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Manojlovich M, Rizvi-Toner A, DasGupta R, Farris K, Friese C, Kostoff D, Mackler E, Millisor V, Titler MG. Video reflexive ethnography as an intervention to improve oral anti-cancer agent patient education: A pilot study. PEC INNOVATION 2023; 2:100148. [PMID: 37214518 PMCID: PMC10194178 DOI: 10.1016/j.pecinn.2023.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 02/27/2023] [Accepted: 03/20/2023] [Indexed: 05/24/2023]
Abstract
Objective Oral anticancer agents (OAAs) are associated with side effects that interfere with medication adherence, despite patient education regarding side effect management. Video reflexive ethnography (VRE) captures care processes on video that allow participants to learn from videos. The purpose of this pilot study was to assess the usefulness and impact of VRE on improving OAA education. Methods This qualitative study was conducted in a pharmacist-managed OAA clinic: two pharmacists and four patients participated. We filmed each pharmacist providing education to two patients. We conducted patient interviews and one reflexivity session with both pharmacists to learn participants' perspectives. We used thematic content analysis to analyze data. Results Two themes emerged: what patients liked/helped, and things that were unclear. Patients liked instructions on temperature taking, directions to safely handle and store OAAs. Unclear areas included knowing the timing of the worst side effects.During the reflexivity session, pharmacists found patients' comments useful to improve their practice. Conclusion VRE was acceptable to pharmacists and patients. Pharmacists recognized VRE as a helpful technique to improve patient education on OAAs. Innovation The use of video enables participants to scrutinize and reshape their practices, making VRE a powerful innovation and adjunct to quality improvement initiatives.
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Affiliation(s)
| | - Amna Rizvi-Toner
- University of Michigan College of Pharmacy, United States of America
| | | | - Karen Farris
- University of Michigan College of Pharmacy, United States of America
| | - Chris Friese
- University of Michigan School of Nursing, United States of America
| | | | - Emily Mackler
- University of Michigan College of Pharmacy, United States of America
| | | | - Marita G. Titler
- University of Michigan School of Nursing, United States of America
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O'Mahony E, Kenny J, Hayde J, Dalton K. Development and evaluation of pharmacist-provided teach-back medication counselling at hospital discharge. Int J Clin Pharm 2023:10.1007/s11096-023-01558-0. [PMID: 37093415 PMCID: PMC10124684 DOI: 10.1007/s11096-023-01558-0] [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: 11/07/2022] [Accepted: 02/15/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Pharmacists can use teach-back to improve patients' understanding of medication; however, the evidence of its impact on patient outcomes is inconsistent. From the literature, there is no standardised way to provide pharmacist-delivered medication counselling at hospital discharge, with limited reporting on training. AIM To develop a standardised medication counselling procedure using teach-back at hospital discharge, and to evaluate feedback from patients and pharmacists on this initiative. METHOD A standardised intervention procedure was developed. Participating pharmacists (n = 9) were trained on teach-back via an online education module and watching a demonstration video created by the researchers. Pharmacists provided patients with discharge medication counselling utilising teach-back and a patient-friendly list of medication changes to take home. To obtain feedback, patients were surveyed within seven days of discharge via telephone and pharmacists answered an anonymous survey online. RESULTS Thirty-two patients (mean age: 57 years; range: 19-91) were counselled on a mean 2.94 medications/patient with the mean counselling time as 23.6 min/patient. All patients responded to the survey, whereby 93.7% had increased confidence regarding medication knowledge and were satisfied with the counselling and the information provided. All pharmacist survey respondents (n = 8) agreed they were given adequate training and that teach-back was feasible to apply in practice. CONCLUSION This is the first study to evaluate patients' views on pharmacist-provided teach-back medication counselling. With positive patient outcomes, a standardised procedure, and a comprehensive description of the training, this study can inform the development of discharge medication counselling utilising teach-back going forward.
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Affiliation(s)
- E O'Mahony
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - J Kenny
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - J Hayde
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - K Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
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Varghese S, Hahn-Goldberg S, Deng Z, Bradley-Ridout G, Guilcher SJT, Jeffs L, Madho C, Okrainec K, Rosenberg-Yunger ZRS, McCarthy LM. Medication Supports at Transitions Between Hospital and Other Care Settings: A Rapid Scoping Review. Patient Prefer Adherence 2022; 16:515-560. [PMID: 35241910 PMCID: PMC8887864 DOI: 10.2147/ppa.s348152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Transitions in care (TiC) often involves managing medication changes and can be vulnerable moments for patients. Medication support, where medication changes are reviewed with patients and caregivers to increase knowledge and confidence about taking medications, is key to successful transitions. Little is known about the optimal tools and processes for providing medication support. This study aimed to identify describe patient or caregiver-centered medication support processes or tools that have been studied within 3 months following TiC between hospitals and other care settings. METHODS Rapid scoping review; English-language publications from OVID MEDLINE, OVID EMBASE, Cochrane Library and EBSCO CINAHL (2004-July 2019) that assessed medication support interventions delivered within 3 months following discharge were included. A subset of titles and abstracts were assessed by two reviewers to evaluate agreement and once reasonable agreement was achieved, the remainder were assessed by one reviewer. Eligibility assessment for full-text articles and data charting were completed by an experienced reviewer. RESULTS A total of 7671 unique citations were assessed; 60 studies were included. Half of the studies (n = 30/60) were randomized controlled trials. Most studies (n = 45/60) did not discuss intervention development, particularly whether end users were involved in intervention design. Many studies (n = 37/60) assessed multi-component interventions with written/print and verbal education components. Few studies (n = 5/60) included an electronic component. Very few studies (n = 4/60) included study populations at high risk of adverse events at TiC (eg, people with physical or intellectual disabilities, low literacy or language barriers). CONCLUSION The majority of studies were randomized controlled trials involving verbal counselling and/or physical document delivered to the patient before discharge. Few studies involved electronic components or considered patients at high-risk of adverse events. Future studies would benefit from improved reporting on development, consideration for electronic interventions, and improved reporting on patients with higher medication-related needs.
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Affiliation(s)
- Shawn Varghese
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Michael G.Degroote School Of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shoshana Hahn-Goldberg
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - ZhiDi Deng
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Glyneva Bradley-Ridout
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lianne Jeffs
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sinai Health, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Craig Madho
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - Karen Okrainec
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Zahava R S Rosenberg-Yunger
- Ted Rogers School of Management, School of Health Services Management, Ryerson University, Toronto, Ontario, Canada
| | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Correspondence: Lisa M McCarthy, Clinician Scientist, Institute for Better Health, Trillium Health Partners, Tel +1 416-566-2793, Email
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Vesela R, Elenjord R, Lehnbom EC, Ofstad EH, Johnsgård T, Zahl-Holmstad B, Risør T, Wisløff T, Røslie L, Filseth OM, Valle PC, Svendsen K, Frøyshov HM, Garcia BH. Integrating the clinical pharmacist into the emergency department interdisciplinary team: a study protocol for a multicentre trial applying a non-randomised stepped-wedge study design. BMJ Open 2021; 11:e049645. [PMID: 34824109 PMCID: PMC8627400 DOI: 10.1136/bmjopen-2021-049645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The 'emergency department (ED) pharmacist' is an integrated part of the ED interdisciplinary team in many countries, which have shown to improve medication safety and reduce costs related to hospitalisations. In Norway, few EDs are equipped with ED pharmacists, and research describing effects on patients has not been conducted. The aim of this study is to investigate the impact of introducing clinical pharmacists to the interdisciplinary ED team. In this multicentre study, the intervention will be pragmatically implemented in the regular operation of three EDs in Northern Norway; Tromsø, Bodø and Harstad. Clinical pharmacists will work as an integrated part of the ED team, providing pharmaceutical care services such as medication reconciliation, review and/or counselling. The primary endpoint is 'time in hospital during 30 days after admission to the ED', combining (1) time in ED, (2) time in hospital (if hospitalised) and (3) time in ED and/or hospital if re-hospitalised during 30 days after admission. Secondary endpoints include time to rehospitalisation, length of stay in ED and hospital and rehospitalisation and mortality rates. METHODS AND ANALYSIS We will apply a non-randomised stepped-wedge study design, where we in a staggered way implement the ED pharmacists in all three EDs after a 3, 6 and 9 months control period, respectively. We will include all patients going through the three EDs during the 12-month study period. Patient data will be collected retrospectively from national data registries, the hospital system and from patient records. ETHICS AND DISSEMINATION The Regional Committee for Medical and Health Research Ethics and Local Patient Protection Officers in all hospitals have approved the study. Patients will be informed about the ongoing study on a general basis with ads on posters and flyers. TRIAL REGISTRATION NUMBER NCT04722588.
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Affiliation(s)
- Renata Vesela
- Hospital Pharmacy of North Norway Trust, Tromso, Norway
| | - Renate Elenjord
- Hospital Pharmacy of North Norway Trust, Tromso, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Norway
| | - Elin C Lehnbom
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Norway
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Eirik Hugaas Ofstad
- Department of Medicine, Nordland Hospital Trust, Bodo, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Tine Johnsgård
- Hospital Pharmacy of North Norway Trust, Tromso, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Norway
| | - Birgitte Zahl-Holmstad
- Hospital Pharmacy of North Norway Trust, Tromso, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Norway
| | - Torstein Risør
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
- Department of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Torbjørn Wisløff
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Lars Røslie
- Department of Emergency Medicine, University Hospital of North Norway Trust, Tromso, Norway
| | - Ole Magnus Filseth
- Department of Emergency Medicine, University Hospital of North Norway Trust, Tromso, Norway
| | - Per-Christian Valle
- Department of Emergency Medicine, University Hospital of North Norway Trust, Harstad, Norway
| | - Kristian Svendsen
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Norway
| | - Hanne Mathilde Frøyshov
- Department of Emergency Medicine, University Hospital of North Norway Trust, Harstad, Norway
| | - Beate H Garcia
- Hospital Pharmacy of North Norway Trust, Tromso, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Norway
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Visscher BB, Vervloet M, Te Paske R, van Dijk L, Heerdink ER, Rademakers J. Implementation of an animated medication information tool in community pharmacies, with a special focus on patients with limited health literacy. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:566-572. [PMID: 34427591 DOI: 10.1093/ijpp/riab038] [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: 02/03/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The animated medication information tool 'Watchyourmeds' provides information in an accessible manner through animated videos and therefore appears to be especially suitable for people with limited health literacy. This study aimed to assess the implementation of this animated medication information tool in Dutch community pharmacies, with a special focus on patients with limited health literacy. METHODS A cross-sectional survey based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was sent to approximately 75% of the ±1900 community pharmacies in the Netherlands through email newsletters of pharmacy networks. KEY FINDINGS 140 pharmacists (⁓10%) completed the survey and 125 of them (89%) indicated that they offered the animated medication information tool to their patients. 108 pharmacists indicated that the tool was offered to all patients, not only to patients with limited health literacy. The distribution method was primarily passive (patients were given a leaflet and were not explicitly pointed to or informed about the tool). Two frequently cited motivations for offering the tool were that it complemented other sources of information and that the health insurer provided a financial incentive. The main reasons patients refused to use the tool were that they had no access to or no affinity for the required technology. CONCLUSIONS This study demonstrated that the tool is used in community pharmacies and that it is offered to all patients, regardless of their presumed health literacy level. A more active method of offering the tool may be warranted to better reach patients with limited health literacy.
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Affiliation(s)
- Boudewijn B Visscher
- Researchgroup Innovations in Pharmaceutical Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Roland Te Paske
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,Department of PharmacoTherapy, -Epidemiology, and -Economics (PTEE), Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, the Netherlands
| | - Eibert R Heerdink
- Researchgroup Innovations in Pharmaceutical Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Jany Rademakers
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,CAPHRI, Care and Public Health Research Institute, Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
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Shersher V, Haines TP, Sturgiss L, Weller C, Williams C. Definitions and use of the teach-back method in healthcare consultations with patients: A systematic review and thematic synthesis. PATIENT EDUCATION AND COUNSELING 2021; 104:118-129. [PMID: 32798080 DOI: 10.1016/j.pec.2020.07.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/16/2020] [Accepted: 07/26/2020] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To review and synthesise definitions of the teach-back method in the literature. The second aim is to synthesise the barriers, facilitators and perceptions of teach-back use in healthcare consultations with patients. METHODS A systematic review and thematic synthesis following Braun and Clarke's method. RESULTS The primary search found 1429 citations and the secondary search added 221 citations. Screening identified 66 citations eligible for data extraction. We contrasted and synthesised operational definitions of the teach-back method. The synthesis generated seven themes related to healthcare provider (HCP) and patient perceptions of teach-back (effectiveness, stigma and time-related perceptions), the universal application of teach-back, patient health outcomes and healthcare provider training. DISCUSSION Operational definitions of the teach-back method varied in the literature and contained implied steps. HCPs and patient perceptions of teach-back operated as both enablers and barriers to its use. HCPs training programs for the teach-back method were identified as beneficial for altering HCPs perceptions about the method and increased its use with patients. PRACTICE IMPLICATIONS Standardising operational definitions of the teach-back method can support replicability of research and enhance HCPs communication skills training programs. HCPs training on teach-back use can support the increased use of the technique with broader patient populations.
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Affiliation(s)
- Violetta Shersher
- School of Primary and Allied Health Care, Monash University, VIC, 3199, Australia.
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, VIC, 3199, Australia
| | - Liz Sturgiss
- Department of General Practice, School of Primary and Allied Healthcare, Monash University, VIC, 3168, Australia
| | - Carolina Weller
- School of Nursing and Midwifery, Monash University, VIC, 3004, Australia
| | - Cylie Williams
- School of Primary and Allied Health Care, Monash University, VIC, 3199, Australia
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