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Gidal BE, Resnick T, Smith MC, Wheless JW. Zonisamide: A Comprehensive, Updated Review for the Clinician. Neurol Clin Pract 2024; 14:e200210. [PMID: 38170117 PMCID: PMC10759004 DOI: 10.1212/cpj.0000000000200210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/15/2023] [Indexed: 01/05/2024]
Abstract
Purpose of Review Zonisamide (ZNS) was first approved in the United States in 2000 for the adjunctive treatment of patients aged 16 years or older with partial (focal) seizures. Although ZNS has been proven to treat multiple seizure types, it has been largely underutilized in US clinical practice. Recent Findings Published literature demonstrated that antiseizure medications (ASMs) acting on Na+ and Ca2+ channels may add beneficial effects in many seizure types by reducing seizure frequency and leading to overall improvements. In addition, effects of ZNS may lead to clinical improvements in Parkinson disease, alcohol and sleep disorders, pain, and migraine. ZNS is available in multiple formulations and is a safe and effective, broad spectrum ASM. Summary The purpose of this review was to provide an update to what is known about the efficacy of ZNS and where it shows benefits in the treatment of patients with epilepsy and other CNS disorders through its many unique mechanisms of action.
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Affiliation(s)
- Barry E Gidal
- Pharmacy Practice & Translational Research (BEG), University of Wisconsin-Madison; Department of Neurology (TR), Nicklaus Children Hospital; Department of Neurology, Florida International University, Miami, FL; Department of Neurological Sciences (MCS), Rush Medical College; Rush University Medical Center, Chicago, IL; and Pediatric Neurology (JWW), University of Tennessee Health Science Center; Neuroscience Institute & Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, Memphis, TN
| | - Trevor Resnick
- Pharmacy Practice & Translational Research (BEG), University of Wisconsin-Madison; Department of Neurology (TR), Nicklaus Children Hospital; Department of Neurology, Florida International University, Miami, FL; Department of Neurological Sciences (MCS), Rush Medical College; Rush University Medical Center, Chicago, IL; and Pediatric Neurology (JWW), University of Tennessee Health Science Center; Neuroscience Institute & Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, Memphis, TN
| | - Michael C Smith
- Pharmacy Practice & Translational Research (BEG), University of Wisconsin-Madison; Department of Neurology (TR), Nicklaus Children Hospital; Department of Neurology, Florida International University, Miami, FL; Department of Neurological Sciences (MCS), Rush Medical College; Rush University Medical Center, Chicago, IL; and Pediatric Neurology (JWW), University of Tennessee Health Science Center; Neuroscience Institute & Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, Memphis, TN
| | - James W Wheless
- Pharmacy Practice & Translational Research (BEG), University of Wisconsin-Madison; Department of Neurology (TR), Nicklaus Children Hospital; Department of Neurology, Florida International University, Miami, FL; Department of Neurological Sciences (MCS), Rush Medical College; Rush University Medical Center, Chicago, IL; and Pediatric Neurology (JWW), University of Tennessee Health Science Center; Neuroscience Institute & Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, Memphis, TN
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Robert V, Fabri B, Bouillot E, Papailhau C, Abbes M, Grino M, Vincentelli MB. A description of dry oral forms of medication administration modifications by nurses in home settings. Geriatr Nurs 2021; 43:249-253. [PMID: 34952308 DOI: 10.1016/j.gerinurse.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022]
Abstract
Modifying the galenic of dry oral forms (DOF) to be administered to patients with swallowing or behavioral disorders is frequent in long term care homes. The objective was to investigate the practice of modifying DOF galenic by nurses in home settings (NHS). A 14-question electronic survey was distributed to 1977 NHS. Almost 3/4 of respondents reported crushing tablets or opening capsules, with 37% on a daily basis. Approximately 22% did not inquire about the feasibility of modifying galenic DOF beforehand. Nearly 75% of NHS were aware about the risk of ineffectiveness after crushing tablets or opening capsules. However, only 14% mentioned the risk of overdosing associated with this practice. More than 60% of NHS never wore protective equipment when changing dosage form. Changing the dosage form of DOF is a widespread practice in home settings. Our present work urges the need to improve collaboration between prescribing physicians, nurses and pharmacists.
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Affiliation(s)
- Vincent Robert
- Internal Pharmacy Department, State Geriatric Center, 176 avenue de Montolivet, Marseille 13012, France.
| | - Benjamin Fabri
- Internal Pharmacy Department, State Geriatric Center, 176 avenue de Montolivet, Marseille 13012, France
| | - Elodie Bouillot
- Internal Pharmacy Department, State Geriatric Center, 176 avenue de Montolivet, Marseille 13012, France
| | - Charlotte Papailhau
- Internal Pharmacy Department, State Geriatric Center, 176 avenue de Montolivet, Marseille 13012, France
| | - Mélissa Abbes
- Internal Pharmacy Department, State Geriatric Center, 176 avenue de Montolivet, Marseille 13012, France
| | - Michel Grino
- Department of Clinical Research, State Geriatric Center, Marseille, France
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Establishing an Electronic Referral System from Speech and Language Therapy to Pharmacy to Improve Medication Administration in Patients with Dysphagia in an Acute Hospital Setting. Dysphagia 2021; 37:125-136. [PMID: 33587172 DOI: 10.1007/s00455-021-10256-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
Dysphagia affects swallowing not only of food and drink, but also of orally administered medications. Altering solid or liquid dose formulations renders administration unlicensed and may have adverse effects. Medication administration in patients with dysphagia necessitates a multidisciplinary approach with no one profession holding all necessary expertise. This project aimed to improve the process of medication administration for patients with dysphagia in an acute hospital. Following a baseline audit of practice, an electronic referral system from Speech & Language Therapy (SLT) to Pharmacy was established. Repeat post-implementation audits documenting medication administration to patients with dysphagia and SLT compliance in completing electronic referral were conducted. Of the 43 patients included in the post-implementation audits, 14 (32.6%) were referred from SLT to Pharmacy using the electronic referral system. Those patients referred electronically were reviewed by Pharmacy quicker than those patients who were not referred and had a higher percentage of optimally administered medications. All SLTs eligible (n = 10) were surveyed to explore use of the system and barriers to its use; reasons given for not completing an electronic referral included not prioritizing the referral if under time pressure and lack of IT access to make the referral. Overall compliance with use of the electronic referral system was lower than expected; further work is needed to establish consistency of practice in using the electronic referral system in the interest of optimizing medication administration to patients.
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Solberg H, Devik SA, Bell HT, Zeiss DH, Olsen RM. Drug modification by nurses in Norwegian nursing homes: A cross-sectional study. Geriatr Nurs 2021; 42:351-357. [PMID: 33561616 DOI: 10.1016/j.gerinurse.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
Crushing and dividing pills among older patients in nursing homes appears to be a common yet not harmless practice. Because few updates exist regarding the role of nurses and their dispensing of drugs in nursing homes, this study sought to describe the occurrence, methods, and causes of nurses' drug modification and to examine possible factors associated with drug modification in this context. A cross-sectional study of 273 dispensing episodes of solid oral drugs made by nurses, were observed during day and evening shifts. Modifications were made in 20.5% of the dispensing episodes, including 80.4% where alterations were made by crushing and 19.6% where alterations were made dividing. The most commonly reported reasons for modification were 'swallowing difficulties' (53.6%) and 'lack of understanding by the patient' (19.6%). The logistic regression analysis showed a significant association between the occurrence of drug modification and both cognitive impairment and administration method.
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Affiliation(s)
- Hege Solberg
- Faculty of Nursing and Health Sciences, Nord University, PO Box 474, 7801 Namsos Norway.
| | - Siri Andreassen Devik
- Centre for Care Research Mid-Norway, Nord University, PO Box 474, 7801 Namsos, Norway
| | - Hege Therese Bell
- Faculty of Nursing and Health Sciences, Nord University, PO Box 474, 7801 Namsos Norway; Faculty of Nursing and Health Sciences, Nord University, PO Box 93, 760 Levanger, Norway; Master in Pharmacy, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Høgskoleringen, 1, 7491 Trondheim, Norway
| | - Daniel Horst Zeiss
- Faculty of Nursing and Health Sciences, Nord University, PO Box 474, 7801 Namsos Norway
| | - Rose Mari Olsen
- Faculty of Nursing and Health Sciences, Nord University, PO Box 474, 7801 Namsos Norway
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Shariff Z, Kirby D, Missaghi S, Rajabi-Siahboomi A, Maidment I. Patient-Centric Medicine Design: Key Characteristics of Oral Solid Dosage Forms that Improve Adherence and Acceptance in Older People. Pharmaceutics 2020; 12:pharmaceutics12100905. [PMID: 32977445 PMCID: PMC7598259 DOI: 10.3390/pharmaceutics12100905] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023] Open
Abstract
Older people represent a very heterogeneous patient population and are the major user group of medication. Age-related changes mean that this population can encounter barriers towards taking medicines orally. The aim of this study was to investigate the characteristics of oral solid dosage forms that contribute to an age appropriate dosage design, with an aim to improve overall medication adherence and acceptance in older people. Fifty-two semistructured interviews were conducted with older people, informal (family) carers, and health and social care professionals. Formulation characteristics impacted three stages of the medication taking process: (1) medication identification and memorability, (2) medication handling and (3) swallowability. Small round tablets (≤7 mm) are least accepted amongst older people and their carers and had a negative impact on all stages. The use of bright, two-coloured preparations and interesting shapes improves identification and further aids memorability of indications and the timing of tablets. Palatability, while useful to enhance swallowability, also has an impact on the visual appeal and memorability of medication. Environmental, patient, medication and disease characteristics also determine preferences for formulation. Developing an age appropriate dosage design for older people, therefore, requires a holistic, patient-centric approach to improve adherence and acceptance.
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Affiliation(s)
- Zakia Shariff
- Aston Pharmacy School, Aston University, Birmingham B4 7ET, UK;
- Correspondence: (Z.S.); (D.K.)
| | - Daniel Kirby
- Aston Pharmacy School, Aston University, Birmingham B4 7ET, UK;
- Correspondence: (Z.S.); (D.K.)
| | | | | | - Ian Maidment
- Aston Pharmacy School, Aston University, Birmingham B4 7ET, UK;
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Shariff ZB, Dahmash DT, Kirby DJ, Missaghi S, Rajabi-Siahboomi A, Maidment ID. Does the Formulation of Oral Solid Dosage Forms Affect Acceptance and Adherence in Older Patients? A Mixed Methods Systematic Review. J Am Med Dir Assoc 2020; 21:1015-1023.e8. [PMID: 32224260 DOI: 10.1016/j.jamda.2020.01.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Age-related changes mean that the older population can encounter barriers toward taking medication orally. Further work is needed to identify the characteristics of oral solid dosage forms that will improve patient acceptance and adherence. The aim of this systematic review was to identify if and how formulation aspects of oral solid dosage forms affect acceptance and adherence in older people. DESIGN Mixed methods systematic review using a data-based convergent synthesis design. SETTING AND PARTICIPANTS Articles were selected if they included participants aged 60 years and older, or included health care professionals, social care professionals, and informal carers of patients aged 60 years and older. METHODS A systematic search of the following databases was undertaken: Web of Science, MEDLINE, Scopus, and The Cochrane Databases. The search of databases was supplemented by a search of gray literature, and reference lists of included papers were manually searched. RESULTS A total of 16 studies were included in the final synthesis. Three themes were generated from the thematic analysis: (1) dimensions, (2) palatability, and (3) appearance. The dimensions and palatability are often modified to improve swallowability by breaking tablets in half or taste masking with food. Polypharmacy can lead to patients using the appearance to identify tablets; however, this can lead to confusion when products appear similar. No study was identified that explored formulation characteristics across all 3 categories directly in the older population. CONCLUSION AND IMPLICATIONS Manufacturers should take into account practical problems older people may encounter when considering the dimensions, palatability, and appearance of the final drug product. These characteristics should be optimized to aid visual identification and swallowability. Medical providers and pharmacists have an important role in ensuring that these patient-centric drug products are prescribed and dispensed appropriately so that patients receive the most suitable formulation.
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Affiliation(s)
- Zakia B Shariff
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom.
| | - Dania T Dahmash
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Daniel J Kirby
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | | | | | - Ian D Maidment
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
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Thiazolidinedione as an alternative to facilitate oral administration in geriatric patients with Alzheimer's disease. Eur J Pharm Sci 2019; 129:173-180. [DOI: 10.1016/j.ejps.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/04/2018] [Accepted: 01/09/2019] [Indexed: 02/02/2023]
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Mc Gillicuddy A, Kelly M, Crean AM, Sahm LJ. Understanding the knowledge, attitudes and beliefs of community-dwelling older adults and their carers about the modification of oral medicines: A qualitative interview study to inform healthcare professional practice. Res Social Adm Pharm 2019; 15:1425-1435. [PMID: 30658913 DOI: 10.1016/j.sapharm.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/24/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Oral medicines are commonly modified (e.g. tablets split/crushed) to meet the dosing and swallowing requirements of older adults. However, there is limited research investigating the opinions of community-dwelling patients and carers about medicine modification. OBJECTIVES The aim of this study was to investigate the views of community-dwelling older adults and their carers about oral medicine modification. METHODS Semi-structured, face-to-face interviews were conducted with community-dwelling older adults and carers of older adults who experienced difficulty swallowing medicines, or who required medicines to be modified. Participants were recruited from purposively selected community pharmacies using a combination of purposive, convenience and snowball sampling. Interviews were audio-recorded, transcribed verbatim and analysed thematically. The Francis method governed when data saturation had been reached. RESULTS Twenty-six interviews (13 patients, 13 carers) were conducted (76.9% female, median length 11 min (IQR 8-16 min)). Four themes emerged from the data: variation in medical needs and preferences; balancing acceptance and resignation; healthcare professional engagement and; opportunities for optimising formulation suitability. The heterogeneity of medical conditions experienced by community-dwelling older adults resulted in a variety of modifications being required. Patients and carers are accepting of their medications and formulations. However, when challenges arise, they tend to feel resigned to coping within the constraints of the current medication regimen, resulting in a lack of focused communication with healthcare professionals. Thus, healthcare professionals were unaware of their difficulties and unable to offer advice or solutions. CONCLUSION Healthcare professionals must engage proactively with this group. Whilst a holistic approach to medication management is ideal, the disadvantage is that no single healthcare professional may identify this as their responsibility. Whilst the input and expertise of all healthcare professionals will be required, as medication experts, the pharmacy profession should take ownership and become the champion of, and for, the patient.
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Affiliation(s)
- Aoife Mc Gillicuddy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork (UCC), Cork, Ireland.
| | - Maria Kelly
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork (UCC), Cork, Ireland.
| | - Abina M Crean
- School of Pharmacy, University College Cork (UCC), Cork, Ireland.
| | - Laura J Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork (UCC), Cork, Ireland; Pharmacy Department, Mercy University Hospital, Cork, Ireland.
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Khan MS, Roberts MS. Challenges and innovations of drug delivery in older age. Adv Drug Deliv Rev 2018; 135:3-38. [PMID: 30217519 DOI: 10.1016/j.addr.2018.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Both drug delivery performance and various age-related physical, mental and physiological changes can affect drug effectiveness and safety in elderly patients. The many drug delivery systems developed over the years include recent novel transdermal, nasal, pulmonary and orally disintegrating tablets that provide consistent, precise, timely and more targeted drug delivery. Certain drug delivery systems may be associated with suboptimal outcomes in the elderly because of the nature of drug present, a lack of appreciation of the impact of age-related changes in drug absorption, distribution and clearance, the limited availability of pharmacokinetic, safety and clinical data. Polypharmacy, patient morbidity and poor adherence can also contribute to sub-optimal drug delivery systems outcomes in the elderly. The development of drug delivery systems for the elderly is a poorly realised opportunity, with each system having specific advantages and limitations. A key challenge is to provide the innovation that best meets the specific physiological, psychological and multiple drug requirements of individual elderly patients.
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Ranmal SR, O’Brien F, Lopez F, Ruiz F, Orlu M, Tuleu C, Walsh J, Liu F. Methodologies for assessing the acceptability of oral formulations among children and older adults: a systematic review. Drug Discov Today 2018; 23:830-847. [DOI: 10.1016/j.drudis.2018.01.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/07/2017] [Accepted: 01/15/2018] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE Oral medicines are frequently modified (eg, tablets crushed) for older adults. However, these modifications can have clinical, legal and/or ethical implications. Nurses bear responsibility for medicine administration and hence, perform these modifications. The aim of this study was to investigate the knowledge, attitudes and beliefs of nurses about oral medicine modification for older adults. DESIGN A qualitative study was conducted using semi-structured, face-to-face interviews with nurses providing care to older adults in acute and long-term care settings. Interviews were audio-recorded, transcribed verbatim and analysed thematically. SETTINGS Sixteen purposively selected care settings; 4 acute-care and 12 long-term care settings were included. Nurses were recruited by convenience sampling at these sites. PARTICIPANTS Eighteen nurses participated (83% female, 67% long-term care, 33% acute-care, median age (IQR) 38 years (32.5-52.0)). RESULTS Three major themes: modifying-a necessary evil, nurses' role as patient advocate and modifying-we are working very much as a team and two minor themes: fractional dosing, and covert administration emerged from the data. Nurses viewed oral medicine modifications as being a routine and necessary occurrence in geriatric patient care due to limitations of available formulations and the presence of age-related challenges in drug administration. Nurses' knowledge of residents' requirements ensured that they advocate for those with individualised formulation needs, however, nurses rely on pharmacists for information about modifications. Nurses expressed a desire for supports including increased education and ward-specific, pharmacist-developed recommendations on common modifications. CONCLUSIONS This study has provided useful insights into the views of nurses regarding oral medicine modification for older adults. The unique and varied formulation requirements of older adults must be acknowledged. Increased engagement by healthcare professionals, the pharmaceutical industry, regulatory agencies and policy-makers is required to facilitate the development of age-appropriate formulations. In the interim, practical interventions, informed by the findings of this study, are required.
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Affiliation(s)
- Aoife Mc Gillicuddy
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork National University of Ireland, Cork, Republic of Ireland
| | - Abina M Crean
- Synthesis and Solid State Pharmaceutical Centre, School of Pharmacy, University College Cork, Cork, Republic of Ireland
| | - Maria Kelly
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork National University of Ireland, Cork, Republic of Ireland
| | - Laura Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork National University of Ireland, Cork, Republic of Ireland
- Pharmacy Department, Mercy University Hospital, Cork, Republic of Ireland
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The knowledge, attitudes and beliefs of patients and their healthcare professionals around oral dosage form modification: A systematic review of the qualitative literature. Res Social Adm Pharm 2016; 13:717-726. [PMID: 27729203 DOI: 10.1016/j.sapharm.2016.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The objective of this systematic review was to synthesize the available qualitative evidence on the knowledge, attitudes and beliefs of adult patients, healthcare professionals and carers about oral dosage form modification. DESIGN A systematic review and synthesis of qualitative studies was undertaken, utilising the thematic synthesis approach. DATA SOURCES The following databases were searched from inception to September 2015: PubMed, Medline (EBSCO), EMBASE, CINAHL, PsycINFO, Web of Science, ProQuest Databases, Scopus, Turning Research Into Practice (TRIP), Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR). Citation tracking and searching the references lists of included studies was also undertaken. Grey literature was searched using the OpenGrey database, internet searching and personal knowledge. An updated search was undertaken in June 2016. REVIEW METHODS Studies meeting the following criteria were eligible for inclusion; (i) used qualitative data collection and analysis methods; (ii) full-text was available in English; (iii) included adult patients who require oral dosage forms to be modified to meet their needs or; (iv) carers or healthcare professionals of patients who require oral dosage forms to be modified. Two reviewers independently appraised the quality of the included studies using the Critical Appraisal Skills Programme Checklist. A thematic synthesis was conducted and analytical themes were generated. RESULTS Of 5455 records screened, seven studies were eligible for inclusion; three involved healthcare professionals and the remaining four studies involved patients. Four analytical themes emerged from the thematic synthesis: (i) patient-centred individuality and variability; (ii) communication; (iii) knowledge and uncertainty and; (iv) complexity. The variability of individual patient's requirements, poor communication practices and lack of knowledge about oral dosage form modification, when combined with the complex and multi-faceted healthcare environment complicate decision making regarding oral dosage form modification and administration. CONCLUSIONS This systematic review has highlighted the key factors influencing the knowledge, attitudes and beliefs of patients and healthcare professionals about oral dosage form modifications. The findings suggest that in order to optimise oral medicine modification practices the needs of individual patients should be routinely and systematically assessed and decision-making should be supported by evidence based recommendations with multidisciplinary input. Further research is needed to optimise oral dosage form modification practices and the factors identified in this review should be considered in the development of future interventions.
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