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Jallow F, Stehling E, Sajwani-Merchant Z, Daniel KM, Fulda KG, Gurses AP, Arbaje AI, Xiao Y. Medication Management Strategies by Community-Dwelling Older Adults: A Multisite Qualitative Analysis. J Patient Saf 2024; 20:192-197. [PMID: 38372504 PMCID: PMC10963160 DOI: 10.1097/pts.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Community-dwelling older adults taking 5 or more medications are at risk for medication-related harm. Managing multiple medications is a challenging task for patients and caregivers. Community-dwelling older adults self-manage their medications with minimal healthcare professional supervision. Although organizations, such as the Food and Drug Administration, often issue guidelines to ensure medication safety, how older adults understand and mitigate the risk of harm from medication use in the home environment is poorly understood. METHODS We conducted semistructured interviews with community-dwelling older adults 65 years and older who took 5 or more prescription medications to explore medication safety strategies they use. We also compared 2 organizations' medication safety guidelines for areas of concordance and discordance. RESULTS A total of 28 older adults were interviewed. Four overarching themes of medication management strategies emerged: collaborating with prescribers, collaborating with pharmacists, learning about medications, and safe practices at home. Study findings revealed that older adults followed some of the published guidelines by the 2 government organizations, although there were some areas of discord. Some of the strategies used were unintentionally against the recommended guidelines. For example, older adults tried weaning themselves off their medications without notifying their providers. CONCLUSIONS Older adults and their caregivers in our study used strategies different from those recommended by government organizations in managing medications to enhance drug safety. Patient-provider collaboration and positive patient outcomes can be improved by understanding and respecting strategies older adults use at home. Future studies must effectively incorporate older adults' perspectives when developing medication safety guidelines.
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Affiliation(s)
- Fatoumata Jallow
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Elisa Stehling
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Zara Sajwani-Merchant
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Kathryn M. Daniel
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
| | - Kimberly G. Fulda
- The University of North Texas Health Science Center, Department of Family Medicine and Osteopathic Manipulative Medicine. Fort Worth, TX; North Texas Primary Care Practice-Based Research Network (NorTex), Fort Worth, TX
| | - Ayse P Gurses
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins Medicine. Baltimore, Maryland
| | - Alicia I. Arbaje
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins Medicine. Baltimore, Maryland
- Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Yan Xiao
- University of Texas at Arlington, College of Nursing and Health Innovation, Arlington, Texas
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Silva Almodóvar A, Keller MS, Lee J, Mehta HB, Manja V, Nguyen TPP, Pavon JM, Terman SW, Hoyle D, Mixon AS, Linsky AM. Deprescribing medications among patients with multiple prescribers: A socioecological model. J Am Geriatr Soc 2024; 72:660-669. [PMID: 37943070 PMCID: PMC10947820 DOI: 10.1111/jgs.18667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/14/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
Deprescribing is the intentional dose reduction or discontinuation of a medication. The development of deprescribing interventions should take into consideration important organizational, interprofessional, and patient-specific barriers that can be further complicated by the presence of multiple prescribers involved in a patient's care. Patients who receive care from an increasing number of prescribers may experience disruptions in the timely transfer of relevant healthcare information, increasing the risk of exposure to drug-drug interactions and other medication-related problems. Furthermore, the fragmentation of healthcare information across health systems can contribute to the refilling of discontinued medications, reducing the effectiveness of deprescribing interventions. Thus, deprescribing interventions must carefully consider the unique characteristics of patients and their prescribers to ensure interventions are successfully implemented. In this special article, an international working group of physicians, pharmacists, nurses, epidemiologists, and researchers from the United States Deprescribing Research Network (USDeN) developed a socioecological model to understand how multiple prescribers may influence the implementation of a deprescribing intervention at the individual, interpersonal, organizational, and societal level. This manuscript also includes a description of the concept of multiple prescribers and outlines a research agenda for future investigations to consider. The information contained in this manuscript should be used as a framework for future deprescribing interventions to carefully consider how multiple prescribers can influence the successful implementation of the service and ensure the intervention is as effective as possible.
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Affiliation(s)
- Armando Silva Almodóvar
- Institute of Therapeutic Innovations and Outcomes (ITIO), The Ohio State University College of Pharmacy, Columbus, Ohio, USA
| | - Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jiha Lee
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Hemalkumar B Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Veena Manja
- Veterans Affairs Northern California Healthcare System, Mather, California, USA
- University of California Davis, Sacramento, California, USA
| | - Thanh Phuong Pham Nguyen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Juliessa M Pavon
- Division of Geriatrics, Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Samuel W Terman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Hoyle
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Amanda S Mixon
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy M Linsky
- General Internal Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Previdoli G, Alldred DP, Silcock J, Tyndale‐Biscoe S, Okeowo D, Cheong V, Fylan B. 'It's a job to be done'. Managing polypharmacy at home: A qualitative interview study exploring the experiences of older people living with frailty. Health Expect 2024; 27:e13952. [PMID: 39102701 PMCID: PMC10777610 DOI: 10.1111/hex.13952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Many older people live with both multiple long-term conditions and frailty; thus, they manage complex medicines regimens and are at heightened risk of the consequences of medicines errors. Research to enhance how people manage medicines has focused on adherence to regimens rather than on the wider skills necessary to safely manage medicines, and the older population living with frailty and managing multiple medicines at home has been under-explored. This study, therefore, examines in depth how older people with mild to moderate frailty manage their polypharmacy regimens at home. METHODS Between June 2021 and February 2022, 32 patients aged 65 years or older with mild or moderate frailty and taking five or more medicines were recruited from 10 medical practices in the North of England, United Kingdom, and the CARE 75+ research cohort. Semi-structured interviews were conducted face to face, by telephone or online. The interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. FINDINGS Five themes were developed: (1) Managing many medicines is a skilled job I didn't apply for; (2) Medicines keep me going, but what happened to my life?; (3) Managing medicines in an unclear system; (4) Support with medicines that makes my work easier; and (5) My medicines are familiar to me-there is nothing else I need (or want) to know. While navigating fragmented care, patients were expected to fit new medicines routines into their lives and keep on top of their medicines supply. Sometimes, they felt let down by a system that created new obstacles instead of supporting their complex daily work. CONCLUSION Frail older patients, who are at heightened risk of the impact of medicines errors, are expected to perform complex work to safely self-manage multiple medicines at home. Such a workload needs to be acknowledged, and more needs to be done to prepare people in order to avoid harm from medicines. PATIENT AND PUBLIC INVOLVEMENT An older person managing multiple medicines at home was a core member of the research team. An advisory group of older patients and family members advised the study and was involved in the first stages of data analysis. This influenced how data were coded and themes shaped.
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Affiliation(s)
- Giorgia Previdoli
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK
- NIHR Yorkshire and Humber Patient Safety Research CollaborationBradfordUK
- Department of Health SciencesUniversity of YorkYorkUK
| | - David P. Alldred
- NIHR Yorkshire and Humber Patient Safety Research CollaborationBradfordUK
- School of Healthcare, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Jonathan Silcock
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK
| | | | - Daniel Okeowo
- NIHR Yorkshire and Humber Patient Safety Research CollaborationBradfordUK
- School of Healthcare, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
- School of PharmacyNewcastle UniversityNewcastle upon TyneUK
| | | | - Beth Fylan
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK
- NIHR Yorkshire and Humber Patient Safety Research CollaborationBradfordUK
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Kajander-Unkuri S, Vaismoradi M, Katajisto J, Kangasniemi M, Turjamaa R. Effect of robot for medication management on home care professionals' use of working time in older people's home care: a non-randomized controlled clinical trial. BMC Health Serv Res 2023; 23:1344. [PMID: 38042773 PMCID: PMC10693699 DOI: 10.1186/s12913-023-10367-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Medication management has a key role in the daily tasks of home care professionals delivered to older clients in home care. The aim of this study was to examine the effect of using a robot for medication management on home care professionals´ use of working time. METHODS A pragmatic non-randomized controlled clinical trial was conducted. The participants were home care professionals who carried out home care clients' medication management. Home care clients were allocated into intervention groups (IG) and control groups (CG) (n = 64 and 46, respectively) based on whether or not they received the robot. Data were collected using the Working Time Tracking Form prior to and 1 and 2 months after introducing the intervention. The t-test was used to compare the groups at each three timepoints. Analysis of Covariance was used to examine the groups' differences for the total time for medications as the number of visits per day as the covariate. RESULTS With robot use, the total amount of home visits decreased by 89.4% and 92.4% after 1 and 2 months of intervention use, respectively, compared to pre-intervention (p < 0.001). The total working time used for medication management considering the number of visits per day decreased from 54.2 min (95% CI 37.4-44.3) to 34.9 min (31.4-38.3), i.e., by slightly over 19 min (p < 0.001) in the IG group. During the follow-up, the total working time used for medication management considering the number of visits per day remained the same in the CG group. CONCLUSION Using a robot for medication management had a notable effect on decreasing the use of working time of home care professionals. For health services, decreased use of working time for medication management means that the time saved can be assigned to services that cannot be replaced otherwise. More digital solutions should be developed based on home care clients' and professionals' needs to meet the challenge of the growing number of older people in need of home care and ensure their safety. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05908604 retrospectively registered (18/06/2023).
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Affiliation(s)
- Satu Kajander-Unkuri
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Diaconia University of Applied Sciences, Helsinki, Finland
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia.
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
- Satasairaala, Pori, Finland
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Dimitrow M, Saarenmaa R, Airaksinen M, Hassan G, Puumalainen E, Pitrová M, Kivelä SL, Fialová D, Puustinen J, Toivo T. Medication risk checklist for older adults (LOTTA) - development and validation of a self-assessment tool. Ann Med 2023; 55:2287707. [PMID: 38035545 PMCID: PMC10732188 DOI: 10.1080/07853890.2023.2287707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Patient safety strategies highlight patients' own active involvement in ensuring medication safety. A prerequisite for involving patients in their medication therapy is having tools that can assist them in ensuring safe medicine use. Older home-dwelling adults with multiple medications are at high risk for medication-related problems, yet only a few age-specific patient self-administered medication risk screening tools exist. This study aimed to develop, validate, and assess the feasibility of a self-administered medication risk checklist for home-dwelling older adults ≥65 years. MATERIALS AND METHODS The draft checklist was formed based on a validated practical nurse-administered Drug Related Problem Risk Assessment Tool supplemented with findings from two systematic literature reviews. The content validity of the draft checklist was determined by a three-round Delphi survey with a panel of 19 experts in geriatric care and pharmacotherapy. An agreement of ≥80% was required. A feasibility assessment (i.e. understandability of the items, fill-out time of the checklist) of the content-validated checklist was conducted among older adults ≥65 years (n = 87) visiting community pharmacies (n = 4). Data were analysed using qualitative content analysis. RESULTS The final validated and feasibility-tested Medication Risk Checklist (LOTTA) for home-dwelling older adults consists of eight items screening the highest priority systemic risks (three items), potentially drug-induced symptoms (one item), adherence, and self-management problems (four items). The checklist proved feasible for self-administration, the mean fill-out time being 6.1 min. CONCLUSIONS A wide range of potential medication risks related to the medication use process can be identified by patient self-assessment. Screening tools such as LOTTA can enhance early detection of potential medication risks and risk communication between older adults and their healthcare providers. A wider and more integrated use of the checklist could be facilitated by making it electronically available as part of the patient information systems.
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Affiliation(s)
- Maarit Dimitrow
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Roosa Saarenmaa
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Marja Airaksinen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Ghada Hassan
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Emmi Puumalainen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Markéta Pitrová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
- Clinical Pharmacy Department, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Sirkka-Liisa Kivelä
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Juha Puustinen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- Service Unit of Neurology, Satasairaala Central Hospital, Wellbeing County of Satakunta, Pori, Finland
| | - Terhi Toivo
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Shahrestanaki SK, Rafii F, Najafi Ghezeljeh T, Farahani MA, Majdabadi Kohne ZA. Patient safety in home health care: a grounded theory study. BMC Health Serv Res 2023; 23:467. [PMID: 37165357 PMCID: PMC10171141 DOI: 10.1186/s12913-023-09458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The home environment is designed for living, not for professional care. For this reason, safe patient care is one of the most important challenges of home health care. Despite abundant research on safe care, there is still little understanding of safety issues in home care. DESIGN The aim of the present study was to explain the process of safe patient care in home health care. A qualitative, grounded theory study was conducted based on the approach proposed by Corbin & Strauss in 2015. METHOD In total, 22 interviews were conducted with 16 participants including 9 home care nurses, 2 home care nursing assistants, 1 home care inspector, 1 home care physician and 3 family caregivers in Tehran, Iran. Four observation sessions were conducted in different homes. Purposeful sampling was used followed by theoretical sampling from August 2020-July 2022. Data analysis was carried out based on the approach proposed by Corbin & Strauss in 2015. RESULTS The results showed that the healthcare members (nurses, family caregivers, patients and home care centers) used the model of safe patient care in home health care based on four assessment methods, i.e. prevention, foresight, establishment of safety and verification. The core variable in this process is foresight-based care. CONCLUSION The results of this study showed that the key to safe patient care in home health care, which helps to maintain patient safety and prevent threats to safe care, is the foresight of healthcare members, which is essential for identifying threats to safe care considering the many risks of home health care.
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Affiliation(s)
| | - Forough Rafii
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Ashghali Farahani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Tennant R, Allana S, Mercer K, Burns CM. Caregiver Expectations for Interfacing with Voice Assistants to Support Complex Home Care: Mixed-Methods Study (Preprint). JMIR Hum Factors 2022; 9:e37688. [PMID: 35771594 PMCID: PMC9284358 DOI: 10.2196/37688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 12/03/2022] Open
Abstract
Background Providing care in home environments is complex, and often the pressure is on caregivers to document information and ensure care continuity. Digital information management and communication technologies may support care coordination among caregivers. However, they have yet to be adopted in this context, partly because of issues with supporting long-term disease progression and caregiver anxiety. Voice assistant (VA) technology is a promising method for interfacing with digital health information that may aid in multiple aspects of being a caregiver, thereby influencing adoption. Understanding the expectations for VAs to support caregivers is fundamental to inform the practical development of this technology. Objective This study explored caregivers’ perspectives on using VA technology to support caregiving and inform the design of future digital technologies in complex home care. Methods This study was part of a larger study of caregivers across North America on the design of digital health technologies to support health communication and information management in complex home care. Caregivers included parents, guardians, and hired caregivers such as personal support workers and home care nurses. Video interviews were conducted with caregivers to capture their mental models on the potential application of VAs in complex home care and were theoretically analyzed using the technology acceptance model. Interviews were followed up with Likert-scale questions exploring perspectives on other VA applications beyond participants’ initial perceptions. Results Data were collected from 22 caregivers, and 3 themes were identified: caregivers’ perceived usefulness of VAs in supporting documentation, care coordination, and person-centered care; caregivers’ perceived ease of use in navigating information efficiently (they also had usability concerns with this interaction method); and caregivers’ concerns, excitement, expected costs, and previous experience with VAs that influenced their attitudes toward use. From the Likert-scale questions, most participants (21/22, 95%) agreed that VAs should support prompted information recording and retrieval, and all participants (22/22, 100%) agreed that they should provide reminders. They also agreed that VAs should support them in an emergency (18/22, 82%)—but only for calling emergency services—and guide caregivers through tasks (21/22, 95%). However, participants were less agreeable on VAs expressing a personality (14/22, 64%)—concerned they would manipulate caregivers’ perceptions—and listening ambiently to remind caregivers about their documentation (16/22, 73%). They were much less agreeable about VAs providing unprompted assistance on caregiving tasks (9/22, 41%). Conclusions The interviews and Likert-scale results point toward the potential for VAs to support family caregivers and hired caregivers by easing their information management and health communication at home. However, beyond information interaction, the potential impact of VA personality traits on caregivers’ perceptions of the care situation and the passive collection of audio data to improve user experience through context-specific interactions are critical design considerations that should be further examined.
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Affiliation(s)
- Ryan Tennant
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Sana Allana
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Kate Mercer
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
- Library, University of Waterloo, Waterloo, ON, Canada
| | - Catherine M Burns
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
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Faisal S, Ivo J, McMillan C, Grindrod K, Patel T. In-home medication management by older adults: a modified ethnography study using digital photography walkabouts. Age Ageing 2022; 51:6399894. [PMID: 34718366 DOI: 10.1093/ageing/afab207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Medication mismanagement can lead to non-optimal management of chronic diseases and poor health outcomes. OBJECTIVE The purpose of this study was to better understand meanings associated with in-home medication management and storage practices of older adults with chronic diseases. METHODS A modified ethnographic approach using digital photography walkabouts, observation protocols and field notes were used to document in-home medication organisation and storage locations. Thematic analysis was used to generate themes and sub-themes. RESULTS Data from multiple home visits of 10 participants (mean age = 76 years; 80% females) including 30 photographs, 10 observation protocols and field notes were analysed. The average number of medications used was reported to be 11.1 (range: 5-20). Themes and sub-themes include choice of storage location (sub-themes: impact on medication behaviour, visibility of medications and storage with other items), knowledge regarding appropriate medication storage conditions (sub-themes: impact on safety of patient and impact on stability of medications) and systems to manage in-home medication intake. DISCUSSION In-home medication management reflects older adults perspectives regarding privacy, medication taking routine, knowledge about safe and effective storage and organisation systems. The lack of knowledge causing inappropriate medication storage not only impacts the stability of medications, but also increases risk of medication errors and safety, ultimately affecting medication intake behaviours.
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Affiliation(s)
- Sadaf Faisal
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Jessica Ivo
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Colleen McMillan
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Renison University College, University of Waterloo, Waterloo, Ontario, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
- Schlegel – University of Waterloo Research Institute of Aging, Waterloo, Ontario, Canada
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
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Ekstedt M, Kirsebom M, Lindqvist G, Kneck Å, Frykholm O, Flink M, Wannheden C. Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases: A Theory-Driven User-Centered Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010391. [PMID: 35010652 PMCID: PMC8744716 DOI: 10.3390/ijerph19010391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 05/07/2023]
Abstract
The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients' engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application-ePATH (electronic Patient Activation in Treatment at Home)-with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management.
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Affiliation(s)
- Mirjam Ekstedt
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 391 82 Kalmar, Sweden
- Correspondence: (M.E.); (C.W.); Tel.: +46-(0)480-44-63-99 (M.E.); +46-(0)8-524-839-34 (C.W.)
| | - Marie Kirsebom
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 351 95 Växjö, Sweden; (M.K.); (G.L.)
| | - Gunilla Lindqvist
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 351 95 Växjö, Sweden; (M.K.); (G.L.)
| | - Åsa Kneck
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stigbergsgatan 30, Box 111 89, 100 61 Stockholm, Sweden;
| | - Oscar Frykholm
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Stockholm, Sweden;
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Carolina Wannheden
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Correspondence: (M.E.); (C.W.); Tel.: +46-(0)480-44-63-99 (M.E.); +46-(0)8-524-839-34 (C.W.)
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10
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Dijkstra NE, Sino CGM, Schuurmans MJ, Schoonhoven L, Heerdink ER. Medication self-management: Considerations and decisions by older people living at home. Res Social Adm Pharm 2020; 18:2410-2423. [PMID: 33627223 DOI: 10.1016/j.sapharm.2020.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/24/2020] [Accepted: 09/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medication self-management is complicated for older people. Little is known about older persons' considerations and decisions concerning medication therapy at home. OBJECTIVE (s): To explore how older people living at home self-manage their medication and what considerations and decisions underpin their medication self-management behavior. METHODS Semi-structured interviews with consenting participants (living at home, aged ≥65, ≥5 different prescription medications daily) were recorded and transcribed with supporting photographs. Content was analyzed with a directed approach and presented according to three phases of medication self-management (initiation, execution, and discontinuation). RESULTS Sixty people were interviewed. In the initiation phase, participants used different techniques to inform healthcare professionals and to fill and check prescriptions. Over-the-counter medication was seldom discussed, and potential interactions were unknown to the participants. Some participants decided to not start treatment after reading the patient information leaflets for fear of side effects. In the execution phase, participants had various methods for integrating the use of new and chronic medication in daily life. Usage problems were discussed with healthcare professionals, but side effects were not discussed, since the participants were not aware that the signs and symptoms of side effects could be medication-related. Furthermore, participants stored medication in various (sometimes incorrect) ways and devised their own systems for ordering and filling repeat prescriptions. In the discontinuation phase, some participants decided to stop or change doses by themselves (because of side effects, therapeutic effects, or a lack of effect). They also mentioned different considerations regarding medication disposal and disposed their medication (in)correctly, stored it for future use, or distributed it to others. CONCLUSIONS Participants' considerations and decisions led to the following: problems in organizing medication intake, inadequate discussion of medication-related information with healthcare professionals, and incorrect and undesirable medication storage and disposal. There is a need for medication self-management observation, monitoring, and assistance by healthcare professionals.
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Affiliation(s)
- Nienke E Dijkstra
- Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands; Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands; Research Group Innovation in Pharmaceutical Care, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, PO Box 12011, 3501, AA, Utrecht, the Netherlands.
| | - Carolien G M Sino
- Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands.
| | - Marieke J Schuurmans
- Education Center, University Medical Center Utrecht, Utrecht University, Utrecht, Hijmans van Den Bergh Building, 3508, GA, Utrecht, the Netherlands.
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, United Kingdom.
| | - Eibert R Heerdink
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Heidelberglaan 8, 3584, CS, Utrecht, the Netherlands; Research Group Innovation in Pharmaceutical Care, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, PO Box 12011, 3501, AA, Utrecht, the Netherlands.
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11
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How smart medication systems are used to support older people's drug regimens: A systematic literature review. Geriatr Nurs 2020; 41:677-684. [PMID: 32192722 DOI: 10.1016/j.gerinurse.2020.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/17/2022]
Abstract
Smart medication systems are used to help older people, and the professionals and family who care for them, to organize and manage their daily drug regimes. However, synthetized knowledge on previous studies about how these improve everyday life is needed. We searched the PubMed, Scopus, CINAHL, PsycINFO, SocINDEX and Cochrane library databases from 2005 to 2019 and this review focused on nine of the 2,424 papers we identified. According to our analysis, smart medication systems make it possible to regulate medication times and doses and detect medication errors. With further development, smart medication systems could be more be effective at preventing medication errors, improving medication adherence by older people and freeing up healthcare professional, so that they can focus on other tasks. However, more research on different systems is needed to improve existing solutions and to understand how they can make older people more independent when it comes to their daily medication.
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12
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Kivimäki T, Stolt M, Charalambous A, Suhonen R. Safety of older people at home: An integrative literature review. Int J Older People Nurs 2019; 15:e12285. [PMID: 31746103 DOI: 10.1111/opn.12285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/30/2019] [Accepted: 09/30/2019] [Indexed: 11/27/2022]
Abstract
AIM The aim of this review was to examine the relevant health literature, to describe safety in the homes of older and older people's perceptions and understanding of their safety at home based on current literature. BACKGROUND Safety is a multifaceted, basic need of older people living at home. Many studies are hospital focused and few focus on safety at home. Research on the safety of older people at home appears to be under-researched. METHODS MEDLINE, CINAHL, Scopus and Web of Science databases from the earliest to August 2017 were investigated. The integrative literature review was conducted in December 2017. The full text of the remaining n = 93 papers was then screened for relevance by inclusion and exclusion criteria which reduced the number by 59 to n = 34. RESULTS Four dimensions of safety at home were discovered, namely physical, social, emotional and mental, and cognitive safety. Safety dimensions had both positive and negative components. Older people's main wish was to be able to live in their own home for as long as possible. Their perceptions of safety at home was categorised as active living, coping at home, managed living and the knowledge of the existence of disease. CONCLUSIONS The safety of older people at home is a worldwide concern. Identification of safety issues can assist in developing measures to help people stay at home for longer as they age. The management of this would need to take account of all four dimensions of safety, in ways that promote ageing at home. IMPLICATIONS FOR PRACTICE Learning, understanding and developing new strategies about safety affect everyone who visits the home of older people, and stakeholders have an important role to identify safety risks.
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Affiliation(s)
- Taina Kivimäki
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, University of Turku, Turku, Finland.,City of Turku, Welfare Division, Turku, Finland
| | - Andreas Charalambous
- Department of Nursing Science, University of Turku, Turku, Finland.,Cyprus University of Technology, Limassol, Cyprus
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, University of Turku, Turku, Finland.,City of Turku, Welfare Division, Turku, Finland
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13
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[Assessment of medication prescribing in a geriatric follow-up care and rehabilitation]. SOINS. GÉRONTOLOGIE 2019; 24:39-43. [PMID: 31307689 DOI: 10.1016/j.sger.2019.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the study was to analyse the prescriptions and identify the factors associated with inappropriate prescribing (IP) and polypharmacy. Polypharmacy and IP concerned 80% of the 54 patients included in the study upon admission, and 78% upon discharge without a statistically significant reduction. A critical analysis of prescriptions would help to reduce inappropriate prescribing and polypharmacy in elderly patients.
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14
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Affiliation(s)
- José Joaquín Mira
- a Health Psychology Department , Universidad Miguel Hernández , Sant Joan , Spain.,b Alicante-Sant Joan Health District , Alicante , Spain.,c Prometeo173 Research Group , FISABIO , Sant Joan , Spain
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15
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Squires A, Ridge L, Miner S, McDonald MV, Greenberg SA, Cortes T. Provider Perspectives of Medication Complexity in Home Health Care: A Qualitative Secondary Data Analysis. Med Care Res Rev 2019; 77:609-619. [DOI: 10.1177/1077558719828942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A primary service provided by home care is medication management. Issues with medication management at home place older adults at high risk for hospital admission, readmission, and adverse events. This study sought to understand medication management challenges from the home care provider perspective. A qualitative secondary data analysis approach was used to analyze program evaluation interview data from an interprofessional educational intervention study designed to decrease medication complexity in older urban adults receiving home care. Directed and summative content analysis approaches were used to analyze data from 90 clinician and student participants. Medication safety issues along with provider–provider communication problems were central themes with medication complexity. Fragmented care coordination contributed to medication management complexity. Patient-, provider-, and system-level factors influencing medication complexity and management were identified as contributing to both communication and coordination challenges.
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16
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Lima MADDS, Magalhães AMMD, Oelke ND, Marques GQ, Lorenzini E, Weber LAF, Fan I. Care transition strategies in Latin American countries: an integrative review. ACTA ACUST UNITED AC 2018; 39:e20180119. [PMID: 30517436 DOI: 10.1590/1983-1447.2018.20180119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/12/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify and analyze available literature on care transition strategies in Latin American countries. METHODS Integrative literature review that included studies indexed in PubMed, LILACS, Web of Science Core Collection, CINAHL, SCOPUS databases, and the Scientific Electronic Library Online (SciELO), published in Portuguese, Spanish or English, between 2010 and 2017. RESULTS Eleven articles were selected and the strategies were grouped into components of care transition: discharge planning, advanced care planning, patient education and promotion of self-management, medication safety, complete communication of information, and outpatient follow-up. These strategies were carried out by multidisciplinary team members, in which nurses play a leading role in promoting safe care transitions. CONCLUSIONS Care transition activities are generally initiated very close to patient discharge, this differs from recommendations of care transition programs and models, which suggest implementing care transition strategies from the time of admission until discharge.
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Affiliation(s)
- Maria Alice Dias da Silva Lima
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós- Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Ana Maria Müller de Magalhães
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós- Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | | | | | - Elisiane Lorenzini
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Núcleo de Estudos sobre Gestão em Enfermagem (NEGE), Porto Alegre, Rio Grande do Sul, Brasil
| | - Luciana Andressa Feil Weber
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós- Graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Iris Fan
- University of British Columbia (UBC), Okanagan Campus, School of Nursing. Kelowna, Canada
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17
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McGraw CA. Nurses' perceptions of the root causes of community-acquired pressure ulcers: Application of the Model for Examining Safety and Quality Concerns in Home Healthcare. J Clin Nurs 2018; 28:575-588. [PMID: 30129137 DOI: 10.1111/jocn.14652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 02/01/2023]
Abstract
AIMS AND OBJECTIVES To explore how the context of care influences the development of community-acquired pressure ulcers from the perspective of nurses working in home healthcare settings, to identify and categorise the factors perceived as contributing to the development of these ulcers using the Model for Examining Safety and Quality Concerns in Home Healthcare, and to explore how these risks are managed in practice. BACKGROUND Pressure ulcer reduction is a priority in both hospital and community settings. Evidence suggests the factors affecting safety and performance in community settings are not the same as in hospital. However, research pertaining to pressure ulcer risk management has predominantly been undertaken in hospital settings. DESIGN The study was framed by a qualitative exploratory design. METHODS Semistructured interviews were conducted with a purposive sample of 19 registered nurses recruited from an independent regional tissue viability network and five community nursing provider organisations in London. RESULTS The experiences and perceptions of participants mapped onto the components of the Model for Examining Safety and Quality Concerns in Home HealthCare: patient characteristics, provider characteristics, nature of home healthcare tasks, social and community environment, medical devices and new technology, physical environment, and external environment. Four strategies to address identified risks were established: behavioural interventions, technical interventions, safeguarding interventions and initiatives to promote better integration between health, local authorities and families. CONCLUSION Understanding the complex interplay between people and other elements of the healthcare system is critical to the prevention, management and investigation of pressure ulcers. This study has illuminated these elements from the perspective of nurses working in community settings. RELEVANCE TO CLINICAL PRACTICE Further consideration should be given to the importance of place when both developing risk management strategies for pressure ulcer prevention and learning the lessons from failure.
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18
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Backman C, Stacey D, Crick M, Cho-Young D, Marck PB. Use of participatory visual narrative methods to explore older adults' experiences of managing multiple chronic conditions during care transitions. BMC Health Serv Res 2018; 18:482. [PMID: 29925369 PMCID: PMC6011600 DOI: 10.1186/s12913-018-3292-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/11/2018] [Indexed: 12/12/2022] Open
Abstract
Background Older adults with multiple chronic conditions typically have more complex care needs that require multiple transitions between healthcare settings. Poor care transitions often lead to fragmentation in care, decreased quality of care, and increased adverse events. Emerging research recommends the strong need to engage patients and families to improve the quality of their care. However, there are gaps in evidence on the most effective approaches for fully engaging patients/clients and families in their transitional care. The purpose of this study was to engage older adults with multiple chronic conditions and their family members in the detailed exploration of their experiences during transitions across health care settings and identify potential areas for future interventions. Methods This was a qualitative study using participatory visual narrative methods informed by a socio-ecological perspective. Narrated photo walkabouts were conducted with older adults and family members (n = 4 older adults alone, n = 3 family members alone, and n = 2 older adult/family member together) between February and September 2016. The data analysis of the transcripts consisted of an iterative process until consensus on the coding and analysis was reached. Results A common emerging theme was that older adults and their family members identified the importance of active involvement in managing their own care transitions. Other themes included positive experiences during care transitions; accessing community services and resources; as well as challenges with follow-up care. Participants also felt a lack of meaningful engagement during discharge planning, and they also identified the presence of systemic barriers in care transitions. Conclusion The results contribute to our understanding that person- and family-centered care transitions should focus on the need for active involvement of older adults and their families in managing care transitions. Based on the results, three areas for improvement specific to older adults managing chronic conditions during care transitions emerged: strengthening support for person- and family-centered care, engaging older adults and families in their care transitions, and providing better support and resources.
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Affiliation(s)
- Chantal Backman
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451, Smyth Rd, RGN 3239, Ottawa, ON, K1H 8M5, Canada. .,Ottawa Hospital Research Institute, 451, Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451, Smyth Rd, RGN 3239, Ottawa, ON, K1H 8M5, Canada.,Ottawa Hospital Research Institute, 451, Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Michelle Crick
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451, Smyth Rd, RGN 3239, Ottawa, ON, K1H 8M5, Canada
| | - Danielle Cho-Young
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451, Smyth Rd, RGN 3239, Ottawa, ON, K1H 8M5, Canada
| | - Patricia B Marck
- Faculty of Human and Social Development, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, V8W 2Y2, Canada
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19
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Lorenzini E, Oelke ND, Marck PB, Dall'agnol CM. Researching safety culture: deliberative dialogue with a restorative lens. Int J Qual Health Care 2018; 29:745-749. [PMID: 28992142 DOI: 10.1093/intqhc/mzx080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 06/29/2017] [Indexed: 11/14/2022] Open
Abstract
Safety culture is a key component of patient safety. Many patient safety strategies in health care have been adapted from high-reliability organizations (HRO) such as aviation. However, to date, attempts to transform the cultures of health care settings through HRO approaches have had mixed results. We propose a methodological approach for safety culture research, which integrates the theory and practice of restoration science with the principles and methods of deliberative dialogue to support active engagement in critical reflection and collective debate. Our aim is to describe how these two innovative approaches in health services research can be used together to provide a comprehensive effective method to study and implement change in safety culture. Restorative research in health care integrates socio-ecological theory of complex adaptive systems concepts with collaborative, place-sensitive study of local practice contexts. Deliberative dialogue brings together all stakeholders to collectively develop solutions on an issue to facilitate change. Together these approaches can be used to actively engage people in the study of safety culture to gain a better understanding of its elements. More importantly, we argue that the synergistic use of these approaches offers enhanced potential to move health care professionals towards actionable strategies to improve patient safety within today's complex health care systems.
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Affiliation(s)
- Elisiane Lorenzini
- Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Rua São Manoel, 963, Bairro Rio Branco, Porto Alegre, RS, Brazil
| | - Nelly D Oelke
- Interior Health Regional SPOR Support Centre, School of Nursing, Faculty of Health and Social Development, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Canada
| | | | - Clarice Maria Dall'agnol
- Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Rua São Manoel, 963, Bairro Rio Branco, Porto Alegre, RS, Brazil
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20
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Abstract
An important domain of patient safety is the management of medications in home and community settings by patients and their caregiving network. This study applied human factors/ergonomics theories and methods to data about medication adherence collected from 61 patients with heart failure accompanied by 31 informal caregivers living in the US. Seventy non-adherence events were identified, described, and analysed for performance shaping factors. Half were classified as errors and half as violations. Performance shaping factors included elements of the person or team (e.g. patient limitations), task (e.g. complexity), tools and technologies (e.g. tool quality) and organisational, physical, and social context (e.g. resources, support, social influence). Study findings resulted in a dynamic systems model of medication safety applicable to patient medication adherence and the medication management process. Findings and the resulting model offer implications for future research on medication adherence, medication safety interventions, and resilience in home and community settings. Practitioner Summary: We describe situational and habitual errors and violations in medication use among older patients and their family members. Multiple factors pushed performance towards risk and harm. These factors can be the target for redesign or various forms of support, such as education, changes to the plan of care, and technology design.
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Affiliation(s)
- Robin Sue Mickelson
- a Vanderbilt School of Nursing , Vanderbilt University , Nashville , TN , USA
- b The Center for Research and Innovation in Systems Safety (CRISS) , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Richard J Holden
- c Department of BioHealth Informatics , Indiana University School of Informatics and Computing , Indianapolis , IN , USA
- d Indiana University Center for Aging Research , Regenstrief Institute, Inc. , Indianapolis , IN , USA
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21
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Abstract
Purpose
Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to facilitate suggestions for changes in future practices.
Design/methodology/approach
Based on a previous study on visiting nurses’ post-hospital medication management, two workshops were conducted in a visiting nurse department in a Danish municipality.
Findings
The visiting nurses emphasised knowledge of patients’ basic needs and prioritised their performance of context-specific nursing assessments, with a preventive focus as a prerequisite for improved patient safety in post-hospital medication management.
Research limitations/implications
The participatory approach can increase the acceptability and feasibility of changes regarding future practices and thereby reduce the gap between official documents and daily practice. Although the local development of suggestions for changes in practices does not provide general knowledge, a subsequent detailed description of the changes in practices can promote transferability to other healthcare settings after local adjustments are made.
Practical implications
Flexible home healthcare, with stable relationships enabling the continuous assessment of the patient’s needs and symptoms, along with subsequent adjustments being made in care and medical treatment, might enhance patient safety in post-hospital medication management.
Originality/value
This paper adds to the knowledge of the need for integrated care in medication management in patients’ homes. It argues for primary healthcare professionals as “experts in complexity” and suggests a reconsideration of the purchaser-provider division of care to patients with unstable health conditions and complex care needs during the first days following hospital discharge.
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22
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Lohman MC, Cotton BP, Zagaria AB, Bao Y, Greenberg RL, Fortuna KL, Bruce ML. Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients. J Gen Intern Med 2017; 32:1301-1308. [PMID: 28849426 PMCID: PMC5698223 DOI: 10.1007/s11606-017-4157-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/27/2017] [Accepted: 08/03/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population. OBJECTIVE To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients. DESIGN Cross-sectional analysis using data from 132 home health agencies in the US. SUBJECTS Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n = 87,780). MAIN MEASURES Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use. KEY RESULTS In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10-33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR = 1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR = 1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital. CONCLUSIONS Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes, hospitalizations, and care transitions are justified.
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Affiliation(s)
- Matthew C Lohman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,Dartmouth Centers for Health and Aging, Lebanon, NH, USA.
| | - Brandi P Cotton
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Dartmouth Centers for Health and Aging, Lebanon, NH, USA
| | - Alexandra B Zagaria
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Yuhua Bao
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Rebecca L Greenberg
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
| | - Karen L Fortuna
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Dartmouth Centers for Health and Aging, Lebanon, NH, USA
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Dartmouth Centers for Health and Aging, Lebanon, NH, USA
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23
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Kollerup MG, Curtis T, Schantz Laursen B. Visiting nurses’ posthospital medication management in home health care: an ethnographic study. Scand J Caring Sci 2017; 32:222-232. [DOI: 10.1111/scs.12451] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 01/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mette Geil Kollerup
- Aalborg Municipality; Clinical Nursing Research Unit; Aalborg Universityhospital; Aalborg University; Aalborg Denmark
| | - Tine Curtis
- Aalborg Municipality; Aalborg University; University of Southern Denmark; Aalborg Denmark
| | - Birgitte Schantz Laursen
- Aalborg University; Department of Clinical Medicine; Clinical Nursing Research Unit; Aalborg Universityhospital; Aalborg Denmark
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