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In vitro and in vivo evaluation of ketotifen-gold nanoparticles laden contact lens for controlled drug delivery to manage conjunctivitis. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Milosavljevic A, Aspden T, Harrison J. Community pharmacist-led interventions and their impact on patients' medication adherence and other health outcomes: a systematic review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 26:387-397. [PMID: 29927005 DOI: 10.1111/ijpp.12462] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 04/23/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Medication adherence can be defined as the extent to which one's medication-taking behaviour follows that mutually agreed upon by the prescribing physician. Optimal medication adherence is often deemed crucial for the success of a patient's treatment, as suboptimal adherence may lead to treatment failure and unnecessary medical expenditure. Increasing evidence has highlighted the positive contribution community pharmacist-led interventions can have on improving patients' adherence and health outcomes. OBJECTIVES To provide an overview of the published literature on community pharmacist-led interventions and their effectiveness in improving patients' adherence and health outcomes. METHODS A search strategy was developed, aiming to retrieve published reports of community pharmacy interventions worldwide. Medline, EMBASE, International Pharmaceutical Abstracts, Google Scholar and ProQuest Dissertations and Theses databases were searched. Articles meeting the inclusion criteria were collated, relevant data extracted, and a risk of bias assessment undertaken. KEY FINDINGS Twenty-two studies were included in the analysis, and their outcomes were reported in 26 peer-reviewed journal articles. Community pharmacist-led interventions have been shown to improve patients' adherence and contribute to better blood pressure control, cholesterol management, chronic obstructive pulmonary disease and asthma control. Studies in this review, however, did not report statistically significant effects of interventions on diabetes or depression control. CONCLUSION Community pharmacist-led interventions have been shown to contribute to improved adherence and better disease control. Future research should attempt to better understand which particular intervention components make the greatest contribution towards improving adherence and health outcomes, for patients with different medical conditions.
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Affiliation(s)
| | - Trudi Aspden
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Jeff Harrison
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
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3
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Ali PA, Watson R. Language barriers and their impact on provision of care to patients with limited English proficiency: Nurses' perspectives. J Clin Nurs 2018; 27:e1152-e1160. [DOI: 10.1111/jocn.14204] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Parveen Azam Ali
- School of Nursing and Midwifery; University of Sheffield; Sheffield UK
| | - Roger Watson
- Faculty of Social Sciences; University of Hull; Hull UK
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4
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Ewan MA, Greene R. Provision of a community pharmacist-run medication advice service at mental health resource centres. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.24.8.294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo assess what medication information long-term mentally ill patients required and acceptability of an advice service. Confidential consultations were offered by a community pharmacist at two mental health resource centres. The service was evaluated by patients and staff by questionnaire.ResultsData were collected on 33 consultations (30 users; three attended twice). Mean duration of consultations was 14.9 minutes (range 5–45). Antipsychotics and antidepressants were most commonly prescribed and enquired about. Most drug enquiries concerned adverse drug reactions (n=24) and therapy choice (n=17). All patients and staff hoped the service would be fully implemented.Clinical ImplicationsCommunity pharmacists represent an acceptable, but underutilised, information provision service. Such a service could be overseen by specialist psychiatric pharmacists. This study reflects patients' concerns about the use of antipsychotics and antidepressants and the need to address them. Further work is needed to determine the impact of the service on clinical outcome.
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5
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Ali PA, Johnson S. Speaking my patient's language: bilingual nurses’ perspective about provision of language concordant care to patients with limited English proficiency. J Adv Nurs 2016; 73:421-432. [DOI: 10.1111/jan.13143] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Stacy Johnson
- Faculty of Medicine & Health Sciences; Queen's Medical Centre; University of Nottingham; UK
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6
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Heslop IM, Bellingan M, Speare R, Glass BD. Pharmaceutical care model to assess the medication-related risks of travel. Int J Clin Pharm 2014; 36:1196-204. [PMID: 25266664 DOI: 10.1007/s11096-014-0016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND People are at greater risk of health problems when travelling and a significant number of travel-related health problems are associated with the effects of travel on pre-existing chronic diseases. Medications play a key role in the management of these conditions. However, there is a notable lack of research evaluating the potential medication-related risks associated with travel. OBJECTIVE To apply a systematic pharmaceutical care model developed to evaluate potential pharmaceutical risks (PPRs) and pharmaceutical care issues (PCIs) in travellers. SETTING Adult travellers leaving Cairns International Airport, Australia, for an international destination. METHOD A cross-sectional survey using semi-structured interviews, including a systematic medication history, followed by the application of a pharmaceutical care model to evaluate each participant for PPRs and PCIs. MAIN OUTCOME MEASURE Evaluation of standard clinical and travel-related PPRs and PCIs. RESULTS Medications for chronic diseases were being taken by 47.7% of the 218 travellers interviewed. Although 75.2% of participants presented with no PPRs, a total of 274 PCIs were identified across 61.5% of the participants, with an average of 2.04 PCIs per participant. The most prevalent PCIs related to the inadequate precautions taken by some travellers visiting malaria-endemic regions. Although 91 participants recognised that they were travelling to malaria-endemic regions, 65.9% of these participants were not using malarial chemoprophylaxis, and only 16.5% were using chemoprophylaxis that fully complied with standard recommendations. The second most prevalent PCI was the need for 18.8% of participants to be educated about their medications. Other PCIs identified have the potential to increase the risk of acute, travel-related conditions, and complicate the care of travellers, if they inadvertently became unwell while overseas. CONCLUSION PPRs and PCIs were not identified in all participants. However, the impact of many of the identified medication-related issues could be substantial to the traveller. This study represents the novel application of a pharmaceutical care model to identify potential PPRs and PCIs in travellers that may not be identified by other pre-travel risk assessment methods.
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Affiliation(s)
- Ian M Heslop
- Pharmacy (Building 47), College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia,
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7
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Hon A. Factors influencing the adherence of antipsychotic medication (Aripiprazole) in first-episode psychosis: findings from a grounded theory study. J Psychiatr Ment Health Nurs 2012; 19:354-61. [PMID: 22404328 DOI: 10.1111/j.1365-2850.2012.01898.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Antipsychotic medication is central to the treatment of patients with first-episode psychosis (FEP). Although non-adherence with the antipsychotic medication regime is a common barrier to the effective treatment of FEP, knowledge is limited about how patients make decisions about adhering to antipsychotic treatment. This qualitative study aimed to gain a greater understanding of patients' medication-taking practices, and their subjective experiences with antipsychotic treatment. In-depth, semi-structured interviews were conducted with patients between the ages of 18 and 35 years who were treated with Aripiprazole under an Early Intervention Service in the south of England. A grounded theory approach was used for data collection and analysis. Twelve participants were included in the study. The findings indicated that patients taking antipsychotic medication for treatment of FEP varied their medication-taking practices according to the effects of the illness or antipsychotic treatment on their lives. A conceptual model was developed and this consists of three thematic categories: quality of life, discernment and health status. The three main themes are interrelated with a cyclical outcome. The findings contribute to the understanding of the medication-taking practices of patients with FEP and have implications for prescribing practice and strategies to enhance antipsychotic adherence.
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Affiliation(s)
- A Hon
- South West London and St George's (Mental Health) NHS Trust, London, UK.
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8
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Goering EM, Matthias MS. Coping with chronic illness: information use and treatment adherence among people with diabetes. Commun Med 2011; 7:107-18. [PMID: 22049634 DOI: 10.1558/cam.v7i2.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study's goal is to understand the complex relationship among information usage, medication adherence, and disease management in people with diabetes. Toward this end, we conducted 21 in-depth interviews with Type 2 diabetics. We queried patients on the sources and adequacy of information that they received about their disease, as well as on how closely they adhered to their prescribed medication regimen. Interviewees identified 12 sources of information that they used to varying degrees in managing their diabetes. Of these sources, patients relied most heavily on their doctors, particularly upon initial diagnosis, in spite of delivering mixed assessments of the adequacy of their physicians'provision of information. Other sources patients most frequently discussed included diabetes education programs, friends/family, the internet, the information leaflet that accompanies prescriptions and written information. Further, those who reported high adherence to their treatment regimen tended to rely on different sources than those who reported low adherence. Findings are interpreted within the framework of the Health Belief Model, and implications for designing effective interventions are discussed.
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Affiliation(s)
- Elizabeth M Goering
- Department of Communication Studies, Indiana University Purdue University, Indianapolis, IN 46202, USA.
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9
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Blenkinsopp A, Phelan M, Bourne J, Dakhil N. Extended adherence support by community pharmacists for patients with hypertension: a randomised controlled trial. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.2000.tb01002.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Objective
To determine the effects of a patient-centred intervention by community pharmacists on adherence to treatment for hypertension.
Study design
Randomised controlled trial.
Method
Randomisation was at pharmacy level. Pharmacists in the intervention group used a structured, brief questioning protocol to identify patients' medication-related problems and their information needs relating to hypertension and its treatment. Advice, information and referral to the general practitioner (GP) were provided by the pharmacist, based on patients' responses. Pharmacists in the control group provided usual care. The intervention was delivered three times at approximately two-month intervals. Blood pressure measurements were collected retrospectively from GP medical records. Patients completed feedback questionnaires at baseline and post-study. The questionnaire comprised a self-reported adherence measure and explored satisfaction with pharmaceutical services.
Setting
Twenty community pharmacy sites (11 intervention and nine controls) in one health authority area in England.
Outcome measures
Control of blood pressure; patient satisfaction with pharmaceutical services; self-reported adherence.
Results
In total, 180 patients (101 intervention and 79 control) from 43 general medical practices completed the trial. Patients whose blood pressure was uncontrolled prior to the study were more likely to become controlled in the intervention group (P<0.05). Most of the effect on self-reported adherence was seen after the first intervention. Patient satisfaction was high prior to the study and was increased in the intervention group after the study. The increase was statistically significant for five items relating to communication between pharmacist and patient.
Conclusion
A simple intervention delivered by community pharmacists produces positive effects on blood pressure control, self-reported adherence and on patient satisfaction with pharmaceutical services.
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Affiliation(s)
- A Blenkinsopp
- Department of Medicines Management, Keele University, Keele, Staffordshire, England ST5 5BG
| | - M Phelan
- Department of Medicines Management, Keele University, Keele, Staffordshire, England ST5 5BG
| | - J Bourne
- Department of Medicines Management, Keele University, Keele, Staffordshire, England ST5 5BG
| | - N Dakhil
- Department of Medicines Management, Keele University, Keele, Staffordshire, England ST5 5BG
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Begley S, Livingstone C, Hodges N, Williamson V. Impact of domiciliary pharmacy visits on medication management in an elderly population. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.1997.tb00895.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
This paper describes medication management by elderly patients living in their own homes, and the effects of patient counselling during five domiciliary pharmacy visits on patient compliance and medication management. The 190 subjects who completed the 12-month study were randomly allocated to either an intervention group (receiving counselling on the correct use and storage of their drugs during five domiciliary visits), a control (V) group (receiving visits but no counselling), or a control (NV) group (having no contact between an initial visit and the end of the study). The patients' drug knowledge, dexterity and cognitive functioning were assessed, and patients in all three groups were well matched at baseline. At each follow-up visit, patient compliance was measured using pill counts and interviews. After the initial visit, patients in the intervention group demonstrated better compliance, better drug storage practices and a reduced tendency to hoard drugs, and required fewer GP consultations, than patients in either of the control groups. The provision of the domiciliary pharmacy service was effective in detecting drug-related problems in a potentially high risk patient group. The effectiveness of such a service may be improved by increased transfer of patient information between community pharmacists and general medical practitioners.
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Affiliation(s)
- S Begley
- Social Services Research and Information Unit, University of Portsmouth, England
| | - C Livingstone
- Sussex Pharmacy Academic Practice Unit, Shoreham by Sea, West Sussex
| | - N Hodges
- Department of Pharmacy, University of Brighton
| | - V Williamson
- Health and Social Policy Research Centre, University of Brighton
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11
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Time to redefine “counselling”? INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.1996.tb00866.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duggan C, Bates I. Development and evaluation of a survey tool to explore patients' perceptions of their prescribed drugs and their need for drug information. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.2000.tb00985.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Objective
To explore the effect of providing information about their prescribed drugs on patients' perceptions and use of the drugs.
Method
A survey tool was administered to 501 general medical patients in their own homes during a trial to reduce discrepancies between supplies of hospital prescribed drugs and those received in the community following hospital discharge. The patient sample was randomly recruited into two cohorts: 264 in the intervention group (given information regarding drugs prescribed on discharge from hospital to take to their community pharmacy) and 237 in the comparison group. Responses to the survey were explored to assess any effects on patients of providing such information.
Setting
Domiciliary visits to general medical patients in East London.
Key findings
The survey tool was subjected to factor analysis and reliability testing. Principal components analysis (PCA) was used to extract five factors that described an intrinsic desire for information, perceived impact of the illness, perceived utility of medicines, anxiety about illness and worry about changes to medicines. Internal consistency was good, ranging from 0.8 to 0.91 (Cronbach's coefficient alpha). Interconstruct relationships between the scales, patient demographics and the two cohorts were explored. The findings indicated that the degree of patient empowerment is related to two constructs: “intrinsic desire for information” and “worry about changes to medicines.” Patients who expressed a low degree of worry about changes and a high desire for information about their drugs seemed less worried and more empowered when given additional information. Conversely, those who expressed worries about changes in their medicines and did not want information about their medicines (were happy knowing little) seemed more worried and less empowered when given additional information about those changes.
Conclusion
Further exploration of relationships between patient perceptions and information provision is needed to influence appropriately the development of pharmaceutical care between hospital and community.
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Affiliation(s)
- Catherine Duggan
- Academic Department of Pharmacy, St Bartholomew's Hospital, West Smithfield, London, England EC1A 7BE
| | - Ian Bates
- Centre for Practice and Policy, School of Pharmacy, University of London
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Bandesha G, Raynor DK, Teale C. Preliminary investigation of patient information leaflets as package inserts. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.1996.tb00875.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
In the United Kingdom, patient information leaflets (PILs) are now supplied with all medicines licensed or re-licensed since January, 1994. This means that, by 1998, all medicines will come with one of these detailed leaflets inside the pack. In a preliminary investigation of the impact of these leaflets, 117 elderly inpatients were questioned on their experience of PILs prior to admission. Ninety-one (78 per cent) said they had received a PIL and 57 (49 per cent) had read one. The main reasons for not reading a leaflet were the perceived difficulty in understanding and being put off by excessive information. Of the patients who had read a leaflet, 23 (40 per cent) reported difficulty in reading the small print and 26 (46 per cent) said they had difficulty understanding the content. Thirteen patients (23 per cent) reported having to seek help with reading a leaflet. Forty-two of those who had read a leaflet rated it as helpful. Eleven patients said they had asked for advice from their doctor or pharmacist as a result of reading a leaflet. Nine patients said the leaflet had caused some anxiety, with two stopping their medicine as a result. The move to universal PILs in patient packs is a major development in the provision of information to patients about medicines. This study suggests that elderly patients have problems relating to understanding the content of PILs and reading the size of print used in these leaflets.
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Affiliation(s)
- G Bandesha
- Department of Medicine, Seacroft Hospital, York Road, Leeds, England LS14 6UH
| | - D K Raynor
- Division of Academic Pharmacy Practice, University of Leeds
| | - C Teale
- Department of Medicine, Seacroft Hospital, York Road, Leeds, England LS14 6UH
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14
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Coleman DJ, Portlock J, Brown D. Delivering domiciliary pharmaceutical care from a health centre pharmacy. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.2001.tb01040.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Aim
To develop and administer a pharmacist domiciliary visiting programme from a community pharmacy based in a health centre.
Design
Prospective cohort with peer professional intervention assessment and patient feedback questionnaires.
Subjects and setting
Total general practitioner surgery list (4,922 patients) in an urban residential area. Candidates were defined by three inclusion criteria: 65 years or older taking five or more repeat medicines (polypharmacy); any age plus polypharmacy plus significant disablement; 80 years or older taking three or more specified medications on repeat prescription.
Outcome measures
Interventions made during a programme of three visits for each patient; peer assessment of impact on patient care and cost by the three surgery GPs and three clinical pharmacists; patients' perceived worth of the service; cost of the service.
Results
One hundred patients (2 per cent) were visited over a period of six months; 74 completed the three-visit programme that involved a total of 256 visits. There were 160 interventions classified as: medicines management issues (88), health beliefs and concordance (41) or therapeutic problems, including adverse effects (31). Nineteen patients required specific and detailed collaboration with the patient's GP. There was good agreement on the utility of the pharmacist's interventions at this level with only four negative assessments out of a possible 114 (3.5 per cent). The programme was well received by patients. Talking to a pharmacist (as opposed to another health care professional) about their medicines was important to 70 of 74 patients. Sixty-one described their reaction to the visiting programme using one of three positive adjectives, “relieved,” “reassured” or “grateful”. Based on this cohort, the estimated costs to the pharmacy were £5,000 per annum, equivalent to 33 working days. Cost savings based on outcomes were not estimated.
Conclusions
This study demonstrated the feasibility of identifying candidates for domiciliary care from surgery records using carefully selected inclusion criteria. This is likely to encompass between 2 and 3 per cent of a surgery population. The visiting programme, which was well received by patients, had a favourable effect on patient care in the majority of the cohort and a very important impact in a minority (19 per cent). This success required the commitment of all members of the health centre team. It benefited from the proximity of the visiting pharmacist to medical records and prescribers.
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Affiliation(s)
- David J Coleman
- Department of Pharmacy and Biomedical Science, University of Portsmouth, St Michael's Building, White Swan Road, Portsmouth, England PO1 2DT
| | - Jane Portlock
- Department of Pharmacy and Biomedical Science, University of Portsmouth, St Michael's Building, White Swan Road, Portsmouth, England PO1 2DT
| | - David Brown
- Department of Pharmacy and Biomedical Science, University of Portsmouth, St Michael's Building, White Swan Road, Portsmouth, England PO1 2DT
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15
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Raynor DK, Nicolson M, Nunney J, Petty D, Vail A, Davies L. The development and evaluation of an extended adherence support programme by community pharmacists for elderly patients at home. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.2000.tb01001.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Objective
To devise, implement and evaluate a medication adherence support service by community pharmacists for elderly patients living at home and at risk of non-adherence.
Method
Six community pharmacists identified patients who were 65 years of age and older, prescribed four or more regular medicines and living alone. A random sample of patients was visited at home and assessed for adherence-related problems using a structured interview. The pharmacist then drew up an action plan in conjunction with the patient and general practitioner (GP), and returned for a second home visit, where the revised regime was delivered and explained. A self-reported adherence questionnaire was also administered. After two months an independent researcher visited the patients at home to assess progress.
Setting
Six community pharmacies in the city of Leeds, UK, and patients' homes.
Key findings
A total of 143 patients were recruited and 441 medicine-related problems were identified. Of these, 241 (55 per cent) required the provision of information and advice, 106 (24 per cent) required consultation with the GP and 86 (20 per cent) required changes in the presentation of the medicines. The median number of regular prescribed medicines fell from six to five (P<0.001). Overall, there was a reduction in the number of patients with one or more problems from 94 per cent to 58 per cent (P<0.001). The proportion of patients who reported non-adherence fell from 38 per cent to 14 per cent (P<0.001).
Conclusion
This study shows that community pharmacists can target patients at risk of medication non-adherence and, using a structured approach, identify problems and implement solutions. The pharmacy patient medication record is an underutilised tool for identifying patients with adherence problems. The software needs enhancing to enable pharmacists to maximise their use of these records in adherence support. An adherence support programme needs to take more account of intentional non-adherence and should be closely linked with the rest of the primary health care team.
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Affiliation(s)
- D K Raynor
- Division of Academic Pharmacy Practice, University of Leeds, 10 Clarendon Road, Leeds, England LS2 9NN
| | - M Nicolson
- Division of Academic Pharmacy Practice, University of Leeds, 10 Clarendon Road, Leeds, England LS2 9NN
| | - J Nunney
- Division of Academic Pharmacy Practice, University of Leeds, 10 Clarendon Road, Leeds, England LS2 9NN
| | - D Petty
- Division of Academic Pharmacy Practice, University of Leeds, 10 Clarendon Road, Leeds, England LS2 9NN
| | - A Vail
- Division of Academic Pharmacy Practice, University of Leeds, 10 Clarendon Road, Leeds, England LS2 9NN
| | - L Davies
- Division of Academic Pharmacy Practice, University of Leeds, 10 Clarendon Road, Leeds, England LS2 9NN
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16
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Goldstein R, Hulme H, Willits J. Reviewing Repeat Prescribing — General Practitioners and Community Pharmacists Working Together. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011. [DOI: 10.1111/j.2042-7174.1998.tb00917.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
In the United Kingdom, patients receiving medication to treat chronic conditions frequently obtain treatment via repeat prescriptions. This reduces the workload of general practitioners (GPs) but increases the potential for patients to receive inappropriate and unnecessary medication over long periods of time. The aim of this project was to determine the potential role that community pharmacists could fulfil in reviewing and rationalising medication received on repeat prescriptions. Volunteer pharmacists and general practitioners in two health authorities in England formed 47 GP-pharmacist partnerships. Each GP identified up to 50 patients receiving six or more “repeat” medicines. Pharmacists reviewed GP notes and record systems to identify potential problems. Discussions addressing the identified problems and possible solutions were held between the GP-pharmacist partners. Three months later the pharmacists revisited the surgeries to review GP notes to determine whether changes had occurred. On completion of the project, focus groups were held with participating GPs and pharmacists to ascertain their views on the project. In total, repeat prescriptions for 1,564 patients were investigated which resulted in 13,194 medicines being reviewed. The pharmacists identified 9,762 potential “problems” of which the most common were: drugs no longer required, inappropriate quantity ordered, and unsatisfactory directions. The GPs agreed with 58 per cent of identified problems and acted upon 56 per cent of these (32 per cent of the original total). In general, the involvement of pharmacists was beneficial in terms of rationalising prescribing and reducing possible drug interactions and adverse drug reactions resulting from multiple supplies of potentially inappropriate and unnecessary medication. Furthermore, pharmacists were able to rationalise patients' supplies to help improve the actual management of medication in terms of ordering and collecting supplies and coping with complex daily regimens.
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Affiliation(s)
- Ruth Goldstein
- Medicines Research Unit, University of Derby, Derby, England DE3 5GX
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17
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Magadza C, Radloff SE, Srinivas SC. The effect of an educational intervention on patients' knowledge about hypertension, beliefs about medicines, and adherence. Res Social Adm Pharm 2010; 5:363-75. [PMID: 19962679 DOI: 10.1016/j.sapharm.2009.01.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 01/30/2009] [Accepted: 01/30/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND The burden of chronic noncommunicable diseases continues to rise in South Africa, leading to high rates of morbidity and mortality. The control of hypertension is far from optimal because of factors such as inadequate patient understanding of the condition and its therapy, as well as poor adherence to prescribed regimens. OBJECTIVE This study investigated the effect of an educational intervention on selected hypertensive participants' levels of knowledge about hypertension, their beliefs about medicines, and adherence to antihypertensive therapy. METHOD Participants took part in an educational intervention that provided them with information about hypertension and its therapy through presentations, monthly meetings, and a summary information leaflet. The participants' levels of knowledge about hypertension and its therapy as well as their beliefs about medicines were measured using interviews and/or self-administered questionnaires. Levels of adherence were assessed using pill counts, self-reports, and punctuality in collecting medication refills. Paired t tests for dependent samples were performed to compare the participants' levels of knowledge about hypertension and its therapy, beliefs about medicines, and levels of adherence to antihypertensive therapy before and after the educational intervention. RESULTS There were significant increases in the participants' levels of knowledge about hypertension and its therapy (P<.0001). Most of the parameters used to indicate beliefs about medicines were significantly modified in a positive manner (P<.01 for concerns about medicines, P<.01 for beliefs about the harmful nature of medicines, and P<.01 for the necessity-concerns differential). CONCLUSION Results of this study show that the educational intervention led to an increase in the participants' levels of knowledge about hypertension and a positive influence on their beliefs about medicines. Despite these positive changes, adequate time is required before anticipated behavioral changes, such as increased adherence, can be observed.
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Affiliation(s)
- C Magadza
- Faculty of Pharmacy, Rhodes University, Grahamstown, 6140, Eastern Cape, South Africa
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Bane C, Hughe CM, McElnay JC. Determinants of medication adherence in hypertensive patients: an application of self-efficacy and the Theory of Planned Behaviour. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.14.3.0006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
The study aimed to identify the determinants of medication adherence in a population of hypertensive outpatients. The principle objective of the present study was to determine the utility of self-efficacy and the Theory of Planned Behaviour (TPB) in predicting adherence with antihypertensive medication.
Setting
An outpatient hypertension clinic at the Belfast City Hospital, Northern Ireland.
Method
Outpatients who had attended the hypertension clinic on at least one previous occasion were invited to participate in the study. Participants completed a questionnaire incorporating measures of adherence with medication, medical and sociodemographic factors, together with measures of self-efficacy and the TPB. There were no specific study exclusion criteria.
Key findings
A total of 139 participants took part in the study; 20.9% of the participants reported non-adherence with their prescribed antihypertensive medication. A statistically significant difference in self-efficacy scores between the adherent and non-adherent groups was revealed by a Mann-Whitney test, with adherent patients perceiving higher levels of self-efficacy. Regression analysis with the TPB variables revealed that adherence was predicted by intentions and subjective norms, with 41% of the variance explained. Intention was predicted by attitudes and perceived behavioural control, with 61.9% of the variance explained.
Conclusion
The present study provides support for the use of self-efficacy and the TPB in predicting medication adherence; however, further research is required on the application of the TBP in the prediction of health behaviour. These findings have implications for the design of adherence-enhancing interventions.
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Affiliation(s)
- Catherine Bane
- School of Pharmacy, Queen's University Belfast, Northern Ireland, UK
| | - Carmel M Hughe
- School of Pharmacy, Queen's University Belfast, Northern Ireland, UK
| | - James C McElnay
- School of Pharmacy, Queen's University Belfast, Northern Ireland, UK
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Du Pasquier S, Aslani P. Concordance-based adherence support service delivery: consumer perspectives. ACTA ACUST UNITED AC 2008; 30:846-53. [PMID: 18592393 DOI: 10.1007/s11096-008-9237-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Accepted: 06/21/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To explore consumers' attitudes towards, and expectations of, adherence support services in primary health care, specifically in community pharmacy; and to explore consumers' attitudes towards the concept of concordance. SETTING An exploratory qualitative study conducted in Metropolitan Sydney, Australia. METHOD Three focus group discussions with consumers on chronic therapy (n = 22) and two focus groups with consumer representatives (n = 15) were conducted in 2002. Consumer representatives were peer educators volunteering in an association which promotes quality use of medicines among elderly patients. All discussions were audio-taped, transcribed verbatim and thematically content analysed. MAIN OUTCOME MEASURES Consumers' experiences with adherence support services delivered by general practitioners and pharmacists, their expectations towards general practitioners' and pharmacists' role in adherence support; and attitudes towards concordance in consultations. RESULTS Participants expected an increased provision of medicine information and a reduction in the number of medications taken as the main strategies to promote adherence. They believed that once understandable information had been delivered, it was their responsibility to take their medications as prescribed. Yet participants frequently complained about the information received, especially from doctors. Only a subgroup of participants expected pharmacists to be involved in adherence support services. These participants generally relied on pharmacists for medicine information and were satisfied with the communication process when interacting with the pharmacists. All participants were positive about concordance, because they valued two-way communication and increased consideration of their needs and beliefs by healthcare professionals. However, they were hesitant about being involved in a shared treatment decision-making process. Many participants focused on concordance with doctors and identified barriers to the establishment of concordance: time pressures, financial constraints, the gap of competence and power between patients and doctors. CONCLUSIONS Pharmacists should consider consumers' needs for information and establishing concordance, as well as their expectations of the pharmacy profession, in delivering concordance based adherence support services. Given participants' high demand for medicine information, an opportunity might exist for pharmacists to influence consumers' expectations by offering information which is tailored towards their needs.
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Affiliation(s)
- Sophie Du Pasquier
- Faculty of Pharmacy, Building A15, The University of Sydney, Sydney, NSW 2006, Australia.
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Lim AYN, Ellis C, Brooksby A, Gaffney K. Patient Satisfaction with Rheumatology Practitioner Clinics: Can We Achieve Concordance by Meeting Patients’ Information Needs and Encouraging Participatory Decision Making? ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n2p110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Introduction: The objective of this study was to determine if patient information needs are being met and the level of patient satisfaction with rheumatology practitioners in participatory decision-making and thereby indirectly explore whether concordance was achieved.
Materials and Methods: The design was a cross-sectional postal questionnaire survey of 420 patients attending outpatient clinics at the Norfolk and Norwich University Hospital who were taking disease modifying anti-rheumatic drugs (DMARDs) or a biological treatment. The population served is ethnically homogeneous and predominantly Caucasian.
Results: The response rate was 76%. Most respondents (79%) had inflammatory arthritis while 66% had rheumatoid arthritis. Seventy-seven per cent of patients reported that the rationale behind commencing treatment was explained and that they were given ample opportunities to ask questions. Eighty-two per cent said they were given an appropriate amount of information. Sixty-four per cent of patients were satisfied with their level of participation in the decision-making process, although a substantial number (25%) said that information from different sources was conflicting. There was no correlation between concern about side effects and patients’ perceptions of the effectiveness of medication. Females were more concerned than males about possible side effects; P =0.009, using the Mann-Whitney U test. One third of the patients altered their medication in response to whether their arthritis felt better or worse.
Conclusion: The majority of patients were satisfied that their information needs were met and with the care provided in the practitioner clinic. Participatory decision-making was sub-optimal despite patient satisfaction with the amount of time allocated to meeting their information needs. We found that patients exercise autonomy in managing their arthritis by regulating their medications through an active decision-making process, which is informed by their previous experience of medication, and how well controlled they felt their arthritis was. Research into this decision-making process may hold the key to achieving concordance.
Key words: Compliance, Concordance, Decision-making, Satisfaction, Side effects
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Abstract
BACKGROUND Providing written medicines information is being legislated in an increasing number of countries worldwide, with the patient information leaflet (PIL) being the most widely used method for conveying health information. The impact of providing such information on adherence to therapy is reportedly unpredictable. Therapy for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and related opportunistic infections usually involves polytherapy and complex regimens, both of which are risk factors for non-adherence. The objective of this study was to assess the impact of medicines information on adherence to chronic co-trimoxazole therapy in low-literate HIV/AIDS patients. METHODS Two different PILs were designed for co-trimoxazole tablets and were available in both English and isiXhosa. Participants were randomly allocated to a control group (receiving no PIL), group A (receiving a "complex PIL") and group B (receiving a "simple PIL" incorporating pictograms). At the first interview, demographic data were collected and the time, date and day that the participant would take his/her first tablet of the month's course was also documented. In a follow-up interview adherence to therapy was assessed using two methods; self-report and tablet count. RESULTS The medicines information materials incorporating simple text and pictograms resulted in significantly improved adherence to therapy in the short term, whereas a non-significant increase in adherence was associated with the availability of the more complex information. This was shown by both the self-reported assessment as well as the tablet count. CONCLUSION This research suggests that appropriately designed written material can have a positive impact in improving adherence and, together with verbal consultation, are essential for enabling patients to make appropriate decisions about their medicine taking.
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Affiliation(s)
- L E Mansoor
- Faculty of Pharmacy, Rhodes University, Grahamstown 6140, South Africa
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23
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Granas AG, Bates I. Patients' understanding and management of their illnesses and prescribed medicines--a descriptive study. ACTA ACUST UNITED AC 2006; 27:321-8. [PMID: 16228632 DOI: 10.1007/s11096-005-5999-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this study was to explore patients' understanding and management of their illnesses and prescribed medicines. METHOD Patients receiving three or more repeat prescription drugs were interviewed in their homes after their repeat prescriptions had drug-related problem (DRP) identified by a community pharmacist in a GP surgery. RESULTS In total, 58 patients were interviewed. Patients distinguished strongly between 'forgetting' and 'taking less' of their medicines, and some actively reduced the dose themselves. More than 25% of the patients involved their spouse in the administration of their medicines. Patients had more worries about their illness (48%) than their medicines (31%). Any changes made to their present medication, or introduction of new medicines, were thought to 'upset the balance'. CONCLUSION More information is needed on patients' perspectives, both on side effects, compliance and how to deal with long-term medication. Health care professionals should seek to understand and respect patients' choices to assure optimal care.
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Affiliation(s)
- Anne G Granas
- Institute of Pharmacy Practice Research (Apoforsk), Kalfarveien 31, 5018 Bergen, Norway.
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24
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Bane C, Hughes CM, McElnay JC. The impact of depressive symptoms and psychosocial factors on medication adherence in cardiovascular disease. PATIENT EDUCATION AND COUNSELING 2006; 60:187-93. [PMID: 16253468 DOI: 10.1016/j.pec.2005.01.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Revised: 01/04/2005] [Accepted: 01/04/2005] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This study sought to determine the influence of depression and psychosocial factors on medication adherence in cardiovascular disease. METHODS A questionnaire including measures of depression, beliefs about medicines, health locus of control and adherence to medication (self-report) was completed by 122 outpatients attending a cardiac clinic. RESULTS Analysis revealed that 14.8% of participants were non-adherent with their cardiovascular medication and 41.7% had scores indicative of depressive symptoms as determined by the Center for Epidemiological Studies Depression Scale (CES-D). Higher scores on this scale and strong concern scores on the Beliefs about Medicines Questionnaire about the potential adverse effects of using medication as prescribed were found to be associated with self-reported non-adherence. DISCUSSION AND CONCLUSION These findings imply that the relationship between depressive symptoms in cardiovascular patients, together with certain psychosocial factors, could have negative consequences for adherence to medication. PRACTICE IMPLICATIONS Given that there is emerging evidence to suggest an association between depression and medication non-adherence, healthcare professionals should consider this when dealing with cardiovascular patients.
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Affiliation(s)
- Catherine Bane
- Programme Manager, Research and Development Office, Belfast, Northern Ireland, UK.
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25
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Abstract
Adherence to medication is one of the most intriguing and complex behaviours demonstrated by patients. Non-adherence to a therapeutic regimen may result in negative outcomes for patients and may be compounded in populations with multiple morbidities which require multiple drug therapy. Such a population is exemplified by the elderly. However, non-adherence may not be more prevalent in older patients and there is no consensus in the literature that age is a predictor of poor adherence. Indeed, older patients may deliberately choose not to adhere to medication (intentional non-adherence) to avoid adverse effects. Furthermore, many of the studies on adherence lack commonality in terms of how adherence is measured, the definition of an 'older' patient and the range of disease states which have been examined. Adherence may also be affected by access to medications which may be restricted by the use of formularies or insurance programmes. However, non-adherence may represent a greater risk in older people resulting in poor disease control which may be compounded with multiple morbidity and polypharmacy. A range of strategies have been implemented to try and improve adherence in this patient population. The use of forgiving drugs (those which have a prescribed dosage interval that is 50% or less the duration of drug action) may facilitate occasional lapses in drug-taking. Drug holidays (deliberate, supervised non-adherence for a fixed period of time) have been used in Parkinson's disease to reduce adverse effects. Once-daily scheduling of drug administration may offer a pragmatic approach to optimising drug therapy in some patients; this may be supplemented through the use of compliance aids. What is increasingly apparent, however, is that the role of the patient (irrespective of age) is critical in decision-making about medication, together with communication between patients and healthcare professionals. This has been articulated through the concept of concordance which has been described as a therapeutic alliance between the patient and healthcare professional. In addition, interventions employed to improve adherence must be multifaceted, and together with practical approaches (reducing unnecessary drugs and simplifying dosage regimens), the patient perspective must be considered. Good adherence should be seen as a means of achieving a satisfactory therapeutic result and not as an end in itself.
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Affiliation(s)
- Carmel M Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland.
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26
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Gustafsson J, Kälvemark S, Nilsson G, Nilsson JLG. Patient information leaflets — patients’ comprehension of information about interactions and contraindications. ACTA ACUST UNITED AC 2005; 27:35-40. [PMID: 15861933 DOI: 10.1007/s11096-005-1413-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine how well patients could correctly recognize and comprehend the various information items on patient information leaflets, and to explore the reasons underlying poor comprehensibility. METHODS Leaflets from 30 randomly selected, commonly prescribed medicines were examined by experts using protocols to evaluate leaflet layout, language and content. The same leaflets were also evaluated by patients who had their medicines dispensed at 24 randomly selected Swedish pharmacies. A questionnaire was used for the patients' examination. RESULTS The results showed that most information on the leaflets is sound and is well comprehended by the patients. For two information items regarding 'risks of interactions' and 'contraindications' the patient scores were low, indicating poor comprehensibility. CONCLUSION Leaflets with low scores on warnings of interactions and contraindications were found to deliver more complex messages to older patients as compared to leaflets with high scores for these items.
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Gustafsson J, Kälvemark S, Nilsson G, Nilsson JLG. A Method to Evaluate Patient Information Leaflets. ACTA ACUST UNITED AC 2003. [DOI: 10.1177/009286150303700114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
OBJECTIVE To provide an overview of the use and impact of written drug information (WDI) on consumers, and to review the literature on the factors influencing the use of WDI by consumers. DATA SOURCES Relevant articles published in English since the late 1970s were identified based on searches of on-line databases, texts, and cited references in published articles. STUDY SELECTION Articles reporting findings on the origin, use, and impact of WDI were included. Due to limited literature, articles reporting findings on factors influencing the use of written drug as well as disease information were included. DATA EXTRACTION Due to the lack of design consistency between studies and the comparatively small volume of work, subjective assessment rather than a criteria-based objective review was deemed more appropriate. DATA SYNTHESIS To date, research on WDI has focused on its use and impact. WDI has the potential to increase patients' knowledge, compliance, and satisfaction. However, there is also the potential for anxiety or premature cessation of therapy due to fear of possible adverse effects. Multiple factors may potentially influence the use of WDI by consumers including those associated with the written information document (readability, presentation), the patient (health literacy, role of caregiver, demographic factors, health locus of control, coping style, health belief model), and the environment (timing of provision, experience). CONCLUSIONS WDI has the potential to impact consumers positively and negatively. Although not widely investigated, a number of factors can potentially influence the use of WDI by consumers. The findings of this review can form the basis for much needed further research.
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Affiliation(s)
- Michelle M Koo
- Faculty of Pharmacy, The University of Sydney, Sydney NSW, Australia.
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29
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Berry DC, Michas IC, Bersellini E. Communicating Information About Medication: The Benefits of Making it Personal. Psychol Health 2003. [DOI: 10.1080/0887044031000080683] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Gray NJ, Cantrill JA, Noyce PR. 'Health repertories': an understanding of lay management of minor ailments. PATIENT EDUCATION AND COUNSELING 2002; 47:237-244. [PMID: 12088602 DOI: 10.1016/s0738-3991(01)00226-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Data from a programme of research exploring information channels about health and medicines used by young adults (16-24 years old) in the UK were considered, in the light of existing schema and memory theory, to provide a concept of 'health repertories' for self-medication of minor ailments. Focus groups comprising a total of 48 young adults were conducted, followed by structured interviews with 76 young adults who visited a community pharmacy to purchase non-prescription medicines or to ask for advice, and case studies from this cohort. We propose that young adults develop a dynamic 'health repertory' of information for management of minor illness episodes, comprising a number of 'entries', and that these repertories are consistent with schema theory. Each 'repertory' includes description/labelling of symptoms, one or more self-medication strategies, and contingency plans (including formal health care intervention), if these strategies fail. Information in the repertory is drawn from both lay and professional channels.
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Affiliation(s)
- Nicola J Gray
- Drug Usage and Pharmacy Practice Group, School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Oxford Road, England, UK
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Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther 2001; 26:331-42. [PMID: 11679023 DOI: 10.1046/j.1365-2710.2001.00363.x] [Citation(s) in RCA: 1062] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Low compliance to prescribed medical interventions is an ever present and complex problem, especially for patients with a chronic illness. With increasing numbers of medications shown to do more good than harm when taken as prescibed, low compliance is a major problem in health care. Relevant studies were retrieved through comprehensive searches of different database systems to enable a thorough assessment of the major issues in compliance to prescribed medical interventions. The term compliance is the main term used in this review because the majority of papers reviewed used this term. Three decades have passed since the first workshop on compliance research. It is timely to pause and to reflect on the accumulated knowledge. The enormous amount of quantitative research undertaken is of variable methodological quality, with no gold standard for the measurement of compliance and it is often not clear which type of non-compliance is being studied. Many authors do not even feel the need to define adherence. Often absent in the research on compliance is the patient, although the concordance model points at the importance of the patient's agreement and harmony in the doctor-patient relationship. The backbone of the concordance model is the patient as a decision maker and a cornerstone is professional empathy. Recently, some qualitative research has identified important issues such as the quality of the doctor-patient relationship and patient health beliefs in this context. Because non-compliance remains a major health problem, more high quality studies are needed to assess these aspects and systematic reviews/meta-analyses are required to study the effects of compliance in enhancing the effects of interventions.
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Affiliation(s)
- E Vermeire
- Centre for General Practice, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
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Pratt RJ, Robinson N, Loveday HP, Pellowe CM, Franks PJ, Hankins M, Loveday C. Adherence to antiretroviral therapy: appropriate use of self-reporting in clinical practice. HIV CLINICAL TRIALS 2001; 2:146-59. [PMID: 11590523 DOI: 10.1310/89e2-xnjl-w107-r2gl] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study investigated the factors that may affect adherence to antiretroviral therapy in people with HIV infection and compared the use of three self-report tools to determine client adherence. METHOD A descriptive, cross-sectional study of 260 HIV-infected clients attending nine HIV outpatient centers in England was conducted using researcher-administered instruments. Self-reports of adherence were assessed using the Morisky Medication Adherence Scale (MMAS), Reported Adherence to Medication Scale (RAM), and the Patient Adjustment to Medication Scale (PAM). RESULTS Univariate analysis of clients' self-reports indicated a number of associations with adherence. Significant associations with less adherent behavior identified by two or more self-report tools were the reported use of recreational drugs, p =.001; living alone, p =.041; feeling depressed, p =.02; being influenced by the media, p =.037; and lack of a close confidant, p =.037. Greater adherence was associated with clients reporting a positive mental attitude to HIV infection, p =.038. Principal component analysis (PCA) of each self-report tool identified two well-recognized constructs: intentional nonadherence and unintentional nonadherence. In addition, a third construct of following instructions was identified from PAM, a scale developed by the authors. Subsequent regression analysis failed to confirm the associations with adherence suggested by the univariate analysis. CONCLUSION This study suggests that the design and use of self-report tools to identify client's adherence to complex antiretroviral regimens may need to measure individual constructs of adherence to accurately assess adherence behavior.
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Affiliation(s)
- R J Pratt
- Richard Wells Research Centre, Wolfson Institute of Health Sciences, Thames Valley University, London.
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Abstract
The consequences of failing to comply to doctor's instructions can be damaging and devastating for the individual patient and their family. Noncompliance also leads to waste, as it reduces the potential benefits of therapy, and to the extra cost of treating avoidable consequent morbidity. Life-long immunosuppression is a prerequisite for good graft function, and noncompliance is often associated with late acute rejection episodes, graft loss, and death. It might be assumed that transplant patients constitute a highly motivated group, and that compliance would be high. Unfortunately, this is not the case: overall noncompliance rates vary from 20 to 50%. This overview includes literature on heart, liver, and kidney transplants in adult and pediatric transplant patients. Compliance behavior after transplantation, noncompliance and its relationship to organ loss and death, retransplantation outcome after graft loss due to noncompliance, and reasons for postoperative noncompliance will be addressed.
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Affiliation(s)
- K Laederach-Hofmann
- Internal Medicine and Cardiology FMH, Unit for Psychosomatic and Psychosocial Medicine, Inselspital, University of Berne, Berne, Switzerland
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Varma S, McElnay JC, Hughes CM, Passmore AP, Varma M. Pharmaceutical care of patients with congestive heart failure: interventions and outcomes. Pharmacotherapy 1999; 19:860-9. [PMID: 10417035 DOI: 10.1592/phco.19.10.860.31565] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We evaluated a structured pharmaceutical care program for elderly patients (> 65 yrs) with congestive heart failure (CHF) based on objective measures of disease control, quality of life, and use of health care facilities in a randomized, controlled, longitudinal, prospective clinical trial. The 42 patients in group A received education from a pharmacist on the disease and its treatment, and lifestyle changes that could help control symptoms. Patients also were encouraged to monitor their symptoms and comply with prescribed drug therapy. If necessary, dosage regimens were simplified in liaison with hospital physicians. The 41 control patients (group B) received standard care. The following outcome measures were assessed in all patients at baseline (before the start of the trial) and at 3, 6, 9, and 12 months: 2-minute walk test, blood pressure, body weight, pulse, forced vital capacity, quality of life [disease-specific (Minnesota Living with Heart Failure questionnaire) and generic (SF-36)], knowledge of symptoms and drugs, compliance with therapy, and use of health care facilities (hospital admissions, visits to emergency room, emergency calls). Patients in group A showed improved compliance with drug therapy, which in turn improved their exercise capacity compared with those in group B; education on management of symptoms, lifestyle changes, and dietary recommendations were also of benefit. Group A patients significantly improved knowledge of their drug therapy over the 12-month study and had fewer hospital admissions compared with group B patients. They also had improved outcomes compared with group B, despite the small samples. An extension of this trial to other sites with pooling of results would provide additional evidence of the value of this structured program in elderly patients with CHF.
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Affiliation(s)
- S Varma
- Pharmacy Practice Research Group, School of Pharmacy, Queen's University of Belfast, Northern Ireland
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36
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Abstract
The problems of non-adherence with treatment in health care in general, and with medication adherence in particular, is an area with a voluminous and burgeoning literature. However, there appears to be no review of the literature on non-adherence with medications in organ transplant patients. This comprehensive review therefore considers literature on adherence in adult kidney, heart and liver transplantation. The particular problem of adherence in paediatric transplant patients is also addressed. This transplant research literature is then evaluated within the broader context of social science research on medication adherence. From the review it is apparent that there is an urgent need for research which examines the patient's beliefs about their illness and medicines. Such research is a precursor for rigorous nursing intervention studies which aim to promote adherence by being tailored to the patient's perceptions.
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Lilja J, Larsson S. Social pharmacology: unresolved critical issues. THE INTERNATIONAL JOURNAL OF THE ADDICTIONS 1994; 29:1647-737. [PMID: 7851999 DOI: 10.3109/10826089409047958] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This article describes and analyzes decision-making by patients, physicians, and drug information providers about registered medical drugs. Based on a cognitive psychology perspective, cognitive variables (the individual's mediating system) are assumed to be critical factors determining both patient and physician behavior. The individual's psychological functioning is seen as a continuous reciprocal interaction between behavioral, cognitive, and environmental influences; i.e., an interactional paradigm is applied. The importance of research models including cognitive and situation variables to guide the search for appropriate research methods is stressed. An intensive research strategy with a small sample of respondents will often be necessary. Also, respondents should be asked to describe their reactions to specific medical situations. The drug information sender has to select a set of goals for disseminating information to patients. Among the goals most often selected are: message comprehension, receiver satisfaction, changes in knowledge, attitudes, and drug behavior, as well as health effects. More research is needed on how the patient's mediating system, the actual situation, and the perceived situation steer his search for the use of new drug information. A different set of factors influence the patient's decision to start a medicinal or drug treatment than the factors that influence his decision to continue a treatment. The latter factors include forgetfulness, misunderstandings, and the patient's interpretation of physiological signs. More cognitive-oriented research about drug compliance must be undertaken. In such studies the mediating systems of a group of patients could be considered before and after intervention. There are a great number of types of inappropriate (irrational) prescribing. However, a physician may prescribe rationally in one area but irrationally in another. Face-to-face education of physicians has been shown to be effective in reducing inappropriate prescribing in a number of studies. "Overprescribing" of benzodiazepine has been an issue of intensive professional debate during the last decades. The two groups who criticize and defend the existing use of benzodiazepines build their views on different assumptions about the interaction between mind and brain as well as making different value assumptions regarding the use of a psychotropic drug. There is a need for prescription studies where a cognitive and interactional perspective is combined with an information-processing and a normative perspective. The benzodiazepines dependency problem has provoked lively discussion among professionals and the general public. Long-term benzodiazepine use and personality disorders increase the risk of the patient becoming dependent. A great number of research models have been suggested for the analysis of prescription drug dependency and as guides to the treatment of dependency.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- J Lilja
- Department of Pharmacy, Abo Academy University, Turku, Finland
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