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Af Geijerstam P, Falster MO, Chalmers J, McLachlan AJ, Rodgers A, Schutte AE. Prescription and dispensing duration of medicines for hypertension and other chronic conditions: a review of international policies and evidence to inform the Australian setting. Hypertens Res 2024; 47:2104-2114. [PMID: 38849500 PMCID: PMC11298406 DOI: 10.1038/s41440-024-01743-2] [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: 03/16/2024] [Revised: 04/28/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024]
Abstract
The duration of treatment for which a physician may prescribe a medicine, 'prescription duration', is often dispensed at the pharmacy on multiple occasions of shorter time periods, 'dispensing duration'. These durations vary significantly between and within countries. In Australia, the quantity of medication supplied at each dispensing has recently been extended from 30 to 60 days for a selection of medicines used for chronic health conditions, such as diabetes and hypertension. Dispensing durations vary between countries, with 30, 60 or 90 days being the most common-with 90 days aligning with the recommendation of the 2023 Global Report on Hypertension from the World Health Organization. The full impact of shorter vs longer prescription durations on health costs and outcomes is unknown, but current evidence suggests that 90-day dispensing could reduce costs and improve patient convenience and adherence. More rigorous research is needed.
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Affiliation(s)
- Peder Af Geijerstam
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Michael O Falster
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Aletta E Schutte
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.
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2
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Sadaka Y, Horwitz D, Wolff L, Meyerovitch J, Peleg A, Bachmat E, Benis A. Trends in the Prevalence of Chronic Medication Use Within Children in Israel Between 2010 and 2019: Protocol for a Retrospective Cohort Study. JMIR Res Protoc 2022; 11:e36756. [PMID: 35775233 PMCID: PMC9391974 DOI: 10.2196/36756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Prescription of psychostimulants has significantly increased in most countries worldwide for both preschool and school-aged children. Understanding the trends of chronic medication use among children in different age groups and from different sociodemographic backgrounds is essential. It is essential to distinguish between selected therapy areas to help decision-makers evaluate not only the relevant expected medication costs but also the specific services related to these areas. Objective This study will analyze differences in trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments and will identify risk factors and predictors for chronic medication use among children. Methods This is a retrospective study. Data will be extracted from the Clalit Health Services data warehouse. For each year between 2010 and 2019, there are approximately 1,500,000 children aged 0-18 years. All medication classes will be identified using the Anatomical Therapeutic Chemical code. A time-trend analysis will be performed to investigate if there is a significant difference between the trends of children’s psychobehavioral and nonpsychobehavioral medication prescriptions. A logistic regression combined with machine learning models will be developed to identify variables that may increase the risk for specific chronic medication types and identify children likely to get such treatment. Results The project was funded in 2019. Data analysis is currently underway, and the results are expected to be submitted for publication in 2022. Understanding trends regarding medications considered psychobehavioral treatments and medications considered nonpsychobehavioral treatments will support the identification of risk factors and predictors for chronic medication use among children. Conclusions Analyzing the response of the patient (and their parents or caregivers) population over time will hopefully help improve policies for prescriptions and follow-up of chronic treatments in children. International Registered Report Identifier (IRRID) DERR1-10.2196/36756
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Affiliation(s)
- Yair Sadaka
- Neuro-Developmental Research Center, Mental Health Institute, Ministry of Health, Ben Gurion University, Beer Sheva, IL
| | - Dana Horwitz
- Neuro-Developmental Research Center, Mental Health Institute, Ministry of Health, Ben Gurion University, Beer Sheva, IL
| | - Leor Wolff
- Clalit Health Services, Clalit Health Services, Tel-Aviv, IL
| | - Joseph Meyerovitch
- Community division, and Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes Schneider, Schneiders Children's Medical Center of Israel, Clalit Health Services, Petah Tikva, IL
| | - Assaf Peleg
- Neuro-Developmental Research Center, Mental Health Institute, Ministry of Health, Ben Gurion University, Beer Sheva, IL
| | - Eitan Bachmat
- Neuro-Developmental Research Center, Mental Health Institute, Ministry of Health, Ben Gurion University, Beer Sheva, IL
| | - Arriel Benis
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Golomb St. 52, Holon, IL.,Faculty of Digital Technologies in Medicine, Holon Institute of Technology, Holon, IL
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3
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Herbert S, Rowbotham NJ, Smith S, Wilson P, Elliott ZC, Leighton PA, Duff A, Smyth AR. Exploring the challenges of accessing medication for patients with cystic fibrosis. Thorax 2021; 77:295-297. [PMID: 34556553 DOI: 10.1136/thoraxjnl-2021-217140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/07/2021] [Indexed: 11/03/2022]
Abstract
Reducing treatment burden in cystic fibrosis (CF) is the top research priority for patients and clinicians. Difficulty accessing medication is one aspect of treatment burden. We investigated this with an online survey available globally for patients with CF and healthcare professionals. Almost three quarters of patients with CF in our survey report difficulty getting repeat prescriptions on time, and most community pharmacists experience interrupted supplies of CF-specific medications. These barriers affect emotional and physical health of people with CF. Two-thirds of people with CF would like to get all their CF medication from one place, their CF centre.
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Affiliation(s)
- Sophie Herbert
- Evidence Based Child Health Group, University of Nottingham School of Medicine, Nottingham, UK
| | - Nicola Jane Rowbotham
- Evidence Based Child Health Group, University of Nottingham School of Medicine, Nottingham, UK
| | - Sherie Smith
- Evidence Based Child Health Group, University of Nottingham School of Medicine, Nottingham, UK
| | - Patrick Wilson
- Pharmacy Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Zoe C Elliott
- Parent of Children with Cystic Fibrosis, Nottingham, UK
| | - Paul A Leighton
- NIHR Research Design Service for the East Midlands, University of Nottingham, Nottingham, UK
| | - Alistair Duff
- Clinical and Health Psychology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alan Robert Smyth
- Evidence Based Child Health Group, University of Nottingham School of Medicine, Nottingham, UK
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Dixon E, Puckey M, Collins N, Marsh G, Pabary R. Striving for perfection, accepting the reality: A reflection on adherence to airway clearance and inhalation therapy for paediatric patients with chronic suppurative lung disease. Paediatr Respir Rev 2020; 34:46-52. [PMID: 31130423 DOI: 10.1016/j.prrv.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/28/2022]
Abstract
Non-adherence to prescribed treatment is considered the foremost cause of treatment failure in chronic medical conditions. Airway clearance techniques (ACT) play a key role in the management of chronic suppurative lung disease yet, along with inhaled therapies such as nebulised antibiotics, adherence to these is often lower than to other treatments. In this review we discuss methods of monitoring adherence to these therapies and potential barriers and outline suggestions for improving adherence in the paediatric population.
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Affiliation(s)
- Emma Dixon
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Michele Puckey
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Nicola Collins
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Gemma Marsh
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom
| | - Rishi Pabary
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, SW7 2AZ, United Kingdom.
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Gupta S, McColl MA, Guilcher SJT, Smith K. An Adapted Model of Cost-Related Nonadherence to Medications Among People With Disabilities. JOURNAL OF DISABILITY POLICY STUDIES 2019. [DOI: 10.1177/1044207319868779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite emerging evidence on cost-related nonadherence (CRNA) to prescription medications, there is little conceptualization and exploration of this phenomenon with respect to disability. Specifically, there is a gap in the literature that explores factors influencing medication cost–adherence relationship among individuals living with a disability. To advance research on and policy for CRNA to medications among people with disabilities, we need a framework that can contribute towards guiding solutions to this problem. We examined the applicability of Piette and colleagues’ existing model for CRNA to the context of people with disabilities and suggested an adapted model (CRNA to medications for persons with disability [CRNA-d]) that can provide a more specific conceptualization of CRNA with respect to disability. The adapted CRNA-d model depicts that CRNA to prescription medications with respect to disability is a dynamic and multifaceted phenomenon, determined by various socioeconomic, disability-related, medication-related, prescriber-related, and system-related factors. We discuss how higher susceptibility to health complications, barriers to income and employment, additional health care costs, the complexity of medical regimens, limited access to physician services, and other policy-related factors increase the risk of persons with disabilities to face cost-related barriers to fulfill their necessary medications.
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Affiliation(s)
| | | | | | - Karen Smith
- Queen’s University, Kingston, Ontario, Canada
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Oluyase AO, Raistrick D, Hughes E, Lloyd C. The appropriateness of psychotropic medicines: an interview study of service users attending a substance misuse service in England. Int J Clin Pharm 2019; 41:972-980. [PMID: 31197547 PMCID: PMC6677701 DOI: 10.1007/s11096-019-00861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/06/2019] [Indexed: 11/04/2022]
Abstract
Background Mental health problems are common in people with substance misuse problems. However, there is a paucity of evidence regarding prescribing of psychotropic medications for people with comorbid mental health and substance misuse problems. Objective To explore the views of service users attending an addiction service on the appropriateness of psychotropic medications prescribed for their co-existing mental health problems. Setting A specialist addiction service in the North of England. Method A phenomenological approach was adopted. Semi-structured interviews were conducted with twelve service users. Data were analysed using thematic framework analysis. Main outcome measure Service users’ views concerning the appropriateness of their prescribed psychotropic medications. Results The following themes captured service users’ views on the appropriateness of their medications: benefits from medicines, entitlement to medicines, and assessment and review. Service users mostly described benefits from their medications (including those prescribed outside guideline recommendations) and there was also an awareness of the adverse effects they experienced from them. It appears that people with substance misuse problems have a particularly strong sense of their own needs and seek to influence prescribing decisions. Service users further described varied practices regarding assessment and review of their medications with evidence of regular reviews while others identified suboptimal or inadequate practices. Conclusion Most service users described improved functioning as a result of their prescribed psychotropic medications. Prescriptions that are inappropriate in terms of their usual indications may well be justified if they assist in stabilising service users and moving them on to recovery.
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McMillan SS, King MA, Sav A, Wheeler AJ, Kelly F. Support for Australian carers from community pharmacy: Insight into carer perspectives of a novel service. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:320-329. [PMID: 30187990 DOI: 10.1111/hsc.12649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/14/2018] [Accepted: 07/16/2018] [Indexed: 06/08/2023]
Abstract
The feasibility of an individualised carer support service delivered in community pharmacies was assessed from the perspective of carer participants using a pre-post questionnaire and semistructured interviews. Eligible pharmacies were required to offer a medication management service relevant to carers and have a semiprivate space for conversations. Carers were required to self-identify as an unpaid support person for someone with a chronic condition or disability. Between September 2016 and March 2017, staff from 11 community pharmacies in South-East Queensland, Australia were trained, and provided with ongoing mentoring from a pharmacist and carer to support service implementation. Identification of carers and support to achieve a personal and care-giving goal were key features of the service. Questionnaires included the EQ-5D-3L, the Bakas Caregiving Outcomes Scale, and questions relating to goal achievement, carer roles, and responsibilities. Seven follow-up carer interviews were undertaken between March and May 2017 and analysed thematically. Pre-post questionnaires were available for 17 carers (one withdrew, two incomplete). Of the 29 goals set, 10 were achieved and 14 partially achieved. EQ-5D-3L scores were unchanged, while 7 of the 15 items comprising the Bakas score improved (p < 0.05). Carer service evaluation was generally favourable, and these two main interview themes were the impact of caring and pharmacy experience. The impact of caring, while variable, was significant. Pharmacy experiences were mostly positive and the opportunity for carers to further engage with pharmacy staff was appreciated. The service was feasible and initial reported benefits to carers may support further research potentially in terms of a larger controlled trial.
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Affiliation(s)
- Sara S McMillan
- Griffith University, Quality Use of Medicines Network, Menzies Health Institute Queensland, Southport, Queensland, Australia
| | - Michelle A King
- Griffith University, Quality Use of Medicines Network, Menzies Health Institute Queensland, Southport, Queensland, Australia
| | - Adem Sav
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Amanda J Wheeler
- Griffith University, Quality Use of Medicines Network, Menzies Health Institute Queensland, Nathan, Queensland, Australia
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Fiona Kelly
- Griffith University, Quality Use of Medicines Network, Menzies Health Institute Queensland, Southport, Queensland, Australia
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Nurse-led hypertension management was well accepted and non-inferior to physician consultation in a Chinese population: a randomized controlled trial. Sci Rep 2018; 8:10302. [PMID: 29985459 PMCID: PMC6037742 DOI: 10.1038/s41598-018-28721-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/28/2018] [Indexed: 11/29/2022] Open
Abstract
The objective of this study is to evaluate if nurse-led repeated prescription (NRP) could ensure non-inferior disease control and would be accepted in Chinese patients with controlled hypertension (HT) in primary care clinics. A 12-month follow-up non-inferiority randomized trial was conducted. The non-inferior margins for systolic and diastolic blood pressure were 6.6 mmHg and 3.7 mmHg, respectively. Eligible patients (>18 years of age) with HT were randomized to the NRP and usual care (UC) groups for their regular clinical follow-up. We used ANCOVA to study the difference-of-difference of the blood pressures between the two groups. The levels of patient acceptance and experience of NRP were assessed by the observed opt-out rate and a qualitative analysis. We found no statistically significant differences in BP blood pressure between the NRP (N = 194) and UC (N = 199) groups. Only 4 of the participants in the NRP group opted out due to a preference for assessment by a physician. The interviewed participants (N = 12) felt positive about NRP, because they experienced more relaxed communication with the nurse and believed that the eligibility to join the NRP program was an indication of optimal BP control. We observed no adverse events. The findings show that NRP was well accepted and found to be non-inferior to physician consultation for HT management.
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Abstract
BACKGROUND Long-term conditions place a substantial burden on primary care services, with drug therapy being a core aspect of clinical management. However, the ideal frequency for issuing repeat prescriptions for these medications is unknown. AIM To examine the impact of longer-duration (2-4 months) versus shorter-duration (28-day) prescriptions. DESIGN AND SETTING Systematic review of primary care studies. METHOD Scientific and grey literature databases were searched from inception until 21 October 2015. Eligible studies were randomised controlled trials and observational studies that examined longer prescriptions (2-4 months) compared with shorter prescriptions (28 days) in patients with stable, chronic conditions being treated in primary care. Outcomes of interest were: health outcomes, adverse events, medication adherence, medication wastage, professional administration time, pharmacists' time and/or costs, patient experience, and patient out-of-pocket costs. RESULTS From a search total of 24 876 records across all databases, 13 studies were eligible for review. Evidence of moderate quality from nine studies suggested that longer prescriptions are associated with increased medication adherence. Evidence from six studies suggested that longer prescriptions may increase medication waste, but results were not always statistically significant and were of very low quality. No eligible studies were identified that measured any of the other outcomes of interest, including health outcomes and adverse events. CONCLUSION There is insufficient evidence relating to the overall impact of differing prescription lengths on clinical and health service outcomes, although studies do suggest medication adherence may improve with longer prescriptions. UK recommendations to provide shorter prescriptions are not substantiated by the current evidence base.
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Miani C, Martin A, Exley J, Doble B, Wilson E, Payne R, Avery A, Meads C, Kirtley A, Jones MM, King S. Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling. Health Technol Assess 2017; 21:1-128. [PMID: 29268843 PMCID: PMC5757186 DOI: 10.3310/hta21780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain. OBJECTIVE To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care. DESIGN/DATA SOURCES The design of the study comprised three elements. First, a systematic review comparing 28-day prescriptions with longer prescriptions in patients with chronic conditions treated in primary care, evaluating any relevant clinical outcomes, adherence to treatment, costs and cost-effectiveness. Databases searched included MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials. Searches were from database inception to October 2015 (updated search to June 2016 in PubMed). Second, a cost analysis of medication wastage associated with < 60-day and ≥ 60-day prescriptions for five patient cohorts over an 11-year period from the Clinical Practice Research Datalink. Third, a decision model adapting three existing models to predict costs and effects of differing adherence levels associated with 28-day versus 3-month prescriptions in three clinical scenarios. REVIEW METHODS In the systematic review, from 15,257 unique citations, 54 full-text papers were reviewed and 16 studies were included, five of which were abstracts and one of which was an extended conference abstract. None was a randomised controlled trial: 11 were retrospective cohort studies, three were cross-sectional surveys and two were cost studies. No information on health outcomes was available. RESULTS An exploratory meta-analysis based on six retrospective cohort studies suggested that lower adherence was associated with 28-day prescriptions (standardised mean difference -0.45, 95% confidence interval -0.65 to -0.26). The cost analysis showed that a statistically significant increase in medication waste was associated with longer prescription lengths. However, when accounting for dispensing fees and prescriber time, longer prescriptions were found to be cost saving compared with shorter prescriptions. Prescriber time was the largest component of the calculated cost savings to the NHS. The decision modelling suggested that, in all three clinical scenarios, longer prescription lengths were associated with lower costs and higher quality-adjusted life-years. LIMITATIONS The available evidence was found to be at a moderate to serious risk of bias. All of the studies were conducted in the USA, which was a cause for concern in terms of generalisability to the UK. No evidence of the direct impact of prescription length on health outcomes was found. The cost study could investigate prescriptions issued only; it could not assess patient adherence to those prescriptions. Additionally, the cost study was based on products issued only and did not account for underlying patient diagnoses. A lack of good-quality evidence affected our decision modelling strategy. CONCLUSIONS Although the quality of the evidence was poor, this study found that longer prescriptions may be less costly overall, and may be associated with better adherence than 28-day prescriptions in patients with chronic conditions being treated in primary care. FUTURE WORK There is a need to more reliably evaluate the impact of differing prescription lengths on adherence, on patient health outcomes and on total costs to the NHS. The priority should be to identify patients with particular conditions or characteristics who should receive shorter or longer prescriptions. To determine the need for any further research, an expected value of perfect information analysis should be performed. STUDY REGISTRATION This study is registered as PROSPERO CRD42015027042. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Céline Miani
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Adam Martin
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Josephine Exley
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Brett Doble
- Cambridge Centre for Health Services Research, Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ed Wilson
- Cambridge Centre for Health Services Research, Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Rupert Payne
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Anthony Avery
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Catherine Meads
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
- School of Nursing and Midwifery, Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK
| | - Anne Kirtley
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
- Strategy Division, Wellcome Trust, London, UK
| | - Molly Morgan Jones
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Sarah King
- Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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McMillan SS, Wheeler AJ, Sav A, King MA, Kelly F. Caring for carers in community pharmacy. Res Social Adm Pharm 2017; 13:254-256. [DOI: 10.1016/j.sapharm.2016.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 11/24/2022]
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Mohammed MA, Moles RJ, Chen TF. Medication-related burden and patients' lived experience with medicine: a systematic review and metasynthesis of qualitative studies. BMJ Open 2016; 6:e010035. [PMID: 26839015 PMCID: PMC4746464 DOI: 10.1136/bmjopen-2015-010035] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/15/2015] [Accepted: 12/22/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To explore medication-related burden (MRB) and patients' lived experience with medicines (PLEM) without regard to particular medication therapies or medical conditions. DESIGN Systematic review and metasynthesis of qualitative studies. DATA SOURCES MEDLINE, EMBASE, International Pharmaceutical Abstracts, PsycINFO, Global health, CINAHL and Web of Science were searched from January 2000 to August 2014 using medication burden and patients' lived experience terms. SYNTHESIS METHODS Synthesis was undertaken following metaethnography methods and a comparative thematic analysis technique. RESULTS 34 articles from 12 countries with a total of 1144 participants were included. 3 major inter-related themes emerged central to PLEM: MRB, medication related beliefs and medication taking practice. The negative impact of MRB, due to its interference on patients' daily lives and effects on well-being, its influence on patients' beliefs and behaviours, and a potential risk for drug-related problems (DRPs) was evident. This resulted in non-adherence and poorer outcomes (unachieved therapeutic goals and damage to patients' health). Patients who experienced MRB interference in their life over time begin to juggle their medicines. Others continue their medicines despite experiencing MRB resulting in compromised physical, social or psychological well-being. CONCLUSIONS There is a shared commonality of PLEM among the studies. MRB plays a central role in influencing patients' health and well-being, beliefs and behaviour towards medicines. Given the complexity of MRB and its impact evident from this review, there is a need for healthcare practitioners to have insight into PLEM in therapeutic care plans. Understanding PLEM is an opportunity for practitioners to identify particular MRBs that patients encounter, and provide individualised care through selection of therapeutic care plans that suit a patient's life. This may assist in helping to achieve patients' medication-related needs, and improve medication therapy and health outcomes.
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Affiliation(s)
- Mohammed A Mohammed
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah J Moles
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy F Chen
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
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Esmaeil Zadeh P, Tremblay MC. A review of the literature and proposed classification on e-prescribing: Functions, assimilation stages, benefits, concerns, and risks. Res Social Adm Pharm 2016; 12:1-19. [DOI: 10.1016/j.sapharm.2015.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 01/01/2023]
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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: 91] [Impact Index Per Article: 10.1] [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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Irani Z, Weerakkody V, Molnar A, Lee H, Hindi N, Osman I. A user satisfaction study of the NHS Online Prescription Prepayment Certificate. HEALTH POLICY AND TECHNOLOGY 2014. [DOI: 10.1016/j.hlpt.2014.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Petty DR, Zermansky AG, Alldred DP. The scale of repeat prescribing--time for an update. BMC Health Serv Res 2014; 14:76. [PMID: 24552190 PMCID: PMC3943802 DOI: 10.1186/1472-6963-14-76] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The NHS spends billions of pounds annually on repeat prescriptions in primary care, but data on their extent and use is out of date. Understanding the scale of repeat prescribing and for whom it is prescribed is important for the NHS to plan services and develop policies to improve patient care. METHOD Anonymous data on prescription numbers and practice population demographics was obtained from GP computer systems in a large urban area.Searches were conducted in November 2011 to identify the numbers of repeat items listed on individuals' repeat lists by sex and age.The proportion of all prescription items issued as repeats was identified by conducting searches on items issued as repeat and acute prescriptions. RESULTS In the year of study 4,453,225 items were issued of which 3,444,769 (77%) were repeats (mean 13 items per patient/annum) and 1,008,456 (23%) acute prescriptions (mean 3.9 items per patient per annum). The mean number of repeat Items per patient was 1.87 (range 0.45 ages 0-9 years; 7.1 ages 80-89 years). At least one repeat medicine was prescribed to 43% of the population (range 20% for ages 0-9; over 75% for ages 60+). CONCLUSION A significant proportion of the population receive repeat prescriptions and the proportion increases with age. Whilst the proportion of repeat items to acute items has remained unchanged over the last two decades the number of repeat prescriptions items issued has doubled (from 5.8 to 13.3 items/patient/annum). This has implications for general practice workload, patient convenience, NHS costs and risk.
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Affiliation(s)
- Duncan R Petty
- School of Healthcare, University of Leeds, Leeds LS2 9UT, UK.
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