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Langerman C, Forbes A, Robert G. A qualitative study of the experiences of insulin use by older people with type 2 diabetes mellitus. BMC PRIMARY CARE 2024; 25:180. [PMID: 38778253 DOI: 10.1186/s12875-024-02318-3] [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: 11/09/2023] [Accepted: 02/22/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND There is a rising prevalence of type 2 diabetes among older people. This population also suffers from co-morbidity and a greater number of diabetes related complications, such as visual and cognitive impairment, which can potentially affect their ability to manage insulin regimens. Understanding the experiences of older people when they transition to insulin will help the development of healthcare interventions to enhance their diabetes outcomes, overall health and quality of life. AIMS The aims of this exploratory study were to (1) understand the experiences of older people with type 2 diabetes in relation to insulin treatment initiation and management and (2) use this understanding to consider how the insulin management support provided to older people by healthcare providers could be more tailored to their needs. METHOD A qualitative study using semi structured (remote) interviews with older people with diabetes (n = 10) and caregivers (n = 4) from the UK. Interviews were audio recorded and transcribed, and framework analysis was used to analyse the data. RESULTS Three main themes, along with six subthemes, were generated from the study data. Participants generally felt at ease with insulin administration following training, yet some reported feelings of failure at transitioning to insulin use. Participants were also frustrated at what they perceived were insufficient resources for effective self-management, coupled with a lack of professional interest in optimising their health as older people. Some also expressed dissatisfaction regarding the brevity of their consultations, inconsistent information from different healthcare professionals and poor treatment coordination between primary and secondary care. CONCLUSION Overall, the study emphasised that older people need better support, education and resources to help manage their insulin use. Healthcare professionals should be encouraged to adopt a more individualised approach to supporting older people that acknowledges their prior knowledge, physical and psychological capabilities and motivation for diabetes self-management. In addition, better communication between different services and greater access to specialist support is clearly needed for this older population. PRACTICE IMPLICATIONS An integrated care pathway for insulin use in older people could be considered. This would include an assessment of the older person's needs and capacity on their initiation to insulin; targeted education and training in self-management; timely access to appropriate emotional and peer support resources; care plans developed collaboratively with patients; and individualised glucose targets that recognise the needs and preferences of the older person.
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Affiliation(s)
- Chaya Langerman
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Zarza-Arribas M, Menárguez Puche JF, Morales López R, Barber Valles JX, Orozco Beltrán DL. Cross-Cultural Adaptation and Validation of the Perception of the Doctor-Patient Relationship (PREMEPA) Questionnaire in Chronic Multi-Pathological Patients. J Prim Care Community Health 2024; 15:21501319241241198. [PMID: 38554060 PMCID: PMC10981856 DOI: 10.1177/21501319241241198] [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: 01/10/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 04/01/2024] Open
Abstract
OBJECTIVE To conduct a cross-cultural adaptation and validation in Primary Care of the PREMEPA doctor-patient relationship perception questionnaire. DESIGN Descriptive, cross-sectional study, using self-administered questionnaires. Qualitative validation: an adapted version of the original questionnaire, was adapted to our culture. The process consisted of the evaluation, cross-cultural adaptation and consensus of a group of experts. The questionnaire was piloted on a sample of 32 patients diagnosed with at least 2 chronic pathologies. MEASURES Cognitive piloting, comprehensibility assessment, content validation and internal consistency analysis using Cronbach's alpha coefficient. Quantitative validation: the internal consistency, construct validity and validity of the questionnaire were studied by means of a confirmatory factor analysis developed in a multicenter study, randomly selecting 202 patients with at least 2 chronic pathologies. RESULTS Content validity of the new Spanish version was confirmed to be adequate. Comprehensibility and internal consistency (Cronbach's α coefficient = 0.78) were adequate. The confirmatory factor analysis showed good dimensionality, factor relationship and internal consistency, as well as acceptable construct validity. The final result was a 13-item questionnaire consisting of 2 dimensions, which explain 58.5% of the variance: participation in decision-making (accounting for 45.2% of the variance) and person-centered communication (encompassing courtesy, empathy, humanity, and trust). CONCLUSIONS This adapted version of the PREMEPA questionnaire can be considered valid for use in the Spanish population with a history of chronic pathology. This version of PREMEPA provides a new instrument to understand and improve chronic patient care, which can improve the doctor-patient relationship, encouraging adherence to treatment and enhancing health outcomes.
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Crutzen S, Baas G, Abou J, van den Born-Bondt T, Hugtenburg JG, Bouvy ML, Heringa M, Taxis K, Denig P. Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study. Front Pharmacol 2020; 11:1268. [PMID: 32973509 PMCID: PMC7468428 DOI: 10.3389/fphar.2020.01268] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/31/2020] [Indexed: 01/01/2023] Open
Abstract
Background Deprescribing has been recommended for managing polypharmacy but deprescribing preventive medication in older patients is still uncommon. We aimed to investigate older patients’ barriers to and enablers of deprescribing cardiometabolic medication. Methods Two focus groups were conducted among patients ≥70 years with polypharmacy, including cardiometabolic medication. Purposive sampling through four community pharmacies was used in two regions in the Netherlands. A topic list was developed using literature and the theoretical domains framework (TDF). The meetings were audio recorded, transcribed verbatim and coded using thematic coding, attribute coding and the TDF. In addition, patients were categorized on attitudes towards medication and willingness to stop. Results The meetings were attended by 17 patients and 1 caregiver (71 to 84 years). In total 15 barriers and 13 enablers were identified within four themes, partly related to beliefs, fears and experiences regarding using or stopping medication, and partly related to the relationship with the health care professional and the conditions to stop. Some patients attributed their wellbeing to their medication and were therefore unwilling to stop. Reducing cardiometabolic medication because of less strict treatment targets confused some patients and was a barrier to deprescribing. Having options to monitor clinical measurements and restart medication were enablers. Patients were only willing to stop cardiometabolic medication when this was proposed by a HCP they trusted. Patients with a positive attitude towards medication varied in their willingness to stop cardiometabolic medication. Patients with a negative attitude towards medication were generally willing to stop medication but still perceived several barriers and may consider some medication as being essential. Conclusion Fears, beliefs, and experiences regarding using and stopping medication as well as trust in the HCP influence willingness to have medication deprescribed. Attitudes towards medication in general do not necessarily translate into willingness or unwillingness to stop specific medication. For deprescribing cardiometabolic medication, patient involvement when setting new treatment targets and monitoring the effects on short-term outcomes are important.
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Affiliation(s)
- Stijn Crutzen
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Gert Baas
- SIR Institute for Pharmacy Practice and Policy, Leiden, Netherlands
| | - Jamila Abou
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, location VUMC, Amsterdam, Netherlands
| | - Tessa van den Born-Bondt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, location VUMC, Amsterdam, Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Leiden, Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Katja Taxis
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Barg FK, Cronholm PF, Easley EE, Davis T, Hampton M, Malay DS, Donohue C, Song J, Thom SR, Margolis DJ. A qualitative study of the experience of lower extremity wounds and amputations among people with diabetes in Philadelphia. Wound Repair Regen 2017; 25:864-870. [PMID: 29220878 DOI: 10.1111/wrr.12593] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 09/27/2017] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to explore perceptions among people with type 2 diabetes about foot ulcers and lower extremity amputations. This was a qualitative observational study utilizing open-ended, semistructured interviews of 39 people with diabetes who were purposively selected because they had either a foot ulcer (n = 19) or a lower extremity amputation (n = 20). Interviews were audio-recorded, deidentified, and entered into NVivo 10.0 for coding and analysis. Our integrated analytic approach combined inductively and deductively derived codes that were applied to all transcripts. Coded data were summarized and examined for patterns. Participants' description of the relationship between diabetes and their foot ulcer or amputation revealed a limited understanding of the disease process. Disruption and loss of independence was expressed whether the person had a foot ulcer or an amputation. Treatment recommendations for foot ulcers were viewed by most as extremely difficult. Amputation was a feared outcome, but some learned to adapt and, at times felt that the amputation enhanced their quality of life. Clinicians have assumed that a focus on limb salvage is preferred over a major amputation. However, because of the complexity of care requiring frequent healthcare provider visits, the frequency of care failure, the frequency of recurrence, and mortality associated with having had a foot ulcer, it may be more appropriate for clinicians to prioritize quality-of-life salvage. Foot ulcer treatment failure may be due to a lack of providers' understanding of the impact of treatment on a patient's life.
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Affiliation(s)
- Frances K Barg
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ebony E Easley
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Trocon Davis
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Michelle Hampton
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - D Scot Malay
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Jinsup Song
- Gait Study Center; Temple University School of Podiatric Medicine, Philadelphia, PA
| | - Stephen R Thom
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - David J Margolis
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Sav A, Salehi A, Mair FS, McMillan SS. Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature. BMC Med Res Methodol 2017; 17:140. [PMID: 28899342 PMCID: PMC5596495 DOI: 10.1186/s12874-017-0411-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/31/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although there has been growing research on the burden of treatment, the current state of evidence on measuring this concept is unknown. This scoping review aimed to provide an overview of the current state of knowledge as well as clear recommendations for future research, within the context of chronic disease. METHODS Four health-based databases, Scopus, CINAHL, Medline, and PsychInfo, were comprehensively searched for peer-reviewed articles published between the periods of 2000-2016. Titles and abstracts were independently read by two authors. All discrepancies between the authors were resolved by a third author. Data was extracted using a standardized proforma and a comparison analysis was used in order to explore the key treatment burden measures and categorize them into three groups. RESULTS Database searching identified 1458 potential papers. After removal of duplications, and irrelevant articles by title, 1102 abstracts remained. An additional 22 papers were added via snowball searching. In the end, 101 full papers were included in the review. A large number of the studies involved quantitative measures and conceptualizations of treatment burden (n = 64; 63.4%), and were conducted in North America (n = 49; 48.5%). There was significant variation in how the treatment burden experienced by those with chronic disease was operationalized and measured. CONCLUSION Despite significant work, there is still much ground to cover to comprehensively measure treatment burden for chronic disease. Greater qualitative focus, more research with cultural and minority populations, a larger emphasis on longitudinal studies and the consideration of the potential effects of "identity" on treatment burden, should be considered.
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Affiliation(s)
- Adem Sav
- School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia. .,, PO Box 456, Virginia, 4014, Australia.
| | - Asiyeh Salehi
- Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, Australia
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Sara S McMillan
- Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, Australia
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Tjia J, Kutner JS, Ritchie CS, Blatchford PJ, Bennett Kendrick RE, Prince-Paul M, Somers TJ, McPherson ML, Sloan JA, Abernethy AP, Furuno JP. Perceptions of Statin Discontinuation among Patients with Life-Limiting Illness. J Palliat Med 2017; 20:1098-1103. [PMID: 28520522 DOI: 10.1089/jpm.2016.0489] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Optimal management of chronic medications for patients with life-limiting illness is uncertain. Medication deprescribing may improve outcomes in this population, but patient concerns regarding deprescribing are unclear. OBJECTIVE The aim of this study was to quantify the perceived benefits and concerns of statin discontinuation among patients with life-limiting illness. DESIGN Baseline data from a multicenter, pragmatic clinical trial of statin discontinuation were used. SETTING/SUBJECTS Cognitively intact participants with a life expectancy of 1-12 months receiving statin medications for primary or secondary prevention were enrolled. MEASUREMENTS Responses to a 9-item questionnaire addressing patient concerns about discontinuing statins were collected. We used Pearson chi-square tests to compare responses by primary life-limiting diagnosis (cancer, cardiovascular disease, other). RESULTS Of 297 eligible participants, 58% had cancer, 8% had cardiovascular disease, and 30% other primary diagnoses. Mean (standard deviation) age was 72 (11) years. Fewer than 5% of participants expressed concern that statin deprescribing indicated physician abandonment. About one in five participants reported being told to take statins for the rest of their life (18%) or feeling that discontinuation represented prior wasted effort (18%). Many participants reported benefits of stopping statins, including spending less money on medications (63%), potentially stopping other medications (34%), and having a better quality of life (25%). More participants with cardiovascular disease as a primary diagnosis perceived that quality-of-life benefits related to statin discontinuation (52%) than participants with cancer (27%) or noncardiovascular disease diagnoses (27%) [p = 0.034]. CONCLUSION Few participants expressed concerns about discontinuing statins; many perceived potential benefits. Cardiovascular disease patients perceived greater potential positive impact from statin discontinuation.
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Affiliation(s)
- Jennifer Tjia
- 1 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
| | - Jean S Kutner
- 2 Department of Medicine, University of Colorado School of Medicine , Aurora, Colorado
| | - Christine S Ritchie
- 3 Department of Medicine, University of California San Francisco School of Medicine , San Francisco, California
| | - Patrick J Blatchford
- 4 Department of Biostatistics and Informatics, University of Colorado School of Medicine , Aurora, Colorado
| | | | - Maryjo Prince-Paul
- 6 Frances Payne Bolton School of Nursing, Case Western Reserve University , Cleveland, Ohio
| | - Tamara J Somers
- 7 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center , Durham, North Carolina
| | - Mary Lynn McPherson
- 8 Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy , Baltimore, Maryland
| | - Jeff A Sloan
- 9 Department of Health Sciences Research, Mayo Clinic , Rochester, Minnesota
| | | | - Jon P Furuno
- 11 Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy , Portland, Oregon
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McSharry J, McGowan L, Farmer AJ, French DP. Perceptions and experiences of taking oral medications for the treatment of Type 2 diabetes mellitus: a systematic review and meta-synthesis of qualitative studies. Diabet Med 2016; 33:1330-8. [PMID: 27150899 DOI: 10.1111/dme.13152] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 12/01/2022]
Abstract
AIMS To explore patients' perceptions and experiences of taking oral medications for the pharmacological management of Type 2 diabetes mellitus. METHODS Cinahl, EMBASE, Medline and PsycINFO databases were searched in 2014 to identify qualitative studies exploring patients' perceptions or experiences of taking medications for the management of Type 2 diabetes. Key concepts and themes were extracted and synthesized using meta-ethnography. RESULTS Eight studies were included. Primary study findings were synthesized to develop three higher-order constructs that moved beyond the results of individual studies. The first construct, Medications for diabetes: a necessary evil, outlines how patients' negative perceptions of medication risks co-exist with a resounding view that medications are beneficial. Passive patients but active experimenters highlights the contrast between patients' passive acceptance of medication prescriptions and the urge to actively experiment and adjust doses to optimize medication use in daily life. Finally, Taking oral medication for Type 2 diabetes: a unique context describes features specific to the Type 2 diabetes medication experience, including lack of symptoms and the perceived relationship between medication and diet, which may influence adherence. CONCLUSIONS Medication-taking for Type 2 diabetes is a unique adherence context, which requires the development of condition-specific interventions. The present findings indicate patients understand the need for medications but adjust dosage and timing in their daily lives. This review suggests providers should acknowledge patient preferences in the development of management strategies, and highlights an opportunity to direct the motivation evident in patients' experimentation towards potentially more beneficial medication-taking behaviours.
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Affiliation(s)
- J McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland.
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK.
| | - L McGowan
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - A J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - D P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
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Brundisini F, Vanstone M, Hulan D, DeJean D, Giacomini M. Type 2 diabetes patients' and providers' differing perspectives on medication nonadherence: a qualitative meta-synthesis. BMC Health Serv Res 2015; 15:516. [PMID: 26596271 PMCID: PMC4657347 DOI: 10.1186/s12913-015-1174-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/17/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Poor adherence to medication regimens increases adverse outcomes for patients with Type 2 diabetes. Improving medication adherence is a growing priority for clinicians and health care systems. We examine the differences between patient and provider understandings of barriers to medication adherence for Type 2 diabetes patients. METHODS We searched systematically for empirical qualitative studies on the topic of barriers to medication adherence among Type 2 diabetes patients published between 2002-2013; 86 empirical qualitative studies qualified for inclusion. Following qualitative meta-synthesis methods, we coded and analyzed thematically the findings from studies, integrating and comparing findings across studies to yield a synthetic interpretation and new insights from this body of research. RESULTS We identify 7 categories of barriers: (1) emotional experiences as positive and negative motivators to adherence, (2) intentional non-compliance, (3) patient-provider relationship and communication, (4) information and knowledge, (5) medication administration, (6) social and cultural beliefs, and (7) financial issues. Patients and providers express different understandings of what patients require to improve adherence. Health beliefs, life context and lay understandings all inform patients' accounts. They describe barriers in terms of difficulties adapting medication regimens to their lifestyles and daily routines. In contrast, providers' understandings of patients poor medication adherence behaviors focus on patients' presumed needs for more information about the physiological and biomedical aspect of diabetes. CONCLUSIONS This study highlights key discrepancies between patients' and providers' understandings of barriers to medication adherence. These misunderstandings span the many cultural and care contexts represented by 86 qualitative studies. Counseling and interventions aimed at improving medication adherence among Type 2 diabetes might become more effective through better integration of the patient's perspective and values concerning adherence difficulties and solutions.
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Affiliation(s)
- Francesca Brundisini
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Meredith Vanstone
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Danielle Hulan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Deirdre DeJean
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Mita Giacomini
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
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Low LL, Tong SF, Low WY. Social Influences of Help-Seeking Behaviour Among Patients With Type 2 Diabetes Mellitus in Malaysia. Asia Pac J Public Health 2015. [PMID: 26219560 DOI: 10.1177/1010539515596807] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This qualitative study aimed to explore the influence of social networks such as family members, friends, peers, and health care providers toward the help-seeking behaviour (HSB) of patients with type 2 diabetes mellitus in the public and private primary care settings. In-depth interviews of 12 patients, 9 family members, and 5 health care providers, as well as 3 focus groups among 13 health care providers were conducted. All interviews were audio-taped and transcribed verbatim for qualitative analysis. Social influences play a significant role in the help-seeking process; once diagnosed, patients source information from people around them to make decisions. This significant influence depends on the relationship between patients and social networks or the level of trust, support, and comforting feeling. Thus, the impacts on patients' help-seeking behavior are varied. However, the help-seeking process is not solely an individual's concern but a dynamic process interacting with the social networks within the health care system.
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Affiliation(s)
- Lee Lan Low
- University of Malaya, Kuala Lumpur, Malaysia Institute for Health Systems Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Seng Fah Tong
- Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wah Yun Low
- University of Malaya, Kuala Lumpur, Malaysia
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O'Quin KE, Semalulu T, Orom H. Elder and caregiver solutions to improve medication adherence. HEALTH EDUCATION RESEARCH 2015; 30:323-335. [PMID: 25725500 DOI: 10.1093/her/cyv009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Medication mismanagement is a growing public health concern, especially among elders. Annually, it is a major contributor to emergency hospitalization and nursing home placement. Elders and their caregivers, as healthcare consumers and stakeholders in this issue, are uniquely qualified to inform strategies to improve medication adherence. We conducted a qualitative study to ascertain caregiver and elder perceptions of barriers to medication management and to identify community-derived solutions to improve medication management. Nine focus groups (N = 65, mean age = 71) were conducted with caregivers or elders from five communities. Participants were recruited by key informants utilizing snowball sampling methodology. The following themes were identified in the participant-recommended proposed solutions improving medication adherence: (i) use of personal systems to overcome barriers to medication adherence, (ii) various solutions to address cost concerns, (iii) the need for regular review of medications by doctors or pharmacists to eliminate unnecessary medications, (iv) desire for community-driven support systems, and (v) using medical advocates. Elders and caregivers recognized medication non-adherence as a community-wide issue and were eager to offer solutions they thought would work in their communities. These solutions can lend credibility to strategies currently being developed/utilized and offer innovative recommendations for future interventions.
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Affiliation(s)
- K E O'Quin
- The School of Public Health, Georgia State University, P.O. Box 3965, Atlanta, GA 30302-3965, Northern Ontario School of Medicine, Thunder Bay, ON P7B 5E1, Canada and Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14214, USA
| | - T Semalulu
- The School of Public Health, Georgia State University, P.O. Box 3965, Atlanta, GA 30302-3965, Northern Ontario School of Medicine, Thunder Bay, ON P7B 5E1, Canada and Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14214, USA
| | - H Orom
- The School of Public Health, Georgia State University, P.O. Box 3965, Atlanta, GA 30302-3965, Northern Ontario School of Medicine, Thunder Bay, ON P7B 5E1, Canada and Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14214, USA
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Hsu C, Lemon JM, Wong ES, Carson-Cheng E, Perkins M, Nordstrom MS, Liu CF, Sprague C, Bryson CL. Factors affecting medication adherence: patient perspectives from five veterans affairs facilities. BMC Health Serv Res 2014; 14:533. [PMID: 25391694 PMCID: PMC4239388 DOI: 10.1186/s12913-014-0533-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 10/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the United States, more than 25 million people have diabetes. Medication adherence is known to be important for disease control. However, factors that consistently predict medication adherence are unclear and the literature lacks patient perspectives on how health care systems affect adherence to oral hypoglycemic agents (OHAs). This study explored facilitators and barriers to OHA adherence by obtaining the perspectives of Veterans Affairs (VA) patients with OHA prescriptions. METHODS A total of 45 patients participated in 12 focus groups that explored a wide range of issues that might affect medication adherence. Participants were patients at clinics in Seattle, Washington; San Antonio, Texas; Portland, Oregon; Salem, Oregon, and Warrenton, Oregon. RESULTS Key system-level facilitators of OHA adherence included good overall pharmacy service and several specific mechanisms for ordering and delivering medications (automated phone refill service, Web-based prescription ordering), as well as providing pillboxes and printed lists of current medications to patients. Barriers mirrored many of the facilitators. Poor pharmacy service quality and difficulty coordinating multiple prescriptions emerged as key barriers. CONCLUSIONS VA patient focus groups provided insights on how care delivery systems can encourage diabetes medication adherence by minimizing the barriers and enhancing the facilitators at both the patient and system levels. Major system-level factors that facilitated adherence were overall pharmacy service quality, availability of multiple systems for reordering medications, having a person to call when questions arose, counseling about the importance of adherence and providing tools such as pillboxes and updated medication lists.
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Affiliation(s)
- Clarissa Hsu
- Center for Community Health and Evaluation, Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1448, USA. .,Department of Health Services, School of Public Health and Community Medicine, University of Washington, 1959 NE Pacific St. Magnuson Health Sciences Center, Box 357660, Seattle, WA, 98195, USA.
| | - Jaclyn M Lemon
- VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA.
| | - Edwin S Wong
- VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA. .,Department of Health Services, School of Public Health and Community Medicine, University of Washington, 1959 NE Pacific St. Magnuson Health Sciences Center, Box 357660, Seattle, WA, 98195, USA.
| | - Elizabeth Carson-Cheng
- Center for Community Health and Evaluation, Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1448, USA.
| | - Mark Perkins
- VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA.
| | - Margaret S Nordstrom
- VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA.
| | - Chuan-Fen Liu
- VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA. .,Department of Health Services, School of Public Health and Community Medicine, University of Washington, 1959 NE Pacific St. Magnuson Health Sciences Center, Box 357660, Seattle, WA, 98195, USA.
| | - Carol Sprague
- Portland VA Medical Center, 3710 SW U.S. Veterans Hospital Road, Portland, OR, 97239, USA. .,Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239-3098, USA.
| | - Christopher L Bryson
- VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA. .,Department of Medicine, University of Washington, Box 356420, , 1959 NE Pacific Street, Seattle, WA, 98195, USA.
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Clark ML, Utz SW. Social determinants of type 2 diabetes and health in the United States. World J Diabetes 2014; 5:296-304. [PMID: 24936251 PMCID: PMC4058734 DOI: 10.4239/wjd.v5.i3.296] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/19/2014] [Accepted: 05/14/2014] [Indexed: 02/05/2023] Open
Abstract
Diabetes is the sixth leading cause of death in the United States. To date, most research and resulting clinical strategies have focused on the individual with short-term health improvements that have not been maintained over time. Researchers more recently have recognized the need to consider the social determinants of diabetes and health along with individual factors. The purpose of this literature review is to examine current understanding of the social determinants affecting diabetes and health. A search of medical and nursing literature was conducted using PubMed, PsychInfo, CINAHL and MEDLINE databases, selecting articles published between 2000 and 2013. Search terms included: type 2 diabetes, social determinants, and health determinants. Inclusion criteria were: English language, human studies, social determinants of diabetes and health, and research in the United States. Additional search methods included reference chaining of the literature. Twenty research articles met the inclusion criteria for the review and analysis and included quantitative and qualitative methods. All studies selected for this review were descriptive in nature (n = 20). Fifteen studies were quantitative studies and five were qualitative studies. No intervention studies met inclusion criteria. Each study is summarized and critiqued. Study findings indicate that external or upstream factors consistently affect individuals diagnosed with diabetes, influencing self-management. Significant methodological limitations result directly from small sample sizes, convenience or nonprobability sampling, and low statistical power.
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Gauthier B, Singh SR, Virani A, Staples H, Colbourne A. Perspectives and experiences of health care professionals and patients regarding treatments for type 2 diabetes. Can Pharm J (Ott) 2014; 147:45-54. [PMID: 24494015 DOI: 10.1177/1715163513506547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several treatment options exist for type 2 diabetes, but little is known about the factors considered by health care providers (HCPs) and patients in Canada in making therapeutic decisions. This study explores perceptions and practices of HCPs and patients related to add-on (i.e., second-line) therapy for type 2 diabetes when initial therapy no longer provides adequate glycemic control. METHODS HCPs (pharmacists, family physicians, diabetes educators, endocrinologists and nurse practitioners) and patients with type 2 diabetes in Ottawa and Halifax were randomly selected to participate in the study. Phone interviews were conducted with endocrinologists and nurse practitioners and focus groups with the other HCPs and patients. RESULTS AND INTERPRETATION Sixty HCPs and 14 patients participated in the study. Metformin was consistently reported by prescribers (physicians and nurse practitioners) as the preferred initial therapy. Important factors in choosing second-line therapy (once glycemic control was inadequate with metformin) were antihyperglycemic efficacy, risk of hypoglycemia and weight gain, and long-term safety. Other considerations were cost, insurance coverage and patient preference. There were differences within and between HCP groups in how these other factors were considered and in the perceived advantages and disadvantages of each drug class. Some patients expressed anxiety when second-line agents were prescribed, and others felt poorly informed about treatment options. CONCLUSION In choosing a second-line therapy for type 2 diabetes, most HCPs placed a high priority on antihyperglycemic efficacy, although there was considerable variability in the relative weight placed on other factors. These findings point to an opportunity for pharmacists to collaborate more actively with other HCPs to ensure that treatment decisions are based on the best available evidence and to educate and involve patients in these decisions.
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Crane MA, Douglass JA, Goeman DP, Cousens NE, Jenkins CR. Development and validation of the Patient Asthma Concerns Tool (PACT) to identify the needs of older people with asthma. Respir Med 2012; 106:1501-8. [PMID: 22921865 DOI: 10.1016/j.rmed.2012.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 07/09/2012] [Accepted: 07/11/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Tools which assist practitioners to identify patient concerns and increase understanding of their needs can improve both the delivery of care and adherence to treatment. The aim of this study was to test the validity and reliability of a 14-item tool, to identify the unmet needs and concerns of older people with asthma. METHODS The Patient Asthma Concerns Tool (PACT) was developed from a pool of 55 items derived from a comprehensive literature review. After pilot and field testing, the initial 55 item questionnaire was administered to a community sample (n = 193), psychometrically tested, and refined to a 14 item PACT tool which was evaluated by a group of clinicians. RESULTS The PACT was shown to have good content and construct validity and was well received by clinicians. The PACT also correlated well with the Juniper ACQ and Brooks' adherence score on related variables and showed good reliability with good-excellent Kappa and ICC scores. Internal consistency of factors was high, and the overall Cronbach's α was 0.70. CONCLUSION The PACT questionnaire was shown to be a valid and reliable tool clinically and psychometrically. We intend to test it in primary care settings and anticipate that its use will assist health professionals to identify the needs and concerns of older patients with asthma and direct tailored asthma management accordingly.
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Schuling J, Gebben H, Veehof LJG, Haaijer-Ruskamp FM. Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC FAMILY PRACTICE 2012; 13:56. [PMID: 22697490 PMCID: PMC3391990 DOI: 10.1186/1471-2296-13-56] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 06/14/2012] [Indexed: 12/03/2022]
Abstract
Background Elderly patients with multimorbidity who are treated according to guidelines use a large number of drugs. This number of drugs increases the risk of adverse drug events (ADEs). Stopping medication may relieve these effects, and thereby improve the patient’s wellbeing. To facilitate management of polypharmacy expert-driven instruments have been developed, sofar with little effect on the patient’s quality of life. Recently, much attention has been paid to shared decision-making in general practice, mainly focusing on patient preferences. This study explores how experienced GPs feel about deprescribing medication in older patients with multimorbidity and to what extent they involve patients in these decisions. Methods Focusgroups of GPs were used to develop a conceptual framework for understanding and categorizing the GP’s view on the subject. Audiotapes were transcribed verbatim and studied by the first and second author. They selected independently relevant textfragments. In a next step they labeled these fragments and sorted them. From these labelled and sorted fragments central themes were extracted. Results GPs discern symptomatic medication and preventive medication; deprescribing the latter category is seen as more difficult by the GPs due to lack of benefit/risk information for these patients. Factors influencing GPs’deprescribing were beliefs concerning patients (patients have no problem with polypharmacy; patients may interpret a proposal to stop preventive medication as a sign of having been given up on; and confronting the patient with a discussion of life expectancy vs quality of life is ‘not done’), guidelines for treatment (GPs feel compelled to prescribe by the present guidelines) and organization of healthcare (collaboration with prescribing medical specialists and dispensing pharmacists. Conclusions The GPs’ beliefs concerning elderly patients are a barrier to explore patient preferences when reviewing preventive medication. GPs would welcome decision support when dealing with several guidelines for one patient. Explicit rules for collaborating with medical specialists in this field are required. Training in shared decision making could help GPs to elicit patient preferences.
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Affiliation(s)
- Jan Schuling
- Department General Practice, University Medical Centre Groningen, A. Deusinglaan 1, 9713AV, Groningen, The Netherlands.
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Foss C, Hofoss D. Elderly persons' experiences of participation in hospital discharge process. PATIENT EDUCATION AND COUNSELING 2011; 85:68-73. [PMID: 20884160 DOI: 10.1016/j.pec.2010.08.025] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 08/16/2010] [Accepted: 08/29/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to describe older hospital patients' discharge experiences on participation in the discharge planning. METHODS A sample of 254 patients aged 80+ was interviewed using a questionnaire developed by the research team. Data were collected by face-to-face interviewing during the first two weeks following patients discharge from hospital. RESULTS In spite of their advanced age the patients in this study did express a clear preference for participation. However, there were no significant correlation between patients' wish for participation and experienced opportunity to share decisions. Hearing ability was the only significant factor affecting the chance to participate, whereas sociodemographic factors did not significantly affect on the likelihood participation the discharge process. CONCLUSION The actual practice of involving old people in the discharge process is not well developed as experienced by old patients themselves. The fact that factors like gender and education have little influence on participation in the oldest patients might be related to age; when you get old enough, old is all that is 'visible'. PRACTICE IMPLICATIONS To determine the extent of elderly patients' desire to participate, one must actively look for it both through research and in the hands-on process of discharge.
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Affiliation(s)
- Christina Foss
- Institute of Health and Society, Department of Nursing and Health Sciences, Blindern, Oslo, Norway.
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Abstract
Patients with issues or health problems usually plan to discuss their concerns with their health care providers. If these concerns were not presented or voiced during the health care provider–patient encounter, the patients are considered to have unvoiced needs. This article examines the extent and possible determinants of patients’ unvoiced needs in an outpatient setting. A cross-sectional study was conducted in 5 Ministry of Health Malaysia primary health facilities throughout the country. Of 1829 who participated, 5 did not respond to the question on planned issues. Of the 1824 respondents, 57.9% (95% confidence interval = 47.1-68.7) claimed to have issues/problems they planned to share, of whom 15.1% to 26.7% had unvoiced needs. Extent of unvoiced needs differed by employment status, perceived category of health care provider, and study center. Perceived category of health care provider, method of questionnaire administration, and study center were the only significant determinants of unvoiced needs. Unvoiced needs do exist in Malaysia and there is a need for health care providers to be aware and take steps to counter this.
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Gorter KJ, Tuytel GJ, de Leeuw RR, Bensing JM, Rutten GEHM. Opinions of patients with type 2 diabetes about responsibility, setting targets and willingness to take medication. A cross-sectional survey. PATIENT EDUCATION AND COUNSELING 2011; 84:56-61. [PMID: 20655164 DOI: 10.1016/j.pec.2010.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 05/05/2010] [Accepted: 06/16/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess opinions and their determinants of patients with type 2 diabetes about responsibility for managing their diabetes, setting treatment targets and willingness taking medication. METHODS Questionnaire survey carried out in general practices and outpatient clinics across the Netherlands. OUTCOMES opinions about responsibility, targets and medication. Multinomial logistic regression analysis. RESULTS Data of 994 consecutive persons were analysed (mean age 65 years; 54% males). Of these 62% agreed to take responsibility for their diabetes. In the opinion of 89% the setting of targets should be by or in cooperation with their physician or nurse and 40% were willing to take tablets until all targets were attained. Patients who perceived dysfunction by barriers to activity did not agree to take responsibility (OR 3.68; 1.65-8.19). Patients with complications preferred to set targets in cooperation with their physician or nurse (OR 1.98; 1.03-3.80). Males were more willing to take tablets until all targets were attained (OR 1.62; 1.17-2.25). CONCLUSION Not all patients want to take responsibility for their diabetes or taking all necessary tablets, especially those with barriers to activity or complications. PRACTICE IMPLICATIONS Doctors and nurses should ask for patients' opinions about responsibility and treatment goals before starting education.
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Affiliation(s)
- Kees J Gorter
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
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Foss C. Elders and patient participation revisited - a discourse analytic approach to older persons' reflections on patient participation. J Clin Nurs 2011; 20:2014-22. [PMID: 21366738 DOI: 10.1111/j.1365-2702.2010.03505.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM AND OBJECTIVE This study focuses on how older persons' accounts of participation might be framed and constructed based on their social and historical situatedness. BACKGROUND The picture emerging from contemporary research tends to portray older people as a group who prefer to leave decisions to the professionals during a hospital stay. Through an approach that sought to contextualise the respondents' accounts of participation, different features of patient participation became visible. DESIGN The study is based on a postmodern framework using a discursive approach, informed by the works of Foucault and on works that have been developed in line with his main ideas. METHOD Eighteen individual in-depth interviews with older people (age 80+) were conducted between one to two weeks after discharge from hospital. RESULTS Findings indicate that older people actively position themselves in relation to various discourses at play in the hospital, and display a wide variety of strategies aimed at gaining influence. To the older persons in this study, participation was practised in a subtle and discreet way, as a matter of choosing a good strategy to interact with the personnel. Participation was also seen as a matter of balancing their own needs against the needs of others and as a behaviour that required self-confidence. CONCLUSION The accounts of patient participation given by the older persons differed from the dominant and taken-for-granted discourse of patient participation as a right. RELEVANCE TO CLINICAL PRACTICE As the older persons' understanding and practice of patient participation do not 'fit' the contemporary idea of participation, it is in danger of being ignored or overlooked by care-givers as well as by researchers. To identify older patients' wish to participate, one must actively search for it.
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Affiliation(s)
- Christina Foss
- Department of Nursing and Health Sciences, Institute of Health and Society, Blindern, Oslo, Norway.
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Casebeer L, Huber C, Bennett N, Shillman R, Abdolrasulnia M, Salinas GD, Zhang S. Improving the physician-patient cardiovascular risk dialogue to improve statin adherence. BMC FAMILY PRACTICE 2009; 10:48. [PMID: 19566950 PMCID: PMC2714292 DOI: 10.1186/1471-2296-10-48] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 06/30/2009] [Indexed: 11/15/2022]
Abstract
Background The purpose of this study was to evaluate the effectiveness of a patient education program developed to facilitate statin adherence. Methods A controlled trial was designed to test the effectiveness of a multifaceted patient education program to facilitate statin adherence. The program included a brief, in-office physician counseling kit followed by patient mailings. The primary end point was adherence to filling statin prescriptions during a 120-day period. Patients new to statins enrolled and completed a survey. Data from a national pharmacy claims database were used to track adherence. Results Patients new to statin therapy exposed to a patient counseling and education program achieved a 12.4 higher average number of statin prescription fill days and were 10% more likely to fill prescriptions for at least 120 days (p = .01). Conclusion Brief in-office counseling on cardiovascular risk followed by patient education mailings can be effective in increasing adherence. Physicians found a one-minute counseling tool and pocket guidelines useful in counseling patients.
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Affiliation(s)
- Linda Casebeer
- Outcomes, Inc, 107 Frankfurt Circle, Birmingham, AL, USA.
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Lau DT, Briesacher B, Mercaldo ND, Halpern L, Osterberg EC, Jarzebowski M, McKoy JM, Mazor K. Older patients' perceptions of medication importance and worth: an exploratory pilot study. Drugs Aging 2008; 25:1061-75. [PMID: 19021304 PMCID: PMC2747735 DOI: 10.2165/0002512-200825120-00007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cost-related medication non-adherence may be influenced by patients' perceived importance of their medications. OBJECTIVES This exploratory pilot study addresses three related but distinct questions: Do patients perceive different levels of importance among their medications? What factors influence perceptions of medication importance? Is perceived importance associated with perceived worth of medications, and does expense impact on that association? METHODS Study participants included individuals aged >or=60 years who were taking three or more prescription drugs. Semi-structured, in-person interviews were conducted to measure how patients rated their medications in terms of importance, expense and worth. Factors that influenced medication importance were identified using qualitative analysis. Ordinal logistic regression analyses were employed to examine the association between perceived importance and perceived worth of medications, and the impact of expense on that association. RESULTS For 143 prescription drugs reported by 20 participants, the weighted mean rating of medication importance was 8.2 (SD 1.04) on a scale from 0 (not important at all) to 10 (most important). Patients considered 38% of these medications to be expensive. The weighted mean rating of worth was 8.4 (SD 1.46) on a scale from 0 (not worth it at all) to 10 (most worth). Three major factors influenced medication importance: drug-related (characteristics, indications, effects and alternatives); patient-related (knowledge, attitudes and health); and external (the media, healthcare and family caregivers, and peers). Regression analyses showed an association between perceived importance and perceived worth for inexpensive medications (odds ratio [OR] 2.23; p = 0.002) and an even greater association between perceived importance and perceived worth for expensive medications (OR 4.29; p < 0.001). DISCUSSION This study provides preliminary evidence that elderly patients perceive different levels of importance for their medications based on factors beyond clinical efficacy. Their perception of importance influences how they perceive their medications' worth, especially for medications of high costs. Understanding how patients perceive medication importance may help in the development of interventions to reduce cost-related non-adherence.
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Affiliation(s)
- Denys T. Lau
- Buehler Center on Aging, Health & Society, Northwestern University, Feinberg School of Medicine. Address: 750 North Lake Shore Drive, Suite 601, Chicago, IL 60611. (W) 312-503-1231. (F) 312-503-5868.
| | - Becky Briesacher
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA.
| | | | - Leslie Halpern
- Buehler Center on Aging, Health & Society, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | | | - Mary Jarzebowski
- Medical Sciences Division, University of Oxford, Oxford, England.
| | - June M. McKoy
- Division of Geriatric Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Kathleen Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA.
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