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Stuijt PJC, Heringa M, van Dijk L, Faber A, Burgers JS, Feenstra TL, Taxis K, Denig P. Effects of a multicomponent communication training to involve older people in decisions to DEPRESCRIBE cardiometabolic medication in primary care (CO-DEPRESCRIBE): protocol for a cluster randomized controlled trial with embedded process and economic evaluation. BMC PRIMARY CARE 2024; 25:210. [PMID: 38862899 PMCID: PMC11165805 DOI: 10.1186/s12875-024-02465-7] [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: 04/23/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Deprescribing of medication for cardiovascular risk factors and diabetes has been incorporated in clinical guidelines but proves to be difficult to implement in primary care. Training of healthcare providers is needed to enhance deprescribing in eligible patients. This study will examine the effects of a blended training program aimed at initiating and conducting constructive deprescribing consultations with patients. METHODS A cluster-randomized trial will be conducted in which local pharmacy-general practice teams in the Netherlands will be randomized to conducting clinical medication reviews with patients as usual (control) or after receiving the CO-DEPRESCRIBE training program (intervention). People of 75 years and older using specific cardiometabolic medication (diabetes drugs, antihypertensives, statins) and eligible for a medication review will be included. The CO-DEPRESCRIBE intervention is based on previous work and applies models for patient-centered communication and shared decision making. It consists of 5 training modules with supportive tools. The primary outcome is the percentage of patients with at least 1 cardiometabolic medication deintensified. Secondary outcomes include patient involvement in decision making, healthcare provider communication skills, health/medication-related outcomes, attitudes towards deprescribing, medication regimen complexity and health-related quality of life. Additional safety and cost parameters will be collected. It is estimated that 167 patients per study arm are needed in the final intention-to-treat analysis using a mixed effects model. Taking loss to follow-up into account, 40 teams are asked to recruit 10 patients each. A baseline and 6-months follow-up assessment, a process evaluation, and a cost-effectiveness analysis will be conducted. DISCUSSION The hypothesis is that the training program will lead to more proactive and patient-centered deprescribing of cardiometabolic medication. By a comprehensive evaluation, an increase in knowledge needed for sustainable implementation of deprescribing in primary care is expected. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov (identifier: NCT05507177).
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Affiliation(s)
- Peter J C Stuijt
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, PO-Box 30001, HPC AP50, UMCG, Groningen, 9700RB, The Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Unit of PharmacoTherapy, - Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Adrianne Faber
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
| | - Jako S Burgers
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Talitha L Feenstra
- Unit of PharmacoTherapy, - Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Dutch National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Katja Taxis
- Unit of PharmacoTherapy, - Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, PO-Box 30001, HPC AP50, UMCG, Groningen, 9700RB, The Netherlands.
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Neiva Pantuzza LL, Reis AMM, Botelho SF, da Rocha ALP, Martins MAP, do Nascimento MMG, Vieira LB, de Souza Groia Veloso RC, do Nascimento E. Medication Literacy Test for Older Adults: psychometric analysis and standardization of the new instrument. Int J Clin Pharm 2024:10.1007/s11096-024-01744-8. [PMID: 38822965 DOI: 10.1007/s11096-024-01744-8] [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: 02/06/2024] [Accepted: 04/25/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Low medication literacy is prevalent among older adults and is associated with adverse drug events. The Medication Literacy Test for Older Adults (TELUMI) was developed and content validated in a previously published study. AIM To evaluate the psychometric properties and provide norms for TELUMI scores. METHOD This was a cross-sectional methodological study with older adults selected from the community and from two outpatient services. Descriptive item-analysis, exploratory factor analysis (EFA), item response theory (IRT), reliability, and validity analysis with schooling and health literacy were performed to test the psychometric properties of the TELUMI. The classification of the TELUMI scores was performed using percentile norms. RESULTS A total of 344 participants, with a mean age of 68.7 years (standard deviation = 6.7), were included; most were female (66.6%), black/brown (61.8%), had low schooling level (60.2%) and low income (55.2%). The EFA pointed to the one-dimensional structure of TELUMI. A three-parameter logistic model was adopted for IRT. All items had an adequate difficulty index. One item had discrimination < 0.65, and three items had an unacceptable guessing index (< 0.35) and were excluded. The 29-item version of TELUMI had excellent internal consistency (KR20 = 0.89). There was a positive and strong association between TELUMI scores and health literacy and education level. The scores were classified as inadequate medication literacy (≤ 10.0 points), medium medication literacy (11-20 points), and adequate medication literacy (≥ 21 points). CONCLUSION The results suggest that the 29-item version of TELUMI is psychometrically adequate for measuring medication literacy in older adults.
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Affiliation(s)
- Laís Lessa Neiva Pantuzza
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, Brazil.
| | - Stephanie Ferreira Botelho
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Luiza Pereira da Rocha
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Auxiliadora Parreiras Martins
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | | | - Liliana Batista Vieira
- Faculdade de Ciências Farmacêuticas, Universidade Federal de Alfenas, 700 Gabriel Monteiro da Silva St., Centro, Alfenas, Minas Gerais, Brazil
| | - Ronara Camila de Souza Groia Veloso
- Hospital das Clínicas, Universidade Federal de Minas Gerais, 110 Professor Alfredo Balena Ave., Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil
| | - Elizabeth do Nascimento
- Departamento de Psicologia, Faculdade de Filosofia e Ciências Humanas, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, Brazil
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Antimisiaris D, Folz RJ, Huntington-Moskos L, Polivka BJ. Specific Medication Literacy in Older Adults with Asthma. J Nurse Pract 2024; 20:104979. [PMID: 38706630 PMCID: PMC11064973 DOI: 10.1016/j.nurpra.2024.104979] [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] [Indexed: 05/07/2024]
Abstract
Purpose To explore specific medication literacy (SML) of older adults and associations of SML strength. Methods This was an observational study. Participants were at least 60 years old, with an asthma diagnosis and in good health. Data were collected by a registered nurse researcher. The SML data collection instrument gathered information about each medication a participant used: name, purpose, how taken, special instructions, adverse effects, and drug-drug or drug-disease interactions. An SML scoring rubric was developed. Results All could provide name, and most provided purpose, how taken. The lowest SML domains were side effects and interactions. Age at time of asthma diagnosis correlated with stronger SML scores and living in a disadvantaged neighborhood correlated with lower SML scores. Discussion Gaps in medication literacy may create less ability to self-monitor. Patients want medication literacy but struggle with appropriate, individualized, information. Conclusion The study provides insights on gaps and opportunities for SML.
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Affiliation(s)
| | - Rodney J. Folz
- Jerald B. Katz Academy, Houston Methodist Research Institute, Houston TX
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Levic M, Bogavac-Stanojevic N, Ubavic S, Krajnovic D. Pharmacotherapy literacy level and predictors of low literacy among diabetes mellitus type 2 patients in Serbia. BMC Public Health 2023; 23:1822. [PMID: 37726735 PMCID: PMC10507974 DOI: 10.1186/s12889-023-16639-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Pharmacotherapy literacy (PTHL) is a specific ability to safely access, appraise and understand the available information concerning medication and to calculate and act accordingly. The concept of PTHL is mostly unknown for the majority of diabetes mellitus type 2 (DMT2) patients in Serbia. With diabetes being one of the major public health problems in Serbia with a prevalence of 9.1%, this two-study research aims at constructing performance-based instrument and estimating the prevalence of PTHL levels and identification of predictors of low PTHL scores in patients with DMT2. METHODS Multistage study was performed to adapt the existing performance-based instrument (PTHL-SR) into specific questionnaire for DMT2 population (PTHL-DM instrument). PTHL levels were assessed through cross-sectional study categorising patients into groups of low, medium, and high PTHL levels. We considered 19 predictors for low PTHL scores, from sociodemographic characteristics, health behaviours and health characteristics, access to health-related information and empowerment-related indicators. Univariate and multivariate logistic regression analyses were used to determine independent predictors of low PTHL. RESULTS The final 15-item PTHL-DM instrument proved to have satisfactory reliability (KR20 = 0.475) and internal reliability [ICC for the whole instrument was 0.97 with 95% confidence intervals (0.95-0.99)]. Positive correlation (rho = 0.69) between PTHL-DM score (15 questions) and the total PTHL-SR score (14 questions) was also observed. It was demonstrated that the majority of 350 patients had low PTHL (62%), and only 5% high PTHL level. Mean score on PTHL-DM was 7.8 ± 2.3. Probability of low PTHL increased among smokers, patients with low interest in health and those who estimated their health as bad. Patients who used pharmacists as sourse of information were less likely to be pharmacotherapy illiterate. Combined therapy with insulin and Oral Hypoglycemic Agents was associated with higher PTHL. CONCLUSIONS Our data indicate that specific PTHL-DM tool is objective, valid, and reliable. It was found that low level of PTHL prevailed among DMT2 patients. Medication literacy is influenced by age, residence, education, and family status. Patients with better health literacy also reported better health behaviours. Different patient empowerment programs and approaches aimed at raising PTHL would be essential to improve self-management and control of this widespread chronic disease in Serbia.
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Affiliation(s)
- Marija Levic
- Doctoral Program of Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, Univesrity of Belgrade, 11221 Belgrade, Serbia
| | - Natasa Bogavac-Stanojevic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia
| | - Stana Ubavic
- Medicines and Medical Devices Agency of Serbia (ALIMS), 11221 Belgrade, Serbia
| | - Dusanka Krajnovic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia
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Pantuzza LLN, do Nascimento E, Botelho SF, da Rocha ALP, Martins MAP, do Nascimento MMG, Vieira LB, Veloso RCDSG, Reis AMM. Development and content validation of the medication literacy test for older adults (TELUMI). Arch Gerontol Geriatr 2023; 112:105027. [PMID: 37080136 DOI: 10.1016/j.archger.2023.105027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/09/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Medication literacy comprises the skills needed to access, understand, and act on medication information. Low medication literacy is frequent among older adults, making them more susceptible to negative health outcomes. The aim of this study was to develop and evaluate the content validity of an instrument to measure medication literacy in this population. METHOD Multistage methodological study. Items were generated according to a conceptual model and a literature review. The instrument was submitted to a panel of experts to assess item's relevance, clarity, and theoretical classification. Subsequently, the instrument was applied to the target population to assess its comprehensibility. RESULTS Content Validity Index results indicated excellent agreement among experts on the instrument's relevance (0.98) and clarity (0.91). Overall agreement between experts regarding the theoretical subdimensions was moderate [Fleiss' kappa=0.57 (p = 0.00)]. Items were reported to be fully understood by most representatives of the target population. The final version of the instrument had 33 items divided into eight scenarios of medication use. CONCLUSION The instrument seems to have adequate content validity and good suitability for the target population. Therefore, it can help health professionals to identify older adults with low medication literacy, aiming to improve their medication use skills.
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Affiliation(s)
- Laís Lessa Neiva Pantuzza
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Brazil.
| | - Elizabeth do Nascimento
- Faculty of Philosophy and Human Sciences, Department of Psychology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Stephanie Ferreira Botelho
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Brazil
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Andreu-March M, Aguas Compaired M, Mariño EL, Modamio P. Cross-cultural adaptation and validation of the Recognizing And Addressing Limited Pharmaceutical Literacy (RALPH) interview guide in community pharmacies. Res Social Adm Pharm 2023; 19:882-888. [PMID: 36868912 DOI: 10.1016/j.sapharm.2023.02.004] [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: 03/04/2022] [Revised: 02/03/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The RALPH (Recognizing and Addressing Limited PHarmaceutical Literacy) interview guide makes it possible to identify patients with limited pharmaceutical knowledge and to assess their skills in the functional, communicative, and critical health literacy domains. OBJECTIVE (s): To perform a cross-cultural validation of the RALPH interview guide in Spanish population; to conduct a descriptive analysis based on patients' responses. METHODS A cross-sectional study of patients' pharmaceutical literacy skills was conducted in three stages: systematic translation, administration of the interview and analysis of psychometric properties. The target population included adult patients (≥18 years) who attend one of the participating community pharmacies in Barcelona (Spain). Content validity was evaluated by an expert committee. Viability was assessed in the pilot test, and reliability was assessed using internal consistency and intertemporal stability. Construct validity was assessed by factor analysis. RESULTS A total of 103 patients were interviewed at 20 pharmacies. Cronbach's alpha values based on standardized items ranged between 0.720 and 0.764. For the longitudinal component, the ICC test-retest reliability was 0.924. The factor analysis was verified by KMO (0.619) and Bartlett's test of sphericity (P-value <0.05). The definitive RALPH guide translated into Spanish maintains the same structure as the original. Some expressions were simplified, and the questions on the comprehension of warnings or specific instructions for use, contradictory information and shared decision-making were reformulated. Pharmaceutical literacy skills were seen to be most limited with regard to the critical domain. The responses of the Spanish patients were in agreement with the original results of the RALPH interview guide. CONCLUSIONS The RALPH interview guide in Spanish complies with the requirements viability, validity, and reliability. This tool may be able to identify the low pharmaceutical literacy skills of patients coming to community pharmacies in Spain, and its use may also be extended to other Spanish-speaking countries.
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Affiliation(s)
- Mònica Andreu-March
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Av. Joan XXIII, 27-31, 08028, Barcelona, Spain
| | - Margarita Aguas Compaired
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Av. Joan XXIII, 27-31, 08028, Barcelona, Spain; Pharmacy Service, University Hospital Sagrat Cor, C. Viladomat, 288, 08029, Barcelona, Spain
| | - Eduardo L Mariño
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Av. Joan XXIII, 27-31, 08028, Barcelona, Spain
| | - Pilar Modamio
- Clinical Pharmacy and Pharmaceutical Care Unit, Department of Pharmacy and Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Av. Joan XXIII, 27-31, 08028, Barcelona, Spain.
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Mlakar-Mastnak D, Kozjek NR, Skela-Savič B. Factors for Effective Identification of Patients at Nutritional Risk in Clinical Practice: Thematic Analysis of Qualitative Research. Zdr Varst 2022; 61:191-197. [PMID: 35855379 PMCID: PMC9245500 DOI: 10.2478/sjph-2022-0025] [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: 08/03/2021] [Accepted: 05/09/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Despite the high prevalence of malnutrition in patients at all levels of healthcare, early prevention and treatment of malnourished patients are often neglected and overlooked in clinical practice. The aim of this systematic literature review was to identify the factors considered most important by healthcare professionals in the identification and treatment of malnourished patients or those at risk of malnutrition. Methods A systematic literature review of qualitative research was conducted. Documents published in scientific journals in English from 2011 to 2021 were searched in the PubMed (MEDLINE), CINAHL and ProQuest databases. The results were analysed with a thematic analysis of qualitative research findings. Results From the search set of 1010 results, 7 sources were included in the final analysis. Factors identified by health professionals as important in the identification and treatment of malnourished patients in clinical practice were grouped into five themes: unclear organizational structure; indefinite structure of nutritional care; poor continuity of nutritional care; lack of knowledge and skills of health professionals; lack of time and human resources. Conclusions Health policy must provide resources for nutritional care for patients at all levels of health care on the initiative of the highest professional bodies at the state level. To improve the nutritional care of patients in clinical practice, the management of health care institutions must promote and enable the professional and organizational establishment of clinical nutrition as a regular medical activity of the institution, develop clinical nutritional pathways, and promote evidence-based clinical practice and interprofessional collaboration.
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Affiliation(s)
- Denis Mlakar-Mastnak
- Institute of Oncology Ljubljana, Clinical Nutrition Unit, Zaloška cesta 2, 1000Ljubljana, Slovenia
| | - Nada Rotovnik Kozjek
- Institute of Oncology Ljubljana, Clinical Nutrition Unit, Zaloška cesta 2, 1000Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Vrazov trg 2, 1000Ljubljana, Slovenia
| | - Brigita Skela-Savič
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, 4270Jesenice, Slovenija
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Atanasova S, Kamin T. From Dimensions, Levels and Domains to Context-specific Conceptualizations of Health Literacy. Zdr Varst 2022; 61:133-136. [PMID: 35855378 PMCID: PMC9245497 DOI: 10.2478/sjph-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/22/2022] Open
Abstract
Health literacy refers to skills and knowledge that enable individuals to navigate health-related information environments, to function in healthcare systems, and to practice behaviors that lead to better health outcomes. Accordingly, health literacy is one of the major preoccupations of public health scholars, policies, and strategies. However, it is a complex, multidimensional, and dynamic concept that incorporates different kinds of health-related skills and knowledge. This editorial briefly presents dimensions, levels, and domains of health literacy and discusses a growing need to acknowledge health literacy as a context-specific concept that includes various forms with context-specific conceptualizations. More specifically, it focuses on three health literacy forms that are gaining attention, namely e-health literacy, vaccine literacy, and mental health literacy. By emphasizing the importance of health literacy research for this journal and in general this editorial calls for increasing engagement in this field and invites further contributions on the topic.
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Affiliation(s)
- Sara Atanasova
- University of Ljubljana, Faculty of Social Sciences, Kardeljeva pl. 5, 1000Ljubljana, Slovenia
| | - Tanja Kamin
- University of Ljubljana, Faculty of Social Sciences, Kardeljeva pl. 5, 1000Ljubljana, Slovenia
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Bajeux E, Alix L, Cornée L, Barbazan C, Mercerolle M, Howlett J, Cruveilhier V, Liné-Iehl C, Cador B, Jego P, Gicquel V, Schweyer FX, Marie V, Hamonic S, Josselin JM, Somme D, Hue B. Pharmacist-led medication reconciliation at patient discharge: a tool to reduce healthcare utilization? an observational study in patients 65 years or older. BMC Geriatr 2022; 22:576. [PMID: 35831783 PMCID: PMC9281036 DOI: 10.1186/s12877-022-03192-3] [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: 01/05/2022] [Accepted: 05/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Older patients often experience adverse drug events (ADEs) after discharge that may lead to unplanned readmission. Medication Reconciliation (MR) reduces medication errors that lead to ADEs, but results on healthcare utilization are still controversial. This study aimed to assess the effect of MR at discharge (MRd) provided to patients aged over 65 on their unplanned rehospitalization within 30 days and on both patients’ experience of discharge and their knowledge of their medication. Methods An observational multicenter prospective study was conducted in 5 hospitals in Brittany, France. Results Patients who received both MR on admission (MRa) and MRd did not have significantly fewer deaths, unplanned rehospitalizations and/or emergency visits related to ADEs (OR = 1.6 [0.7 to 3.6]) or whatever the cause (p = 0.960) 30 days after discharge than patients receiving MRa alone. However, patients receiving both MRa and MRd were more likely to feel that their discharge from the hospital was well organized (p = 0.003) and reported more frequently that their community pharmacist received information about their hospital stay (p = 0.036). Conclusions This study found no effect of MRd on healthcare utilization 30 days after discharge in patients over 65, but the process improved patients’ experiences of care continuity. Further studies are needed to better understand this positive impact on their drug care pathway in order to improve patients’ ownership of their drugs, which is still insufficient. Improving both the interview step between pharmacist and patient before discharge and the transmission of information from the hospital to primary care professionals is needed to enhance MR effectiveness. Trial registration NCT04018781 July 15, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03192-3.
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Affiliation(s)
- Emma Bajeux
- Department of Epidemiology and Public Health, Univ Rennes, Rennes University Hospital, F-35000, Rennes, France.
| | - Lilian Alix
- Department of Internal Medicine and Clinical Immunology, Univ Rennes, Rennes University Hospital, F-35000, Rennes, France
| | - Lucie Cornée
- Department of Geriatrics, St-Laurent Polyclinic, Hospitalité St-Thomas de Villeneuve, F-35000, Rennes, France
| | - Camille Barbazan
- Department of Pharmacy, Rennes University Hospital, F-35000, Rennes, France
| | - Marion Mercerolle
- Department of Pharmacy, Rennes University Hospital, F-35000, Rennes, France
| | - Jennifer Howlett
- Department of Pharmacy, Rennes University Hospital, F-35000, Rennes, France
| | | | - Charlotte Liné-Iehl
- Department of Pharmacy, Montfort/Meu Hospital, F-35160, Montfort/Meu, France
| | - Bérangère Cador
- Department of Internal Medicine and Clinical Immunology, Univ Rennes, Rennes University Hospital, F-35000, Rennes, France
| | - Patrick Jego
- Department of Internal Medicine and Clinical Immunology, Univ Rennes, Rennes University Hospital, F-35000, Rennes, France
| | - Vincent Gicquel
- Department of Pharmacy, Rennes University Hospital, F-35000, Rennes, France
| | - François-Xavier Schweyer
- Department of Human and Social Sciences, Univ Rennes, EHESP, EA7348 MOS, F-35000, Rennes, France
| | | | - Stéphanie Hamonic
- Department of Epidemiology and Public Health, Univ Rennes, Rennes University Hospital, F-35000, Rennes, France
| | | | - Dominique Somme
- Department of Geriatrics, Department of Geriatrics, Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U 1309 , F-35000, Rennes, France
| | - Benoit Hue
- Department of Pharmacy, Rennes University Hospital, F-35000, Rennes, France
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Gentizon J, Bovet E, Rapp E, Mabire C. Medication Literacy in Hospitalized Older Adults: Concept Development. Health Lit Res Pract 2022; 6:e70-e83. [PMID: 35389270 PMCID: PMC8973764 DOI: 10.3928/24748307-20220309-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jenny Gentizon
- Address correspondence to Jenny Gentizon, MSc, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Vaud, 1011, Switzerland; jenny.
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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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Neiva Pantuzza LL, Nascimento ED, Crepalde-Ribeiro K, Botelho SF, Parreiras Martins MA, Camila de Souza Groia Veloso R, Gonzaga do Nascimento MM, Vieira LB, Moreira Reis AM. Medication literacy: A conceptual model. Res Social Adm Pharm 2021; 18:2675-2682. [PMID: 34134939 DOI: 10.1016/j.sapharm.2021.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Medication literacy reflects the specific literacy skills necessary to act on medication-related information. A comprehensive and clear conceptual model that reflects medication literacy is lacking. Conceptual models describe the components that represent a construct, allowing for its understanding and providing a rationale for its measurement. OBJECTIVES To propose a conceptual model to support the development of an instrument to measure medication literacy. METHODS This is a three-phase methodological study. A literature review was conducted to identify the components that should be part of the preliminary conceptual model. Subsequently, the importance of its components was judged on a Likert-5 scale. Then, the model was refined, and the dimensions and subdimensions of medication literacy were defined. RESULTS Forty-five experts were included, with a mean age of 39.9 (SD = 10.5) years, most of them females (86.7%) and pharmacists (80%). All components of the preliminary conceptual model were considered important to extremely important by most experts. "Dosing information", "medication name", and "processing the information received about their medication and acting upon medication instructions" were the components considered most important. In the refinement phase, we identified that the construct has four dimensions - functional literacy, communicative literacy, critical literacy, and numeracy, which include the subdimensions to access, understand, evaluate, calculate, and communicate medication-related information. CONCLUSIONS The conceptual model allowed identifying the components that represent medication literacy, which will support the development of an instrument for measuring the construct in Brazil.
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Affiliation(s)
- Laís Lessa Neiva Pantuzza
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, Brazil.
| | - Elizabeth do Nascimento
- Faculdade de Filosofia e Ciências Humanas, Departamento de Psicologia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Kennedy Crepalde-Ribeiro
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Stephanie Ferreira Botelho
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Auxiliadora Parreiras Martins
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Ronara Camila de Souza Groia Veloso
- Hospital das Clínicas, Universidade Federal de Minas Gerais, 110 Professor Alfredo Balena Ave., Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil
| | | | - Liliana Batista Vieira
- Faculdade de Ciências Farmacêuticas, Universidade Federal de Alfenas, 700 Gabriel Monteiro da Silva St, Centro, Alfenas, Minas Gerais, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, 6627 Presidente Antônio Carlos Ave., Pampulha, Belo Horizonte, Minas Gerais, Brazil
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The impact of health literacy on beliefs about medication in a Dutch medication-using population. Eur J Clin Pharmacol 2021; 77:1219-1224. [PMID: 33594447 DOI: 10.1007/s00228-021-03105-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Medication beliefs are likely contingent on aspects of health literacy: knowledge, motivation, and competences to access, understand, appraise, and apply health information. An association between medication beliefs and health literacy is expected as they both influence self-management. The aim of this study was to examine the association between health literacy and the beliefs about overuse and harmful effects of medication and to examine modifying effects of age, gender, and number of medications on this association. METHODS The data were collected using the online "Medication panel" of the Dutch Institute for Rational Use of Medicine. A linear regression model was used to examine the association between health literacy and beliefs about medication and the modifying effects of age, gender, and number of medications on this association. RESULTS Respondents with a lower level of health literacy had more concerns about overuse (β adj.= -.174, p<.001) and harmful (β adj.= -.189, p<.001) effects of medication. This study found no modifying effects. CONCLUSIONS A lower health literacy level is associated with more concerns about the overuse and harmful effects of medication. The results of this study suggest that extra attention should be given to persons with low health literacy level by healthcare professionals, to decrease their concerns about overuse and harmful effects, and improve adherence to self-management behavior.
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Gentizon J, Hirt J, Jaques C, Lang PO, Mabire C. Instruments assessing medication literacy in adult recipients of care: A systematic review of measurement properties. Int J Nurs Stud 2020; 113:103785. [PMID: 33080478 DOI: 10.1016/j.ijnurstu.2020.103785] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/06/2020] [Accepted: 09/27/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The assessment of medication literacy in patients is an important step in assisting clinicians to plan for education, prescription simplification, assistance and/or medication aids. There have been several attempts to develop a standardised, objective measure of medication literacy. The objectives of this systematic review were to critically appraise, compare and summarise the measurement properties of existing instruments that assess medication literacy in adult recipients of care. DESIGN A systematic review was performed. SEARCH METHODS Structured searches were conducted in Embase, MEDLINE PubMed, CINAHL, APA PsycINFO and Web of Science Core Collection in March 2020. Additional searches were performed in ProQuest Dissertations and Theses, DART Europe, and Google Scholar, followed by citation tracking of included studies. REVIEW METHODS Two researchers independently identified eligible studies. Two researchers then assessed the methodological quality of the studies and quality of measurement properties, using the Consensus-based Standards for selection of health Measurement Instruments (COSMIN) guidelines. A best-evidence synthesis for each instrument was performed. RESULTS From the 5035 citations, 17 studies were included that concerned 13 instruments using different administration methods (i.e., performancebased or self-report), medication type (i.e., prescribed or nonprescribed) and context of use (i.e., clinical or community settings). Very low- to moderate-quality evidence supported satisfactory content validity regarding relevance and comprehensibility, while comprehensiveness remained inconsistent. Other measurement properties were less frequently examined and were supported by moderate-quality evidence (i.e., structural validity) to low- or very low-quality evidence (i.e., internal consistency, reliability, construct validity). The bestvalidated instrument is the unidimensional 14-item Medication Literacy in Spanish and English assessment tool (MedLitRxSE), based on direct testing of participant performance regarding four hypothetical scenarios on medication use. Nine instruments have the potential to be recommended but require additional research, while for others, their psychometric soundness is too limited and they require content revisions. CONCLUSION This is the first systematic review to identify instruments for medication literacy. None of the identified instruments had all measurement properties properly assessed and none reported measurement invariance, measurement error and responsiveness of the instrument. Further research is necessary for a better theoretical understanding of medication literacy in order to assist health professionals in identifying patient needs for education, regimen simplification, assistance and/or medication aids. Such research will help conceptualise new instruments that not only cover relevant domains dedicated to specific populations (e.g., polymorbid and/or older individuals), but also exhibit satisfactory measurement properties.
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Affiliation(s)
- Jenny Gentizon
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Switzerland; Lausanne University Hospital, Switzerland.
| | - Julian Hirt
- International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; Institute for Applied Nursing Sciences, Department of Health, FHS St. Gallen, Switzerland
| | - Cécile Jaques
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Cedric Mabire
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Switzerland
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15
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Horvat N, Kos M. Development, validation and performance of a newly designed tool to evaluate functional medication literacy in Slovenia. Int J Clin Pharm 2020; 42:1490-1498. [PMID: 32885323 DOI: 10.1007/s11096-020-01138-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
Background Medication literacy refers to the ability of individuals to safely and appropriately access, understand and act on basic medication information. It is vital for correctly and safely using medications. General health literacy measures do not adequately address specific skills for medication literacy, and there are no general, self-administered, performance-based instruments for assessing patients' medication literacy. Objective The aim was to develop and validate a self-administered performance-based questionnaire measuring functional medication literacy and to evaluate functional medication literacy among the Slovenian general population. Setting A random sample of adult Slovenian residents received the questionnaires at their home addresses. Method The initial content was derived from medication counselling literature. Thirteen patients and 14 healthcare professionals provided feedback about its comprehensibility, comprehensiveness, and difficulty thus supporting content and face validity. The developed questionnaire, comprising 30 items divided into 5 categories (dosage, adverse effects, interactions, precautions, and other information), was sent to a random sample of 1500 adult Slovenian residents. The overall validity of the questionnaire was assessed via reliability, criterion and discriminant validity using the Kuder-Richardson Formula 20, multiple linear regression and Mann-Whitney test. Descriptive statistics were used to evaluate medication literacy. Main outcome measure The psychometric properties of the questionnaire (reliability, content, face, criterion, and discriminant validity); level of functional medication literacy. Results A total of 402 residents returned eligible questionnaires (26.8% response rate). The Kuder-Richardson Formula 20 reliability coefficient for the whole questionnaire was 0.823. One item that did not demonstrate discriminant validity was deleted. Criterion validity was supported by a significant association between age and medication literacy (β = - 0.303). Income (β = 0.243) and current self-perceived health (β = 0.187) also were associated with medication literacy. The median of medication literacy score was 24 out of 29 points. Dosage-related items requiring understanding of long text instructions and the use of numeracy skills received the most incorrect answers. Conclusion A performance-based questionnaire measuring functional medication literacy among a general population with supported validity was developed. Slovenian residents encountered difficulties when dealing with items requiring prose literacy and numeracy skills, especially related to dosing. Special attention should be paid to low-income elderly with poor self-perceived health.
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Affiliation(s)
- Nejc Horvat
- Department of Social Pharmacy, Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Mitja Kos
- Department of Social Pharmacy, Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.
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Hikaka J, Hughes C, Jones R, Connolly MJ, Martini N. A pharmacist-led medicines review intervention in community-dwelling Māori older adults- a feasibility study protocol. Res Social Adm Pharm 2020; 16:1264-1271. [PMID: 31813763 DOI: 10.1016/j.sapharm.2019.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pharmacists have a role to play in supporting the optimal use of medicines to ensure older adults receive therapeutic benefit whilst minimising medicines-related harm. In Aotearoa New Zealand (NZ), Māori (Indigenous people of NZ) experience inequities in the determinants of health, including access to medicines, resulting in increased morbidity, earlier onset of chronic conditions and reduced life expectancy. This study aims to test the feasibility of a pharmacist-led medicines review intervention in community-dwelling Māori older adults. METHOD This is a non-randomised, non-controlled feasibility study undertaken within a kaupapa Māori methodological framework which supports the right of Māori to be included throughout the research process and seeks to potentiate transformational, positive change for Māori. The research pharmacist will recruit 30 participants (Māori; 55 years or older; community-dwelling). Participants will undergo a medicines education session with the pharmacist (medicines reconciliation, medicines information, well-being goal setting), with the option to proceed to a medicines optimisation session that includes the participant, pharmacist and primary prescriber (review of potentially inappropriate prescribing (PIP); medicines management plan development). Primary outcomes: participant and prescriber acceptability of intervention. Secondary outcomes include baseline and post-intervention medicines knowledge, PIP and quality of life scores, and number of changes made to the medicines regimen. ETHICS AND DISSEMINATION Ethical approval was granted by the Northern B Health and Disability Committee (9/NTB/106). Study results will be disseminated to various stakeholders including Māori communities, health practitioners and providers, and researchers through meetings and conference presentations, lay summaries and peer-reviewed journals. This study is an example of health service design, delivery and evaluation, informed by Indigenous knowledge and methodology, developed explicitly to address inequities in health outcomes for, and with, Māori and will inform the decision to proceed to a randomised controlled trial to test the effect of this intervention. TRIAL REGISTRATION NUMBER ACTRN12619001070123.
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Affiliation(s)
- Joanna Hikaka
- School of Pharmacy, University of Auckland, New Zealand; Waitematā District Health Board, Auckland, New Zealand.
| | | | - Rhys Jones
- Te Kupenga Hauora Māori, University of Auckland, New Zealand
| | - Martin J Connolly
- Waitematā District Health Board, Auckland, New Zealand; Freemasons Department of Geriatric Medicine, University of Auckland, New Zealand
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17
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Pantuzza LLN, Nascimento E, Botelho SF, Martins MAP, Souza Groia Veloso RC, Nascimento MMG, Vieira LB, Reis AMM. Mapping the construct and measurement of medication literacy: A scoping review. Br J Clin Pharmacol 2020. [DOI: 10.1111/bcp.14490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Laís Lessa Neiva Pantuzza
- Programa de Pós‐Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia Universidade Federal de Minas Gerais 6627 Presidente Antônio Carlos Ave., Pampulha Belo Horizonte Minas Gerais Brazil
| | - Elizabeth Nascimento
- Faculdade de Filosofia e Ciências Humanas, Departamento de Psicologia Universidade Federal de Minas Gerais 6627 Presidente Antônio Carlos Ave., Pampulha Belo Horizonte Minas Gerais Brazil
| | - Stephanie Ferreira Botelho
- Programa de Pós‐Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia Universidade Federal de Minas Gerais 6627 Presidente Antônio Carlos Ave., Pampulha Belo Horizonte Minas Gerais Brazil
| | | | - Ronara Camila Souza Groia Veloso
- Hospital das Clínicas Universidade Federal de Minas Gerais 110 Professor Alfredo Balena Ave., Santa Efigênia Belo Horizonte Minas Gerais Brazil
| | - Mariana Martins Gonzaga Nascimento
- Faculdade de Farmácia Universidade Federal de Minas Gerais 6627 Presidente Antônio Carlos Ave., Pampulha Belo Horizonte Minas Gerais Brazil
| | - Liliana Batista Vieira
- Faculdade de Ciências Farmacêuticas Universidade Federal de Alfenas 700 Gabriel Monteiro da Silva St., Centro Alfenas Minas Gerais Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia Universidade Federal de Minas Gerais 6627 Presidente Antônio Carlos Ave., Pampulha Belo Horizonte Minas Gerais Brazil
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Maghroudi E, van Hooijdonk CMJ, van Dijk L, Boland G, de Haas C, Journée-Gilissen M, van der Velden J, Vervloet M, Westerhof H, Rademakers JJDJM, Borgsteede SD. Development of Comprehensible Prescription Label Instructions: A Study Protocol for a Mixed-Methods Approach. Front Pharmacol 2020; 11:981. [PMID: 32760269 PMCID: PMC7373784 DOI: 10.3389/fphar.2020.00981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/17/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Patients receive information about their medication from different sources, including prescription labels. These labels are physically attached to each package dispensed to patients and contain the most important instructions on how to use the medication correctly. However, many patients experience difficulties in understanding and applying the instructions on these labels correctly, especially patients with limited health literacy. The aim of this study is to investigate the comprehensibility of prescription label instructions among patients with adequate and limited health literacy skills, and to implement improvements in primary health care. Methods We used a mixed-methods approach, which consisted of four phases. Phase 1 (desk research) was divided into a systematic literature review on the comprehensibility of prescription label instructions (1a) and a content analysis of the textual elements in Dutch prescription label instructions (1b). In phase 2 (patient studies), semi-structured interviews were conducted to investigate the comprehensibility of seven prescription labels among patients with different health literacy skills (2a), and a quantitative study in which the comprehensibility of six optimized prescription labels was compared among patients with different health literacy skills (2b). Patient studies were conducted in eight Dutch pharmacies. In phase 3 optimized prescription label instructions were implemented in national medication databases which has been supported by a guideline (3a), and education of pharmacy workers (3b). Phase 4 consists of evaluating the optimized prescription label instructions by experiences from patients and pharmacists. Anticipated Results This mixed-methods approach will result in scientific publications of the individual studies, and a guideline on how to compose comprehensible prescription label instructions to be put on medication packages. Optimized prescription label instructions will be implemented in national medication databases. Discussion This protocol describes a mixed-method research to compose and implement comprehensible prescription label instructions and will lead to knowledge about the comprehensibility of textual elements in these labels, with specific attention for patients with limited health literacy. Implementation of optimized prescription label instructions will lead to a better understanding of them, which may contribute to improved medication adherence. A limitation is that non-textual aspects of prescription labels are not investigated.
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Affiliation(s)
- Ekram Maghroudi
- Department of Patient Information, Health Base Foundation, Houten, Netherlands.,Department of Family Medicine, Research School CAPHRI, Maastricht University, Maastricht, Netherlands
| | - Charlotte M J van Hooijdonk
- Department of Languages, Literature & Communication, Faculty of Humanities, Universiteit Utrecht, Utrecht, Netherlands
| | - Liset van Dijk
- Department of Pharmaceutical Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Department of PharmacoTherapy, Epidemiology & Economics (PTEE), Faculty of Mathematics and Natural Sciences, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Gudule Boland
- Department of Prevention and Care for the Chronically Ill Programme, Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands
| | - Channah de Haas
- Department of Patient Information, Health Base Foundation, Houten, Netherlands
| | - Marleen Journée-Gilissen
- Medicines Information Centre, Royal Dutch Pharmacists Association (KNMP), The Hague, Netherlands
| | - Janneke van der Velden
- Department of Prevention and Care for the Chronically Ill Programme, Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands
| | - Marcia Vervloet
- Department of Pharmaceutical Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Henk Westerhof
- Department of Computerization of General Practitioner Care, NHG, The Dutch College of General Practitioners, Utrecht, Netherlands
| | - Jany J D J M Rademakers
- Department of Family Medicine, Research School CAPHRI, Maastricht University, Maastricht, Netherlands.,Department of Pharmaceutical Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Sander D Borgsteede
- Department of Clinical Decision Support, Health Base Foundation, Houten, Netherlands
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Visscher BB, Steunenberg B, Heerdink ER, Rademakers J. Medication self-management support for people with diabetes and low health literacy: A needs assessment. PLoS One 2020; 15:e0232022. [PMID: 32330161 PMCID: PMC7182204 DOI: 10.1371/journal.pone.0232022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/06/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION An adequate level of health literacy is regarded as a prerequisite for adequate medication self-management. Low health literacy skills are relatively more common in people with Diabetes Mellitus type 2. The aim of this study was to explore the needs regarding medication self-management of people with type 2 diabetes and low (functional, communicative and critical) health literacy, and their preferences for medication self-management support. MATERIALS AND METHODS A two-stage qualitative needs assessment study was performed using in-depth individual interviews and focus groups. RESULTS The participants preferred to be supported with reliable and easily understandable information, adequate interactive communication with health care professionals and fellow people with diabetes and tools for medication self-management support. DISCUSSION Future interventions should be created in co-creation with people with low health literacy and fulfill the expressed needs on information, communication and tools to improve self-management.
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Affiliation(s)
- Boudewijn B. Visscher
- Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Bas Steunenberg
- Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Eibert R. Heerdink
- Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jany Rademakers
- Research Department, NIVEL (Netherlands institute for health services research), Utrecht, The Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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Krajnović D, Ubavić S, Bogavac-Stanojević N. Pharmacotherapy Literacy and Parental Practice in Use of Over-the-Counter Pediatric Medicines. MEDICINA-LITHUANIA 2019; 55:medicina55030080. [PMID: 30917624 PMCID: PMC6473441 DOI: 10.3390/medicina55030080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: Pharmaceutical literacy skills of parents are crucial for appropriate and safe medication use in pre-school children (ages 1⁻7 years). A recent study on pharmacotherapy literacy from Serbia showed that one in five parents have difficulty understanding common information about the use of medicines. Because antipyretics are considered to be the most frequently used group of over-the-counter (OTC) medications during the pre-school period, we aimed to: (i) examine parental practice and expectations in antipyretic medication use, and (ii) analyze associations of parental practice and expectations related to socio-economic status and pharmacotherapy literacy. Materials and methods: A cross-sectional survey using a self- report validated specific instrument was conducted with the parents of pre-school children in kindergartens in Belgrade, Serbia. Pharmacotherapy literacy refers to the knowledge and personal skills needed to meet the complex demands of medicine use in both healthcare and non-healthcare settings. A comprehensive literature review, expert-focus group consultation, and pre-testing were employed in 4-item multiple-choice test development to explore practice and expectations related to the use of OTC pediatric antipyretic medicines. Results: The final analytical cohort was comprised of 813 participants, the majority (63.3%) chose a medicine based on a physician's suggestion and only 15.4% of parents reported they would follow the advice of a pharmacist. More than a half of parents (54.1%) would need advice about antipyretic medicine from a pharmacist, firstly in a simpler language. Parents satisfied with the information given by a pharmacist had higher pharmacotherapy literacy, compared to parents with lower levels (OR⁻0.718, 95%CI (0.597⁻0.865), p < 0.001). Men had a higher expectation of pharmacists to explain medicine use in a simpler language (OR⁻1.630, 95%CI (1.063⁻2.501), p = 0.025), as well as parents with three or more children (OR⁻2.527, 95%CI (1.43⁻4.459), p = 0.001). Parents with higher knowledge about medicine use were less likely to ask for simpler information (OR⁻0,707; 95%CI (0,583⁻0,856), p < 0,001). Conclusions: Our main finding is that practice in antipyretic OTC medicine use was associated with levels of parental pharmacotherapy literacy. The expectations of pharmacists were higher among parents with lower levels of pharmacotherapy literacy, who expected more information in a simpler and more precise language. This study highlighted the need for pharmacists to identify risks in parental practice and to provide information about medicines to parents of pre-school children in a simpler and more appropriate way.
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Affiliation(s)
- Dušanka Krajnović
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia.
| | - Stana Ubavić
- Medicines and Medical Devices Agency of Serbia (ALIMS), 11221 Belgrade, Serbia.
| | - Nataša Bogavac-Stanojević
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11221 Belgrade, Serbia.
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Miller MJ, Nutbeam D. Advancing international understanding of health literacy in pharmacy: Current trends and future directions. Res Social Adm Pharm 2018; 14:v-vi. [DOI: 10.1016/j.sapharm.2018.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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