Evaluation of a nursing intervention project to promote patient medication education

Nurse-Led Intervention to Improve Knowledge of Medications in Survivors of Stroke or Transient Ischemic Attack: A Cluster Randomized Controlled Trial

INTRODUCTION

Limited evidence exists on effective interventions to improve knowledge of preventive medications in patients with chronic diseases, such as stroke. We investigated the effectiveness of a nurse-led intervention, where a component was to improve knowledge of prevention medications, in patients with stroke or transient ischemic attack (TIA).

METHODS

Prospective sub-study of the Shared Team Approach between Nurses and Doctors for Improved Risk Factor Management, a randomized controlled trial of risk factor management. We recruited patients aged ≥18 years and hospitalized for stroke/TIA. The intervention comprised an individualized management program, involving nurse-led education, and management plan with medical specialist oversight. The outcome, participants' knowledge of secondary prevention medications at 12 months, was assessed using questionnaires. A score of ≥5 was considered as good knowledge. Effectiveness of the intervention on knowledge of medications was determined using logistic regression.

RESULTS

Between May 2014 and January 2015, 142 consecutive participants from the main trial were included in this sub-study, 64 to usual care and 78 to the intervention (median age 68.9 years, 68% males, and 79% ischemic stroke). In multivariable analyses, we found no significant difference between intervention groups in knowledge of medications. Factors independently associated with good knowledge (score ≥5) at 12 months included higher socioeconomic position (OR 4.79, 95% CI 1.76, 13.07), greater functional ability (OR 1.69, 95% CI 1.17, 2.45), being married/living with a partner (OR 3.12, 95% CI 1.10, 8.87), and using instructions on pill bottle/package as an administration aid (OR 4.82, 95% CI 1.76, 13.22). Being aged ≥65 years was associated with poorer knowledge of medications (OR 0.24, 95% CI 0.08, 0.71), while knowledge was worse among those taking three medications (OR 0.15, 95% CI 0.03, 0.66) or ≥4 medications (OR 0.09, 95% CI 0.02, 0.44), when compared to participants taking fewer (≤2) prevention medications.

CONCLUSION

There was no evidence that the nurse-led intervention was effective for improving knowledge of secondary prevention medications in patients with stroke/TIA at 12 months. However, older patients and those taking more medications should be particularly targeted for more intensive education.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12688000166370).

District nurses’ preventive home visits to 75-year-olds: An opportunity to identify factors related to unsafe medication management

Aims: To investigate factors related to unsafe medication management among 75-year-olds during preventive home visits, and to describe the interventions district nurses used. Methods: An explorative study. During a 9- to 12-month period, 36 DNs used the Safe Medication Assessment (SMA) tool during preventive home visits to 75-year-olds who used at least one drug ( n=113). Results: One or more factors related to unsafe medication management were identified in 84% of the 75-year-olds. More than 40% used five or more drugs, and 34.5% reported symptoms potentially indicative of adverse effects of their drugs. Nearly 30% had prescribers from more than two medical units, and 7.1% of the older persons were appraised as having reduced cognitive ability. DNs intervened in more than two-thirds of the cases and used a variety of nursing care interventions to improve the safety of medication management. Conclusions: Preventive home visits seem to provide a unique opportunity to promote safe medication management. Several factors related to unsafe medication management were identified, and several different nursing care interventions were carried out to ensure safe medication management. Use of the SMA tool in preventive home visits seems to be advantageous in improving the safety of medication management among older persons.

[Knowledge about pharmacotherapy among hypertensive patients]

The scope of this study was to evaluate the knowledge of pharmacotherapy among users of arterial hypertension medication. A quantitative cross-sectional study was conducted with adults aged 20 years or older, who were users of antihypertensive drugs dispensed by the Public Pharmacy of São Francisco de Paula in the State of Rio Grande do Sul. The study evaluated the knowledge of patients about the drug name, therapeutic indication, dose, administration routine, and duration of treatment, attributing a score (0-5). Multiple linear regression was used to investigate the relationship between the patients' knowledge and characteristics and 678 medication users were interviewed. The mean knowledge score was 3.27 (SD = 1.16). Lower age, higher schooling, Caucasian, better self-reported health and lower number of prescribed drugs were associated with higher knowledge scores. It was observed that the patients' knowledge of all the aspects evaluated is limited, a result that could compromise the correct and safe use of the drugs, and suggesting the need for better counseling and follow-up of users, to control this morbidity.

[Construction of a questionnaire to assess the knowledge of patients on the waiting list for liver transplantation: a pilot study]

OBJECTIVE

To evaluate the suitability of a questionnaire designed to assess the knowledge of patients on the waiting list for liver transplantation, through a pilot study.

METHOD

A descriptive study of the construction of a knowledge questionnaire for patients on the waiting list for liver transplantation. This study was developed in the liver pre-transplant clinic of the Hospital Clinic of Barcelona from October 2011 to April 2012. An initial questionnaire was designed. This draft was improved following the recommendations of experts in liver transplantation, and after the completion of a preliminary test. The questionnaire obtained was applied to 25 patients in the pilot study. The quality of the questions was measured using the discrimination index and the index of attraction. The construct was assessed by principal component analysis and factor analysis.

RESULTS

The questionnaire consisted of 36 items (questions). Of these, 31 are independent. The discrimination index identified only 4 questions with a good (desired information ai=.30) and very good (list exclusion ai=.40, list and time on list ai=.58) level of discrimination. The remaining questions had a poor or insufficient level of discrimination (ai<29). The principal component analysis and factor analysis indicated that the questions related to the disease (10) and the waiting list (4) were essential in the questionnaire, and the questions related to demographic data (7) and the therapeutic regimen (8) should be eliminated.

CONCLUSIONS

The questionnaire obtained needs to be modified to assess the knowledge of patients on waiting list for liver transplantation.

Informing patients about medicines--a hospital in-patient survey in England

OBJECTIVE

To determine the frequency with which hospital in-patients receive information about medicines and whether this varies dependent on patient characteristics or hospitals.

METHODS

Cross-sectional survey of medical in-patients in six hospitals in North West England.

RESULTS

1218 questionnaires were completed sufficiently for analysis by medical in-patients. 534 (43.9%) respondents were informed fully about their medicines by a hospital doctor, nurse or pharmacist and 411 (33.9%) partly informed, but 272 (22.49%) had received no information or could not recall any. Fewer than 20% had received written medicines information. The majority of respondents (763; 62.6%) were not asked if they had any concerns or could not recall this. Patient factors including age, educational level and number of medicines taken did not influence whether or not medicines information was provided, but there were differences between hospitals.

CONCLUSION

There is considerable variation between hospitals in the frequency with which patients are given verbal and written information about medicines and are asked about any medicine-related concerns.

PRACTICE IMPLICATIONS

Informing patients about medicines while in hospital needs to be improved. Doctors, nurses and pharmacists all need to accept and co-ordinate responsibility for informing patients about medicines and asking if they have any concerns or questions.

How patients' lack of knowledge about oral bisphosphonates can interfere with medical and dental care

BACKGROUND

Oral bisphosphonate use has been associated with a small risk of developing oral osteonecrosis that occurs spontaneously or after the patient has undergone dental surgery. The authors conducted a study to determine whether patients taking bisphosphonates had knowledge about the medical indication for the therapy and the duration of treatment, as well as whether they had been educated by their physicians about possible adverse reactions.

METHODS

From June 2008 through April 2009, people seeking routine care in a dental clinic and who were being treated with bisphosphonates were invited to participate in the study. The participants were asked questions involving knowledge about the medical indications related to their taking bisphosphonates, the duration of their therapy and whether they had been educated about possible adverse reactions.

RESULTS

The authors interviewed 73 participants; 84 percent stated they knew why they were receiving bisphosphonate therapy. However, 80 percent said they were unsure about the duration of therapy, and 82 percent could not recall if they had been told about the risk of experiencing adverse reactions, including oral osteonecrosis, by their physicians.

CONCLUSION

People taking bisphosphonates may be unfamiliar with the drug and its possible adverse oral side effects.

CLINICAL IMPLICATIONS

Dentists should be prepared to educate patients about the risks of developing oral complications resulting from bisphosphonate use and the need for appropriate dental care. Questions regarding discontinuation of bisphosphonate therapy should be answered by the physician.