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Mortelmans L, Goossens E, De Cock AM, Petrovic M, van den Bemt P, Dilles T. The Development of Recommendations for Healthcare Providers to Support Patients Experiencing Medication Self-Management Problems. Healthcare (Basel) 2023; 11:healthcare11111545. [PMID: 37297685 DOI: 10.3390/healthcare11111545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Medication self-management problems such as the inability to correctly obtain, understand, organize, administer or monitor medication can result in negative patient outcomes. However, supportive tools for healthcare providers to assist patients with medication self-management problems are lacking. This study aimed to develop recommendations for healthcare providers to support patients with polypharmacy who experience medication self-management problems. A three-phase study was conducted starting with (1) the mapping of medication self-management problems, followed by (2) a scoping review providing a list of relevant interventions and actions for each respective problem and (3) a three-round modified e-Delphi study with experts to reach consensus on the relevance and clarity of the recommended interventions and actions. The cut-off for consensus on the relevance and clarity of the recommendations was set at 80% expert agreement. Experts could propose additional recommendations based on their professional experience and expertise. The experts (n = 23) involved were healthcare professionals (i.e., nurses, pharmacists, and physicians) with specific expertise in medication management of patients with polypharmacy. Simultaneous with the second e-Delphi round, a panel of patients with polypharmacy (n = 8) evaluated the usefulness of recommendations. Results obtained from the patient panel were fed back to the panel of healthcare providers in the third e-Delphi round. Descriptive statistics were used for data analysis. Twenty medication self-management problems were identified. Based on the scoping review, a list of 66 recommendations for healthcare providers to support patients with the identified medication self-management problems was composed. At the end of the three-round e-Delphi study, the expert panel reached consensus on the relevance and clarity of 67 recommendations, clustered according to the six phases of the medication self-management model by Bailey et al. In conclusion, this study resulted in a guidance document including recommendations that can serve as a resource for healthcare providers to support patients with polypharmacy in case of medication self-management problems. Future research should focus on the evaluation of the feasibility and user-friendliness of the guide with recommendations in clinical practice.
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Affiliation(s)
- Laura Mortelmans
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
| | - Eva Goossens
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
- Department of Patient Care, Antwerp University Hospital (UZA), 2610 Antwerp, Belgium
| | - Anne-Marie De Cock
- Department of Geriatrics, ZNA, 2020 Antwerp, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, 2610 Antwerp, Belgium
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, 9000 Ghent, Belgium
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, 9000 Ghent, Belgium
| | - Patricia van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Tinne Dilles
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
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Murshed M, Salim M, Boyd BJ. Existing and emerging mitigation strategies for the prevention of accidental overdose from oral pharmaceutical products. Eur J Pharm Biopharm 2022; 180:201-211. [DOI: 10.1016/j.ejpb.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/15/2022]
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Geary U, Ward ME, Callan V, McDonald N, Corrigan S. A socio-technical systems analysis of the application of RFID-enabled technology to the transport of precious laboratory samples in a large acute teaching hospital. APPLIED ERGONOMICS 2022; 102:103759. [PMID: 35413577 DOI: 10.1016/j.apergo.2022.103759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/23/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
The scale and pace of improvement in patient safety in healthcare has been unacceptably slow. A paucity of research into the application of systems-thinking concepts and a failure to appreciate health systems complexity are cited as barriers to sustainable health systems improvement. This study reports on a socio-technical systems analysis, called the CUBE, of the characteristics of a large acute teaching hospital's system for the transport of precious specimens, a system enabled by radio-frequency identification tracking technology. The CUBE proved itself to be an effective analytic tool. The analysis provided a constructive framework to link diverse data and documentation; explicitly inviting consideration of the roles and understandings of different stakeholders; as well as broader cultural factors that could influence current or future activity. The analysis also supported recommendations to improve and extend operations. This study supports the argument for systems understanding and systems thinking being at the core of new approaches to patient safety.
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Affiliation(s)
- Una Geary
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin 8, D08 NHY1, Ireland.
| | - Marie E Ward
- Quality and Safety Improvement Directorate, St James's Hospital, Dublin 8, D08 NHY1, Ireland; Centre for Innovative Human Systems, Trinity College Dublin, Dublin 2, D02 PN40, Ireland.
| | - Vincent Callan
- Facilities Management, St James's Hospital, Dublin 8, D08 NHY1, Ireland.
| | - Nick McDonald
- Centre for Innovative Human Systems, Trinity College Dublin, Dublin 2, D02 PN40, Ireland.
| | - Siobhán Corrigan
- Centre for Innovative Human Systems, Trinity College Dublin, Dublin 2, D02 PN40, Ireland.
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Carli Lorenzini G, Bell A, Olsson A. 'You need to be healthy to be sick': exploring older people's experiences with medication packaging at home. Age Ageing 2022; 51:6544238. [PMID: 35258519 PMCID: PMC8903009 DOI: 10.1093/ageing/afac050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/29/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND the ageing global population is living longer with complex health conditions addressed by multiple medications. Little is known about how older people manage these medications and associated packaging at home. OBJECTIVES to explore how older people manage the use of multiple medication and associated packaging in their process of self-care. METHODS fifteen older, home-dwelling participants (mean age = 76.2 years) participated in this study. All participants used three or more daily medications and resided in Southern Sweden. Data were collected using photographs and written diaries completed by each participant over seven consecutive days, complemented by researcher-led interviews. Interviews and diary data were analysed using thematic analysis. RESULTS six major themes emerged and are discussed: systematic organisation of medication, design of medication packaging, design of tablets, ease of package opening, emotional response to the need for medication, and environmental waste. CONCLUSION packaging plays an important role in protecting products and enabling easy storage, product longevity and transportation. Medication packaging is no exception. However, the design of medication packaging poses challenges for older people managing medications for their chronic health conditions at home. There is a need to facilitate the systematic management of multiple medications, especially for new medication regimes or changes in treatment. Design of both packaging and medication should be consistent for older users to avoid potential errors; difficulties opening packaging can potentially hinder adherence to treatment. This study highlights the need for patient-centred solutions and involvement of older people in a co-design process for medication and packaging design.
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Affiliation(s)
| | - Alison Bell
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Annika Olsson
- Department of Design Sciences, Lund University, Lund, Sweden
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Exploring How and Why to Develop Patient-Centered Packaging: A Multiple-Case Study with Pharmaceutical Companies. Ther Innov Regul Sci 2021; 56:117-129. [PMID: 34581997 PMCID: PMC8688390 DOI: 10.1007/s43441-021-00338-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/01/2021] [Indexed: 11/06/2022]
Abstract
Background Patient centricity has gained attention ranging from regulatory authorities to patient advocacy groups, calling for pharmaceutical companies to revise their traditional business approach to drug development by including the development of solutions that are meaningful in patients’ lives. Medication packaging is one area where empirical evidence is lacking about the incorporation of patient centricity. This study aimed to explore patient centricity applied to pharmaceutical companies’ packaging, and to identify the specific challenges faced and lessons learned when developing patient-centered packaging. Methods The study followed a multiple-case study research approach based on five cases of patient-centered packaging development in mid- and large-sized pharmaceutical companies. Results Patient-centered packaging is often associated with the intuitive and self-explanatory use of the medication by patients. Patient-centered packaging comes with challenges, but also offers opportunities for the creation of better solutions for patients and learning for the teams involved. To overcome these challenges, it is essential to build a business case that justifies such development, one where patient needs are present from the start and aligned with other imperative deadlines of drug development, with stakeholders onboard. Conclusion Patient-centered packaging is the exception rather than the norm in packaging development due to a conventional approach where packaging plays an ancillary role to drug protection. The cases presented here challenge this approach and can inspire other companies to carry out patient-centered packaging development. The cases are also relevant to other actors who are interested in continuously promoting the dialogue about patient centricity in healthcare.
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Carli Lorenzini G. Managing Multiple Medications and Their Packaging for Older People in Home Care Nursing: An Interview Study. Healthcare (Basel) 2021; 9:healthcare9101265. [PMID: 34682945 PMCID: PMC8535860 DOI: 10.3390/healthcare9101265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Home care nurses assist older people in their daily living and well-being, including medication management. Medication management can be challenging for older people with functional constraints and several chronic conditions. This paper presents how home care nurses manage medications and their packaging for older people at their homes. This study followed an explorative qualitative research design, in which semi-structured interviews were conducted with home care nurses in Sweden (n = 14). The study revealed that home care nurses need to coordinate a multitude of interrelated tasks, with documentation being paramount. Regarding medication management, automated systems were preferred, as they reduce medication errors and facilitate dispensing of medications for each patient when compared with analogue systems still in use (i.e., dosing boxes), commonly used by older people. Importantly, the lack of a common journal system for updates on prescribed medication among health care providers and analogue communication still in place creates space for outdated prescription of medications for patients. There are opportunities for further investigation on how technology can help home care nurses in coordinating medication management tasks with other health care providers, and on receiving updates about medication intake by older patients when the nurse is not at their homes.
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Affiliation(s)
- Giana Carli Lorenzini
- Department of Design Sciences, Faculty of Engineering, Lund University, P.O. Box 118, SE 221 00 Lund, Sweden
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Designing Effective Warnings about Addiction on the Patient Information Leaflet of Over-the-Counter Codeine Sold in England to University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155490. [PMID: 32751393 PMCID: PMC7432560 DOI: 10.3390/ijerph17155490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022]
Abstract
(1) Background: The harm of misusing over-the-counter (OTC) codeine-containing medicines among university students in England is being increasingly recognized. Based on English university students, this paper aims to study the importance of information design on information communication, explore methods for effective warning design, and investigate university students’ perception of OTC codeine. (2) Methods: The effective warning design is addressed through case studies, answering correctness by the heat map generated from the eye-tracking experiment (ETE), and the total time spent on the tasks. User perceptions are made though online surveys. (3) Results: Information design significantly affects the way user processes information. Therefore, two emphasized warnings displayed in the headline, and the “possible side effect (PSE)” sections and warning signs of addiction presented under the PSE are suggested as effective ways to display warnings. For students’ perception of OTC codeine, 80% of university students are unfamiliar with the substance. After reading the patient information leaflets (PILs), 47% recommended tight regulation on codeine. (4) Conclusions: The misuse of OTC codeine could be a potential problem among English university students. The design of the PIL significantly influences the chance of unintentional medicine misuse. The display of warnings on the PILs of OTC codeine should be redesigned for better understanding.
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Schneider A, Kolrep H, Jordi C, Richard P, Horn HP, Lange J. How to prevent medication errors: a multidimensional scaling study to investigate the distinguishability between self-injection platform device variants. Expert Opin Drug Deliv 2019; 16:883-894. [PMID: 31246536 DOI: 10.1080/17425247.2019.1637852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The importance of subcutaneous drug delivery using self-injection devices based on common device platforms continues to grow. The resulting broad adoption of potentially look-alike or similar devices, however, raises concerns over limited device distinguishability and ensuing risk of medication errors. The objective of the study is thus to understand whether and how users effectively distinguish between self-injection device variants. Methods: Seventy-four patients, caregivers, and healthcare professionals were asked to pairwise rate the similarity of eight platform autoinjector variants. Multidimensional scaling was then used to convert individual ratings into spatial configurations and thereby identify the attributes that influence device distinguishability. Results: Five different device attributes driving distinguishability were identified. Three of the attributes corresponded to single design features (the label color, device size and device shape). Two device attributes (the aspect ratio and chromaticity) combined distinct yet interrelated design features. Conclusions: The study provides initial empirical evidence that users are able to distinguish between device variants and as to what device attributes drive distinguishability. Furthermore, the results highlight patterns in how various user groups distinguish between device variants. These patterns relate with the user group characteristics (e.g. age, sight or dexterity) and the context of device usage (e.g. healthcare professionals).
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Braun-Münker M, Kahriman B, Ecker F. The package barrier to user adherence: Comparative analysis of various types of opening instructions on the ease of opening comprising effectiveness, efficiency and user satisfaction. Br J Clin Pharmacol 2019; 86:1982-1988. [PMID: 31292979 DOI: 10.1111/bcp.14060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/10/2019] [Accepted: 06/26/2019] [Indexed: 11/29/2022] Open
Abstract
AIMS Adequate user access to drug therapy can only be ensured when the drug can be removed from its package. The aim of this study was to investigate the influence of a variety of opening instructions on the ease of opening a user package and user satisfaction. METHODS This experiment was conducted according to CEN/TS 15945. Ease of opening was defined as the ability to open a package within a defined time frame (effectiveness) and the learning effect by repeated opening (efficiency). (Dis)satisfaction ranged from -2 to +2. Empty bottles with left threat screw caps (rather than the standard right) were studied following 4 different types of instructions: none, arrow in the screw cap, package leaflet, video. Each instruction was studied in a group of 20 different healthy older adult volunteers (65-80 years). No opening aid was permitted. Data were captured in forms and on video. RESULTS Nine (45%) participants could open the package without any instruction, 19 (95%) with an arrow marked bottle and 20 (100%) with a package leaflet or video. No notable differences were observed in median times for first and repeated opening. Participants were most often (n = 11) dissatisfied (score -2) without any instruction and neutral to most satisfied (0-2) with a video (n = 17). CONCLUSION The effectiveness, efficiency and user satisfaction to open a package is strongly influenced by the type of opening instruction. This conclusion requires further consideration in drug product packaging and labelling.
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Affiliation(s)
| | - Bakiye Kahriman
- Hochschule Fulda, Fachbereich Lebensmitteltechnologie, Fulda, Germany
| | - Felix Ecker
- Hochschule Fulda, Fachbereich Lebensmitteltechnologie, Fulda, Germany
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Schnittker R, Marshall SD, Horberry T, Young K. Decision-centred design in healthcare: The process of identifying a decision support tool for airway management. APPLIED ERGONOMICS 2019; 77:70-82. [PMID: 30832780 DOI: 10.1016/j.apergo.2019.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/15/2018] [Accepted: 01/19/2019] [Indexed: 06/09/2023]
Abstract
Current decision support interventions for airway management in anaesthesia lack the application of Human Factors Engineering; leading to interventions that can be disruptive, inefficient and error-inducing. This study followed a decision-centred design process to identify decision support that can assist anaesthesia teams with challenging airway management situations. Field observations, Critical Decision Method interviews and focus groups were conducted to identify the most difficult decisions and their requirements. Data triangulation narrowed the focus to key decisions related to preparation and planning, and the transitioning between airway techniques during difficulties. Five decision-support interventions were identified and positively rated by anaesthesia team members in relation to their perceived effectiveness. An organized airway equipment trolley was chosen as the most beneficial decision support intervention. This study reiterated the key importance of both Human Factors Engineering and data triangulation when designing for healthcare.
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Affiliation(s)
- R Schnittker
- Monash University Accident Research Centre, 21 Alliance Lane, Building 70, Monash University, Clayton Campus, 3800, Victoria, Australia; Department of Anaesthesia and Perioperative Medicine, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Victoria, Australia.
| | - S D Marshall
- Department of Anaesthesia and Perioperative Medicine, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Victoria, Australia.
| | - T Horberry
- Monash University Accident Research Centre, 21 Alliance Lane, Building 70, Monash University, Clayton Campus, 3800, Victoria, Australia.
| | - K Young
- Monash University Accident Research Centre, 21 Alliance Lane, Building 70, Monash University, Clayton Campus, 3800, Victoria, Australia.
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Valdez RS, McGuire KM, Rivera AJ. Qualitative ergonomics/human factors research in health care: Current state and future directions. APPLIED ERGONOMICS 2017; 62:43-71. [PMID: 28411739 DOI: 10.1016/j.apergo.2017.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 01/25/2017] [Accepted: 01/28/2017] [Indexed: 06/07/2023]
Abstract
The objective of this systematic review was to understand the current state of Ergonomics/Human Factors (E/HF) qualitative research in health care and to draw implications for future efforts. This systematic review identified 98 qualitative research papers published between January 2005 and August 2015 in the seven journals endorsed by the International Ergonomics Association with an impact factor over 1.0. The majority of the studies were conducted in hospitals and outpatient clinics, were focused on the work of formal health care professionals, and were classified as cognitive or organizational ergonomics. Interviews, focus groups, and observations were the most prevalent forms of data collection. Triangulation and data archiving were the dominant approaches to ensuring rigor. Few studies employed a formal approach to qualitative inquiry. Significant opportunities remain to enhance the use of qualitative research to advance systems thinking within health care.
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Affiliation(s)
- Rupa Sheth Valdez
- Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Hospital West Complex, Charlottesville, VA 22908, USA.
| | - Kerry Margaret McGuire
- Habitability and Human Factors Branch, NASA's Johnson Space Center, 2101 NASA Parkway, Houston, TX 77058, USA.
| | - A Joy Rivera
- Knowledge and Systems Architect Team, Information Management Services, Children's Hospital of Wisconsin, 9000 W. Wisconsin Ave., Milwaukee, WI 53226, USA.
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Stegemann S, Riedl R, Sourij H. Identification of different shapes, colors and sizes of standard oral dosage forms in diabetes type 2 patients—A pilot study. Int J Pharm 2017; 517:112-118. [DOI: 10.1016/j.ijpharm.2016.11.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 01/14/2023]
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Endestad T, Wortinger LA, Madsen S, Hortemo S. Package Design Affects Accuracy Recognition for Medications. HUMAN FACTORS 2016; 58:1206-1216. [PMID: 27591209 PMCID: PMC5570154 DOI: 10.1177/0018720816664824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Our aim was to test if highlighting and placement of substance name on medication package have the potential to reduce patient errors. BACKGROUND An unintentional overdose of medication is a large health issue that might be linked to medication package design. In two experiments, placement, background color, and the active ingredient of generic medication packages were manipulated according to best human factors guidelines to reduce causes of labeling-related patient errors. METHOD In two experiments, we compared the original packaging with packages where we varied placement of the name, dose, and background of the active ingredient. Age-relevant differences and the effect of color on medication recognition error were tested. In Experiment 1, 59 volunteers (30 elderly and 29 young students), participated. In Experiment 2, 25 volunteers participated. RESULTS The most common error was the inability to identify that two different packages contained the same active ingredient (young, 41%, and elderly, 68%). This kind of error decreased with the redesigned packages (young, 8%, and elderly, 16%). Confusion errors related to color design were reduced by two thirds in the redesigned packages compared with original generic medications. CONCLUSION Prominent placement of substance name and dose with a band of high-contrast color support recognition of the active substance in medications. APPLICATION A simple modification including highlighting and placing the name of the active ingredient in the upper right-hand corner of the package helps users realize that two different packages can contain the same active substance, thus reducing the risk of inadvertent medication overdose.
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Affiliation(s)
- Tor Endestad
- University of Oslo, Norway
- Norwegian Medicines Agency, Oslo, Norway
| | | | - Steinar Madsen
- University of Oslo, Norway
- Norwegian Medicines Agency, Oslo, Norway
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Stegemann S. Defining Patient Centric Drug Product Design and Its Impact on Improving Safety and Effectiveness. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-43099-7_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Borsci S, Buckle P, Hanna GB. Why you need to include human factors in clinical and empirical studies ofin vitropoint of care devices? Review and future perspectives. Expert Rev Med Devices 2016; 13:405-16. [DOI: 10.1586/17434440.2016.1154277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pires CM, Cavaco AM. Exploring the perspectives of potential consumers and healthcare professionals on the readability of a package insert: a case study of an over-the-counter medicine. Eur J Clin Pharmacol 2014; 70:583-8. [PMID: 24458540 DOI: 10.1007/s00228-014-1645-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/07/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore and compare the opinions of physicians, pharmacists and potential users on the readability of a package insert of an over-the-counter medicine. METHODS Exploratory study based on the administration of a semi-open questionnaire. This instrument was developed according to the readability guideline of the European Medicine Agency (EMA) and used to evaluate participants' accessibility to, and comprehensibility of, the package insert for diclofenac 12.5 mg tablets. Sixty-three participants were recruited from the Lisbon region and enrolled in three groups: physicians (Dg), pharmacists (Pg) and potential consumers (PCg), with a minimum of 20 participants each. RESULTS Almost all (85 %) of the 20 PCg participants were educated above the 9th grade, although the majority of them (95 %) referred to, at least, one package insert interpretation issue, mainly related to the comprehension of technical terms. Amongst other differences between the groups, the Pg participants (n = 22) obtained a significantly less favourable opinion regarding the layout of the titles. Furthermore, the Pg and Dg (n = 21) participants proposed technical enhancements, such as the use of a table to explain the posology, precautions in case of renal failure, or the recommendation to take the tablets with meals. CONCLUSIONS Differences in the way of using the diclofenac tablets are expected, considering the comprehension dissimilarities between health professionals and potential consumers. The package insert of diclofenac 12.5 mg could be enhanced for safer use. Regarding the readability assessment of this package insert, the method proposed in the EMA guidelines might not be as effective as expected. Future research is advisable.
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Affiliation(s)
- Carla M Pires
- iMed.UL Research Institute for Medicines and Pharmaceutical Sciences, Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal,
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Holden RJ, Carayon P, Gurses AP, Hoonakker P, Hundt AS, Ozok AA, Rivera-Rodriguez AJ. SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. ERGONOMICS 2013; 56:1669-86. [PMID: 24088063 PMCID: PMC3835697 DOI: 10.1080/00140139.2013.838643] [Citation(s) in RCA: 608] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Healthcare practitioners, patient safety leaders, educators and researchers increasingly recognise the value of human factors/ergonomics and make use of the discipline's person-centred models of sociotechnical systems. This paper first reviews one of the most widely used healthcare human factors systems models, the Systems Engineering Initiative for Patient Safety (SEIPS) model, and then introduces an extended model, 'SEIPS 2.0'. SEIPS 2.0 incorporates three novel concepts into the original model: configuration, engagement and adaptation. The concept of configuration highlights the dynamic, hierarchical and interactive properties of sociotechnical systems, making it possible to depict how health-related performance is shaped at 'a moment in time'. Engagement conveys that various individuals and teams can perform health-related activities separately and collaboratively. Engaged individuals often include patients, family caregivers and other non-professionals. Adaptation is introduced as a feedback mechanism that explains how dynamic systems evolve in planned and unplanned ways. Key implications and future directions for human factors research in healthcare are discussed.
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Affiliation(s)
- Richard J. Holden
- Assistant Professor, Department of Medicine, Division of General Internal Medicine & Public Health, Department of Biomedical Informatics Vanderbilt University School of Medicine, Phone: +1-615-936-4343, Fax: +1-615-936-7373, Center for Research and Innovation in Systems Safety, 719 Medical Arts Building, 1211 21st Avenue S, Nashville, TN, 37212
| | - Pascale Carayon
- Procter & Gamble Bascom Professor in Total Quality, Department of Industrial and Systems Engineering, Director of the Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3126 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706 - USA, tel: +1-608-265-0503 or +1-608-263-2520, fax: +1-608-263-1425
| | - Ayse P. Gurses
- Associate Professor, Armstrong Institute for Patient Safety and Quality, Department of Anesthesiology and Critical Care Medicine, Division of Health Sciences Informatics, School of Medicine, Department of Health Policy and Management, Bloomberg School of Public Health, Department of Civil Engineering, Whiting School of Engineering, The Johns Hopkins University, 750 E. Pratt St. 15Floor, Baltimore, MD 21202, Phone: +1-410-637-4387
| | - Peter Hoonakker
- Research Scientist and Associate Director of Research, Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3132 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706 – USA, Phone: +1-608-658 0837, Fax: +1-608-263-1425
| | - Ann Schoofs Hundt
- Associate Scientist and Associate Director of Education, Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3132 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706 – USA, Phone: +1-608-262-9100, Fax: +1-608-263-1425
| | - A. Ant Ozok
- Associate Professor, Department of Information Systems, UMBC, Adjunct Associate Professor, Department of Anesthesiology, Visiting Associate Professor, The Armstrong Institute of Patient Safety and Quality, School of Medicine, The Johns Hopkins University, 1000 Hilltop Circle, Baltimore, MD 21250, Phone : +1-410-455-8627, Fax : +1-410-455-1073
| | - A. Joy Rivera-Rodriguez
- Assistant Professor, Department of Industrial Engineering, Clemson University, Phone: +1-864-656-3114, Fax: +1-864-656-0795, 130-C Freeman Hall, Box 340920 Clemson, SC 29631
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Beers E, Egberts TCG, Leufkens HGM, Jansen PAF. The views of healthcare professionals, drug developers and regulators on information about older people needed for rational drug prescription. PLoS One 2013; 8:e72060. [PMID: 23977208 PMCID: PMC3745417 DOI: 10.1371/journal.pone.0072060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/05/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The ICH E7 guideline intends to improve the knowledge about medicines in geriatric patients. As a legislative document, it might not reflect the needs of healthcare professionals. This study investigated what information healthcare professionals, regulatory agencies and pharmaceutical industries consider necessary for rational drug prescribing to older individuals. METHODS AND FINDINGS A 29-item-questionnaire was composed, considering the representation in trials, pharmacokinetics, efficacy, safety, and convenience of use in older individuals, with space for additions. Forty-three European professionals with an interest in medication for older individuals were included. In order to investigate their relevance, five items were included in a second questionnaire, with 11 control items. Median scores, differences between clinical and non-clinical respondents and response consistency were analysed. Consistency was present in 10 control items. Therefore, all items of the first questionnaire and the five additional items were analysed. Thirty-seven (86%) respondents returned the first questionnaire; 31/37 (84%) the second. Information about age-related differences in adverse events, locomotor effects, drug-disease interactions, dosing instructions, and information about the proportion of included 65+ patients was considered necessary by most respondents. Clinicians considered information significantly more important than the non-clinical respondents about the inclusion of 75+, time-until-benefit in older people, anticholinergic effects, drug-disease interactions, and convenience of use. Main study limitations are the focus on information for daily practice, while the ICH E7 guideline is a legislative document focused on market approval of a new medicine. Also, a questionnaire with a Likert scale has its limitations; this was addressed by providing space for comments. CONCLUSIONS This study reveals that items considered necessary are currently not included in the ICH E7 guideline. Also, clinicians' and non-clinicians' opinions differed significantly in 15% of the items. Therefore, all stakeholders should collaborate to improve the availability of information for the rational prescribing to older individuals.
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Affiliation(s)
- Erna Beers
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Toine C. G. Egberts
- Departments of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Departments of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hubert G. M. Leufkens
- Departments of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- Dutch Medicines Evaluation Board, The Hague, The Netherlands
| | - Paul A. F. Jansen
- Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht, The Netherlands
- Dutch Medicines Evaluation Board, The Hague, The Netherlands
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Hignett S, Carayon P, Buckle P, Catchpole K. State of science: human factors and ergonomics in healthcare. ERGONOMICS 2013; 56:1491-503. [PMID: 23926898 DOI: 10.1080/00140139.2013.822932] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
UNLABELLED The past decade has seen an increase in the application of human factors and ergonomics (HFE) techniques to healthcare delivery in a broad range of contexts (domains, locations and environments). This paper provides a state of science commentary using four examples of HFE in healthcare to review and discuss analytical and implementation challenges and to identify future issues for HFE. The examples include two domain areas (occupational ergonomics and surgical safety) to illustrate a traditional application of HFE and the area that has probably received the most research attention. The other two examples show how systems and design have been addressed in healthcare with theoretical approaches for organisational and socio-technical systems and design for patient safety. Future opportunities are identified to develop and embed HFE systems thinking in healthcare including new theoretical models and long-term collaborative partnerships. HFE can contribute to systems and design initiatives for both patients and clinicians to improve everyday performance and safety, and help to reduce and control spiralling healthcare costs. PRACTITIONER SUMMARY There has been an increase in the application of HFE techniques to healthcare delivery in the past 10 years. This paper provides a state of science commentary using four illustrative examples (occupational ergonomics, design for patient safety, surgical safety and organisational and socio-technical systems) to review and discuss analytical and implementation challenges and identify future issues for HFE.
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Affiliation(s)
- Sue Hignett
- a Loughborough Design School, Loughborough University , Loughborough Leics LE11 3TU , UK
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Abstract
The process for developing drug delivery systems has evolved over the past two decades with more scientific rigor, involving a collaboration of various fields, i.e., biology, chemistry, engineering, and pharmaceutics. Drug products, also commonly known in the pharmaceutical industry as formulations or "dosage forms," are used for administering the active pharmaceutical ingredient (API) for purposes of assessing safety in preclinical models, early- to late-phase human clinical trials, and for routine clinical/commercial use. This overview discusses approaches for creating small-molecule API dosage forms, from preformulation to commercial manufacturing.
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Affiliation(s)
- Padma Narayan
- The Dow Chemical Company, Engineering Sciences, Solids Processing, Midland, Michigan, USA
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Carayon P, Buckle P. Editorial for special issue of applied ergonomics on patient safety. APPLIED ERGONOMICS 2010; 41:643-644. [PMID: 20106466 DOI: 10.1016/j.apergo.2009.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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