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Cooper M, Atkinson O, Black D, Lindsey L, Cooper C, Nazar H, Wong G, Hughes C, Richardson CL. Informal carer involvement in the transition of medicines-related care for patients moving from hospital to home: a realist review protocol. BMJ Open 2024; 14:e091005. [PMID: 39266322 PMCID: PMC11409271 DOI: 10.1136/bmjopen-2024-091005] [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] [Indexed: 09/14/2024] Open
Abstract
INTRODUCTION Transition of care for a patient between hospital and home can cause disruption to normal routines, increasing the risk of medicines-related harm. The transition from hospital to home is more complex when a patient does not self-manage their medicines but relies on an informal or unpaid carer (eg, spouse, family member or friend) to provide support. Given the day-to-day medicines-related support provided by informal carers, there is a need to understand how informal carers manage the transition of care from hospital to home; what aspects of hospital discharge act as barriers and facilitators to their involvement and when, how and why these impact patients. METHODS AND ANALYSIS A realist review will be undertaken to develop a programme theory. The programme theory will theorise which medicines-related interventions are useful to carers, and how they are useful. It will outline what aspects of those interventions are the most useful and why, and how context influences engagement and medicine-related outcomes. The review will be reported in line with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards guidelines. Data will be selected, screened and extracted based on defined inclusion and exclusion criteria and relevance to the developing programme theory with the involvement of at least two authors acting independently. Inclusion criteria relate to the relevance to hospital discharge where patients move back to their home, where a carer is involved and where interventions relate to medicines use. Searches will be conducted in PubMed, CINAHL (via EBSCOhost) and EMBASE databases (see supplementary materials for a draft search strategy).Patients and public, participation, involvement and engagement (PPIE) will be incorporated into all stages of the review through iterative engagement and discussion with patient, carers and representatives from carer organisations. The review will follow four steps: (1) development of the initial programme theory, (2) evidence search, (3) selection, extracting, and organising data and (4) synthesising evidence and drawing conclusions.Informal carer involvement in transitions of care is a complex and varied phenomena. The programme theory will be shaped by sustained PPIE reflecting the priorities and experiences of lived experience. The realist review be progressively focused so we can develop a better understanding of carer involvement in patient transitions when moving from hospital to home relating to medicines use. ETHICS AND DISSEMINATION Ethical approval is not required. The findings of the review will be disseminated via journal articles and through patient and public facing resources such as a visual patient-public-carer focused summary. PROSPERO REGISTRATION NUMBER CRD42021262827.
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Affiliation(s)
- Matthew Cooper
- Newcastle Patient Safety Research Collaboration, Newcastle University, Newcastle upon Tyne, UK
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Olivia Atkinson
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - David Black
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Lindsey
- Newcastle Patient Safety Research Collaboration, Newcastle University, Newcastle upon Tyne, UK
| | - Christina Cooper
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Hamde Nazar
- Newcastle Patient Safety Research Collaboration, Newcastle University, Newcastle upon Tyne, UK
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Carmel Hughes
- School of Pharmacy, Queens University Belfast, Belfast, UK
| | - Charlotte L Richardson
- Newcastle Patient Safety Research Collaboration, Newcastle University, Newcastle upon Tyne, UK
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
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Valdez RS, Lyon SE, Corbett JP, Wellbeloved-Stone C, Hasan S, Taylor L, DeBoer MD, Cherñavvsky D, Patek SD. Macroergonomic components of the patient work system shaping dyadic care management during adolescence: a case study of type 1 diabetes. ERGONOMICS 2024:1-21. [PMID: 38712661 DOI: 10.1080/00140139.2024.2343942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024]
Abstract
The role of the social, physical, and organisational environments in shaping how patients and their caregivers perform work remains largely unexplored in human factors/ergonomics literature. This study recruited 19 dyads consisting of a parent and their child with type 1 diabetes to be interviewed individually and analysed using a macroergonomic framework. Our findings aligned with the macroergonomic factors as presented in previous models, while highlighting the need to expand upon certain components to gain a more comprehensive representation of the patient work system as relevant to dyadic management. Examples of design efforts that should follow from these findings include expanding existing data sharing options to include information from the external environment and capitalising on the capabilities of artificial intelligence as a decision support system. Future research should focus on longitudinally assessing patient work systems throughout transition periods in addition to more explicitly exploring the roles of social network members.
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Affiliation(s)
- Rupa S Valdez
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, Virginia, USA
- Health Discovery & Innovations, University of Virginia, Charlottesville, Virginia, USA
| | - Sophie E Lyon
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Saadiq Hasan
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Lauren Taylor
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D DeBoer
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Virginia, Charlottesville, Virginia, USA
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel Cherñavvsky
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
- Dexcom, Inc., San Diego, California, USA
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Heidari S, Tavakkoli-Moghaddam R, Salimi B, Mehdizadeh-Somarin Z, Hamid M. An integrated approach for evaluating and improving the performance of hospital ICUs based on ergonomic and work-motivational factors. Comput Biol Med 2024; 168:107773. [PMID: 38064847 DOI: 10.1016/j.compbiomed.2023.107773] [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: 05/03/2023] [Revised: 10/28/2023] [Accepted: 11/26/2023] [Indexed: 01/10/2024]
Abstract
The intensive care unit (ICU) holds significant importance in hospitals. Primarily concerned with monitoring and providing care to critically ill patients, the ICU has proven effective in reducing mortality rates and minimizing complications of diseases, thanks to the highly complex and specific measures taken within this department. Considering the unique contributions made by the staff in this unit, its performance assessment can help improve patient care and satisfaction. This study presents a framework that utilizes ergonomic and work-motivational factors (WMFs) to assess the performance of various ICUs. Upon the identification of these indicators, a standard questionnaire is developed to collect the required data. The mean efficiency score of the units is then determined using the data envelopment analysis (DEA). The model is validated using the principal component analysis (PCA). Ultimately, the SWOT (strengths, weaknesses, opportunities, and threats) matrix is employed to formulate an appropriate strategy and offer improvement measures to the managerial team to enhance their ICU performance. The proposed framework can be applied to evaluate the performance of other healthcare departments. Among the studied ICU centers, including general ICU, isolation ICU catering to individuals with infectious diseases, cardiac care unit (CCU), and neonatal ICU (NICU). NICU and general ICU have the best and worst performance in terms of macro- and micro-ergonomic and motivational indicators, which are on average 0.826% more elevated and 0.659% lower, respectively. According to the performed sensitivity analysis, the ICUs in question demonstrate the most appropriate and inappropriate performance about the indicators of "knowledge, situation assessment, and situation analysis" and "work stress", respectively.
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Affiliation(s)
- Saeideh Heidari
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran.
| | | | - Behnaz Salimi
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran.
| | | | - Mahdi Hamid
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran.
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Clark CM, Eimer MC, Intorre FM. Transitions of Care: Strategies for Medication Optimization and Deprescribing in Older Adults. J Gerontol Nurs 2023; 49:5-10. [PMID: 38015150 DOI: 10.3928/00989134-20231107-02] [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: 11/29/2023]
Abstract
Older adults have an increased risk of adverse drug events related to polypharmacy and potentially inappropriate medication (PIM) use. These patients are even more vulnerable as they transition through different health care settings. In 2023, the American Geriatrics Society published an updated version of the Beers Criteria®, providing updated guidance on identifying and managing PIMs. Nurses and nurse practitioners play important roles in medication management across the continuum of care. The current article aims to illustrate key concepts regarding medication safety and deprescribing for older adult patients during transitions of care. [Journal of Gerontological Nursing, 49(12), 5-10.].
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Rogers CC, Jang SS, Tidwell W, Shaughnessy S, Milburn J, Hauck FR, Williams IC, Valdez RS. Designing mobile health to align with the social determinants of health. Front Digit Health 2023; 5:1193920. [PMID: 37274765 PMCID: PMC10232872 DOI: 10.3389/fdgth.2023.1193920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
The maternal health crisis in the United States is becoming increasingly worse, with disparities continuing to escalate among marginalized populations. mHealth can contribute to addressing the Social Determinants of Health (SDOH) that produce inequities in maternal morbidity and mortality. Reducing inequities through mHealth can be achieved by designing these technologies to align with SDOH. As mHealth developed to support maternal health has primarily supported the extension of clinical care, there is an opportunity to integrate frameworks and methods from human factors/ergonomics and public health to produce thorough comprehension of SDOH through intentional partnerships with marginalized populations. Potential for this opportunity is presented through a case study derived from a community-based participatory research process focused on transportation access to maternal health services. Through multi-faceted, interdisciplinary, and community-based approaches to designing mHealth that attends to the systemic factors that generate and escalate inequities, improvements in the maternal health crisis could be realized.
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Affiliation(s)
- Courtney C. Rogers
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA, United States
| | - Sophia S. Jang
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | | | | | - Juliane Milburn
- Department of Family and Community Health Nursing, Virginia Commonwealth University, Richmond, VA, United States
| | - Fern R. Hauck
- Department of Family Medicine, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Ishan C. Williams
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Rupa S. Valdez
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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Kandiah J, Nazar H, Blacklock J, Robinson A, Wright D. Contextual factors influencing medicines-related interventions to support safe transitions for care home residents post hospital discharge: a systematic review and meta-ethnographic synthesis. Int J Clin Pharm 2023; 45:26-37. [PMID: 36394785 PMCID: PMC9938806 DOI: 10.1007/s11096-022-01507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Residents of care or nursing homes are at a higher risk of medication-related harm, especially during care transitions. No medicines-related intervention has been identified that supports the safe transition for these residents moving into their residence following hospital discharge. A model of care integrating a number of intervention components is suggested to be most effective AIM: To investigate, via a systematic review and meta-ethnography, the factors which influence the impact of medicines related interventions. METHOD In December 2020, Pubmed, MEDLINE, EMBASE, PsycINFO, and CINAHL Complete were systematically searched. All studies reporting on medicines-related interventions for residents following hospital discharge were included. Quality assessment was undertaken with a validated tool. Meta-ethnography was used to investigate the factors which influenced how interventions did, or did not work. Findings were mapped to a validated conceptual framework for integrated care. RESULTS From 3884 studies, nine met the inclusion criteria and were analysed. These were generally of medium quality (n = 6). The interventions were diverse: some tackled the transition process, some tackled follow-up care and some interventions involved both. The meta-ethnography, using the a priori conceptual framework, captured factors reported within the studies that influenced implementation, delivery and/or outcomes. CONCLUSION The review and synthesis informed the development of a conceptual model for transitionary care for this population group. Researchers and decision-makers can use this as a tool to understand their local context and inform future intervention design, implementation and evaluation in this clinical area.
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Affiliation(s)
- Janani Kandiah
- University of East Anglia, Norwich Research Park, Norwich, UK ,Centre for Pharmacy, University of Bergen, Bergen, Norway
| | - Hamde Nazar
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK.
| | | | - Anna Robinson
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK
| | - David Wright
- Centre for Pharmacy, University of Bergen, Bergen, Norway ,School of Healthcare, University of Leicester, Leicester, UK
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Hernandez R, Roll SC, Jin H, Schneider S, Pyatak EA. Validation of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) adapted for the whole day repeated measures context. ERGONOMICS 2022; 65:960-975. [PMID: 34766872 PMCID: PMC9124236 DOI: 10.1080/00140139.2021.2006317] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
Our objective was to investigate the validity of four-item and six-item versions of the National Aeronautics and Space Administration Task Load Index (NASA-TLX, or TLX for short) for measuring workload over a whole day in the repeated measures context. We analysed data on 51 people with type 1 diabetes from whom we collected ecological momentary assessment and daily diary data over 14 days. The TLX was administered at the last survey of every day. Confirmatory factor analysis fit statistics indicated that neither the TLX-6 nor TLX-4 were a unidimensional representation of whole day workload. In exploratory analyses, another set of TLX items we refer to as TLX-4v2 was sufficiently unidimensional. Raw sum scores from the TLX-6 and TLX-4v2 had plausible relationships with other measures, as evidenced by intra-person correlations and mixed-effects models. TLX-6 appears to capture multiple factors contributing to workload, while TLX-4v2 assesses the single factor of 'mental strain'. Practitioner Summary: Using within-person longitudinal data, we found evidence supporting the validity of a measure evaluating whole-day workload (i.e. workload derived from all sources, not only paid employment) derived from the NASA-TLX. This measure may be useful to assess how day-to-day variations in workload impact quality of life among adults.Abbreviations: NASA-TLX or TLX: National Aeronautics and Space Administration Task Load Index; TLX-6: six item version of the NASA-TLX; TLX-4: four item version of the NASA-TLX, TLX-4v2: four item NASA-TLX version two; NIOSH: National Institute for Occupational Safety and Health; CFA: confirmatory factor analysis; T1D: type 1 diabetes; EMA: ecological momentary assessment; BG: blood glucose; SD: standard deviation; CV: coefficient of variation; RMSEA: root mean square error of approximation; CFI: comparative fit index; TLI: Tucker-Lewis Index; SRMR: standardized root mean square residual; AIC: Akaike information criterion; BIC: Bayesian information criterion; χ2: Chi-square statistic.
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Affiliation(s)
- Raymond Hernandez
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St, Los Angeles, CA 90089 United States
| | - Shawn C. Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St, Los Angeles, CA 90089 United States
| | - Haomiao Jin
- Dornsife Center for Self-Report Science and Center for Social & Economic Research, University of Southern California, Los Angeles, California, USA
| | - Stefan Schneider
- Dornsife Center for Self-Report Science and Center for Social & Economic Research, University of Southern California, Los Angeles, California, USA
| | - Elizabeth A. Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St, Los Angeles, CA 90089 United States
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Holden RJ, Abebe E, Russ-Jara AL, Chui MA. Human factors and ergonomics methods for pharmacy research and clinical practice. Res Social Adm Pharm 2021; 17:2019-2027. [PMID: 33985892 PMCID: PMC8603214 DOI: 10.1016/j.sapharm.2021.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Human factors and ergonomics (HFE) is a scientific and practical human-centered discipline that studies and improves human performance in sociotechnical systems. HFE in pharmacy promotes the human-centered design of systems to support individuals and teams performing medication-related work. OBJECTIVE To review select HFE methods well suited to address pharmacy challenges, with examples of their application in pharmacy. METHODS We define the scope of HFE methods in pharmacy as applications to pharmacy settings, such as inpatient or community pharmacies, as well as medication-related phenomena such as medication safety, adherence, or deprescribing. We identify and present seven categories of HFE methods suited to widespread use for pharmacy research and clinical practice. RESULTS Categories of HFE methods applicable to pharmacy include work system analysis; task analysis; workload assessment; medication safety and error analysis; user-centered and participatory design; usability evaluation; and physical ergonomics. HFE methods are used in three broad phases of human-centered design and evaluation: study; design; and evaluation. The most robust applications of HFE methods involve the combination of HFE methods across all three phases. Two cases illustrate such a comprehensive application of HFE: one case of medication package, label, and information design and a second case of human-centered design of a digital decision aid for medication safety. CONCLUSIONS Pharmacy, including the places where pharmacy professionals work and the multistep process of medication use across people and settings, can benefit from HFE. This is because pharmacy is a human-centered sociotechnical system with an existing tradition of studying and analyzing the present state, designing solutions to problems, and evaluating those solutions in laboratory or practice settings. We conclude by addressing common concerns about the implementation of HFE methods and urge the adoption of HFE methods in pharmacy.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Center for Aging Research, Regenstrief Institute, Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
| | - Ephrem Abebe
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Alissa L Russ-Jara
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Michelle A Chui
- Social & Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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Grimes TC. Is it time for greater patient involvement to enhance transitional medication safety? BMJ Qual Saf 2021; 31:247-250. [PMID: 34417334 DOI: 10.1136/bmjqs-2021-014116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 12/11/2022]
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Holden RJ, Carayon P. SEIPS 101 and seven simple SEIPS tools. BMJ Qual Saf 2021; 30:901-910. [PMID: 34039748 PMCID: PMC8543199 DOI: 10.1136/bmjqs-2020-012538] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/11/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - Pascale Carayon
- Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
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11
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Abebe E, Campbell NL, Clark DO, Tu W, Hill JR, Harrington AB, O'Neal G, Trowbridge KS, Vallejo C, Yang Z, Bo N, Knight A, Alamer KA, Carter A, Valenzuela R, Adeoye P, Boustani MA, Holden RJ. Reducing anticholinergic medication exposure among older adults using consumer technology: Protocol for a randomized clinical trial. Res Social Adm Pharm 2021; 17:986-992. [PMID: 33773639 PMCID: PMC8007932 DOI: 10.1016/j.sapharm.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION A growing body of scientific evidence points to the potentially harmful cognitive effects of anticholinergic medications among older adults. Most interventions designed to promote deprescribing of anticholinergics have directly targeted healthcare professionals and have had mixed results. Consumer-facing technologies may provide a unique benefit by empowering patients and can complement existing healthcare professional-centric efforts. METHODS We initiated a randomized clinical trial to evaluate the effectiveness of a patient-facing mobile application (Brain Safe app) compared to an attention control medication list app in reducing anticholinergic exposure among community-dwelling older adults. Study participants are adults aged 60 years and above, currently using at least one prescribed strong anticholinergic, and receiving primary care. The trial plans to enroll a total of 700 participants, randomly allocated in 1:1 proportion to the two study arms. Participants will have the Brain Safe app (intervention arm) or attention control medication list app (control arm) loaded onto a smartphone (study provided or personal device). All participants will be followed for 12 months and will have data collected at baseline, at 6 months, and 12 months by blinded outcome assessors. The primary outcome of the study is anticholinergic exposure measured as total standard daily dose (TSDD) computed from medication prescription electronic records. Secondary outcomes of the study are cognitive function and health-related quality of life. DISCUSSION A consumer-facing intervention to promote deprescribing of potentially high-risk medications can be part of a multi-pronged approach to reduce inappropriate medication use among older adult patients. Delivering a deprescribing intervention via a mobile app is a novel approach and may hold great promise to accelerate deployment of medication safety initiatives across diverse patient populations. CLINICAL TRIAL REGISTRATION Registered at ClinicalTrials.gov on October 10, 2019. Identifier number: NCT04121858.
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Affiliation(s)
- Ephrem Abebe
- Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Noll L Campbell
- Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, IN, USA; Eskenazi Health, Indianapolis, IN, USA
| | - Daniel O Clark
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jordan R Hill
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Addison B Harrington
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Gracen O'Neal
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Kimberly S Trowbridge
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Christian Vallejo
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Ziyi Yang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Na Bo
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alexxus Knight
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Khalid A Alamer
- Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN, USA
| | - Allie Carter
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robin Valenzuela
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Philip Adeoye
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Malaz A Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA; Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, USA
| | - Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, IN, USA.
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Yang Y, Pitts SI, Chen AR. Barriers in communicating medication changes at hospital discharge: Informing CancelRx design requirements. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211005928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives This operational study aims to investigate the barriers in communicating medication changes at hospital discharge, and to inform design requirements of the CancelRx functionality to better support the communication. Methods We conducted seven semi-structured interviews with inpatient prescribers at an urban academic medical center. The interview protocol was framed from a human factors perspective, specifically the work system design approach. We took notes of the interviews and identified the initial themes of system barriers that may impact patient safety. Results Medication changes need to be communicated to multiple stakeholders. We identified two initial themes of the system barriers: the lack of an information flow that connects all the involved stakeholders, and the difficulties to communicate key pieces of information. We identified three key pieces of information that are difficult to communicate: the discontinuation reasons, the notification urgency, and the duration of changes. Conclusions While the CancelRx functionality can facilitate the communication (e.g. prescribers no longer need to call pharmacists when a medication is discontinued), enhancements are needed to address the system barriers. We proposed enhanced design requirements of the CancelRx functionality, e.g., to allow users to specify a reason for a medication discontinuation and transmit the reasons to other stakeholders, to indicate the urgency of notification, to specify the duration of a change, and to receive system status feedback .
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Affiliation(s)
- Yushi Yang
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Health System, Baltimore, MD, USA
| | - Samantha I Pitts
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Allen R Chen
- Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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