information transfer during transitions of care.
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15
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Tomlinson J, Silcock J, Smith H, Karban K, Fylan B. Post-discharge medicines management: the experiences, perceptions and roles of older people and their family carers. Health Expect 2020; 23:1603-1613. [PMID: 33063445 PMCID: PMC7752204 DOI: 10.1111/hex.13145] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/14/2020] [Accepted: 09/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background Multiple changes are made to older patients’ medicines during hospital admission, which can sometimes cause confusion and anxiety. This results in problems with post‐discharge medicines management, for example medicines taken incorrectly, which can lead to harm, hospital readmission and reduced quality of life. Aim To explore the experiences of older patients and their family carers as they enacted post‐discharge medicines management. Design Semi‐structured interviews took place in participants’ homes, approximately two weeks after hospital discharge. Data analysis used the Framework method. Setting and participants Recruitment took place during admission to one of two large teaching hospitals in North England. Twenty‐seven participants aged 75 plus who lived with long‐term conditions and polypharmacy, and nine family carers, were interviewed. Findings Three core themes emerged: impact of the transition, safety strategies and medicines management role. Conversations between participants and health‐care professionals about medicines changes often lacked detail, which disrupted some participants’ knowledge and medicines management capabilities. Participants used multiple strategies to support post‐discharge medicines management, such as creating administration checklists, seeking advice or supporting primary care through prompts to ensure medicines were supplied on time. The level to which they engaged with these activities varied. Discussion and conclusion Participants experienced gaps in their post‐discharge medicines management, which they had to bridge through implementing their own strategies or by enlisting support from others. Areas for improvement were identified, mainly through better communication about medicines changes and wider involvement of patients and family carers in their medicines‐related care during the hospital‐to‐home transition.
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Affiliation(s)
- Justine Tomlinson
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.,Medicine Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jonathan Silcock
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Heather Smith
- Medicine Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kate Karban
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Beth Fylan
- Medicine Optimisation Research Group, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.,Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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16
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Brandt N, Steinman MA. Optimizing Medication Management During the COVID-19 Pandemic: An Implementation Guide for Post-Acute and Long-Term Care. J Am Geriatr Soc 2020; 68:1362-1365. [PMID: 32424906 PMCID: PMC7276861 DOI: 10.1111/jgs.16573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Nicole Brandt
- University of Maryland School of Pharmacy Lamy Center on Drug Therapy and Aging and Center for Successful Aging at MedStar Good Samaritan Hospital, Baltimore, Maryland, USA
| | - Michael A Steinman
- San Francisco VA Medical Center, University of California, San Francisco, San Francisco, California, USA
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