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Aje AA, Fakeye TO. Factors associated with disease knowledge and attitude among ambulatory patients with type 2 diabetes - a multicenter study. BMC Endocr Disord 2024; 24:158. [PMID: 39187848 PMCID: PMC11345965 DOI: 10.1186/s12902-024-01696-0] [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: 05/16/2023] [Accepted: 08/19/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Diabetes is a multifactorial disease state that requires adequate patient monitoring for improved health outcomes. Diabetes knowledge and attitude, and associated factors such as medication adherence, medication discrepancy, health literacy, and glycemic control were evaluated in this study. The selected factors were also compared with diabetes knowledge and attitude. METHODS A cross-sectional study was carried out among ambulatory diabetes patients in three tertiary healthcare facilities in Nigeria. An interviewer-administered semi-structured questionnaire was utilized for data collection. Data was analysed using descriptive and inferential statistics with the level of significance set at p < 0.05. RESULTS A total of 188 diabetes patients participated in the study; 51 (27.1%) at the Federal Medical Center, Abeokuta, 69 (36.7%) at the University College Hospital, Ibadan, and 68 (36.2%) at the University of Ilorin Teaching Hospital, Ilorin. One hundred and twelve (59.6%) female patients participated in the study and patients' average age was 58.69 ± 13.68 years. Medication discrepancy was observed among 101 (53.7%) patients. One hundred and three (54.8%), 47 (25.0%) and 38 (20.2%) had high, medium, and low medication adherence, respectively. Ninety-one (48.4%) had high health literacy. Mean diabetes knowledge score was 14.64 ± 2.55 points out of a maximum obtainable score of 18 points. Mean diabetes attitude of patients was 62.50 ± 6.86 points out of a maximum obtainable score of 70 points. Significant positive association was observed between diabetes knowledge and health literacy (Beta = 0.021, p = 0.029). Diabetes knowledge was higher in patients with higher level of formal education (p = 0.046), higher diabetes attitude (p < 0.001) and high health literacy (p = 0.002). Patients' diabetes attitude was higher in individuals older than 60 years of age (p = 0.029), and those with high health literacy (p = 0.005). CONCLUSIONS The diabetes patients displayed good disease knowledge, attitude and medication adherence. Average levels of health literacy and medication discrepancy was observed among the patients. Significant differences were observed between patients' diabetes knowledge and level of formal education, diabetes attitude, health literacy and age. Patients' health literacy was significantly associated with diabetes knowledge.
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Affiliation(s)
- Akinniyi A Aje
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
| | - Titilayo O Fakeye
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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Vest TA, Gazda NP, O'Neil DP, Eckel SF. Practice-enhancing publications about the medication-use process in 2021. Am J Health Syst Pharm 2024; 81:e489-e519. [PMID: 38864424 DOI: 10.1093/ajhp/zxae144] [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: 05/23/2024] [Indexed: 06/13/2024] Open
Abstract
PURPOSE This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2021 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following components: prescribing/transcribing, dispensing, administration, and monitoring, and monitoring/medication reconciliation. Articles evaluating at least one step of the MUP were assessed for their usefulness toward practice improvement. SUMMARY A PubMed search was conducted in January 2022 for articles published in calendar year 2021 using targeted Medical Subject Headings (MeSH) keywords, and searches of the table of contents of selected pharmacy journals were conducted, providing a total of 7,178 articles. A thorough review identified 79 potentially practice-enhancing articles: 15 for prescribing/transcribing, 17 for dispensing, 4 for administration, 21 for monitoring, and 22 for monitoring/medication reconciliation. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of their importance within health-system pharmacy. The other articles are listed for further review and evaluation. CONCLUSION It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing the most impactful publications. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of the significant published studies can assist in changing practice at the institutional level.
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Affiliation(s)
- Tyler A Vest
- Duke University Health System, Durham, NC
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | | | | | - Stephen F Eckel
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC
- University of North Carolina Medical Center, Chapel Hill, NC, USA
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Alshyyab MA, Ebbini MAL, Alslewi A, Hughes J, Borkoles E, FitzGerald G, Albsoul RA. Factors Influencing Medication Administration Errors as Perceived by Nurses in Pediatric Units in a Jordanian Tertiary Hospital: A Qualitative Descriptive Study. West J Nurs Res 2024; 46:201-209. [PMID: 38268481 DOI: 10.1177/01939459241227768] [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] [Indexed: 01/26/2024]
Abstract
BACKGROUND The World Health Organization declared that medication errors are the third largest global patient safety challenge. The medication administration stage is a common and susceptible stage for medical errors to occur. OBJECTIVE To explore the factors contributing to medication administration errors specifically in pediatric care units as perceived by nurses in a Jordanian hospital. METHODS A qualitative descriptive study was conducted involving face-to-face audio-recorded interviews with 9 nurses in a tertiary hospital located in the north of Jordan. A convenience sampling technique was used to select the participants of our study. Data were collected between October 2022 and November 2022. The data were analyzed using inductive thematic analysis. RESULTS Four themes emerged affecting medication administration errors in pediatric care units. These were environmental, staff, parents and patient, and medication-related factors. CONCLUSION The findings of this study raise awareness of the most frequent sources of medication errors in a Jordanian hospital. Holding training and supervision to raise awareness among nurses and the availability of equipment and supplies could improve medication safety practices.
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Affiliation(s)
- Muhammad Ahmed Alshyyab
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Muna A L Ebbini
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Asma'a Alslewi
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - James Hughes
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Erika Borkoles
- Research Innovation & Enterprise, Research Services, Federation University Australia, Ballarat, VIC, Australia
| | - Gerard FitzGerald
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rania Ali Albsoul
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
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Ahmadimoghaddam D, Akbari P, Mehrpooya M, Entezari-Maleki T, Rangchian M, Zamanirafe M, Parvaneh E, Mohammadi Y. Comparison between proactive and retroactive models of medication reconciliation in patients hospitalized for acute decompensated heart failure. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2024; 35:143-158. [PMID: 38457155 DOI: 10.3233/jrs-230034] [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] [Indexed: 03/09/2024]
Abstract
BACKGROUND Most research on the impact of medication reconciliation on patient safety focused on the retroactive model, with limited attention given to the proactive model. OBJECTIVE This study was conducted to compare the proactive and retroactive models in patients hospitalized for acute decompensated heart failure. METHODS This prospective, quasi-experimental study was conducted over six months, from June to November 2022, at the cardiology unit of an academic hospital in Iran. Eligible patients were those hospitalized for acute decompensated heart failure using a minimum of five regular medications before admission. Medication reconciliation was performed in 81 cases using the proactive model and in 81 using the retroactive model. RESULTS 556 medications were reconciled using the retroactive model, and 581 were reconciled using the proactive model. In the retroactive cases, 341 discrepancies (both intentional and unintentional) were identified, compared to 231 in the proactive cases. The proportion of patients with at least one unintentional discrepancy was significantly lower in the proactive cases than in the retroactive cases (23.80% versus 74.03%). Moreover, the number of unintentional discrepancies was significantly lower in the proactive cases compared to the retroactive cases (22 out of 231 discrepancies versus 150 out of 341 discrepancies). In the retroactive cases, medication omission was the most frequent type of unintentional discrepancy (44.00). About, 42.70% of reconciliation errors detected in the retroactive cases were judged to have the potential to cause moderate to severe harm. While the average time spent obtaining medication history was similar in both models (00:27 [h: min] versus 00:30), the average time needed to complete the entire process was significantly shorter in the proactive model compared to the retroactive model (00:41 min versus 00:51). CONCLUSION This study highlighted that the proactive model is a timely and effective method of medication reconciliation, particularly in improving medication safety for high-risk patients.
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Affiliation(s)
- Davoud Ahmadimoghaddam
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Paniz Akbari
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Mehrpooya
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Taher Entezari-Maleki
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Rangchian
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Zamanirafe
- Medical Faculty, Hamadan University of Medical Science, Hamadan, Iran
| | - Erfan Parvaneh
- Department of Cardiology, School of Medicine, Clinical Research Development Unit of Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Younes Mohammadi
- Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Araya A, Thornton LR, Kwon D, Ferguson GM, Highfield LD, Hwang KO, Holmes HM, Bernstam EV. Medication Reconciliation during Transitions of Care Across Institutions: A Quantitative Analysis of Challenges and Opportunities. Appl Clin Inform 2023; 14:923-931. [PMID: 37726022 PMCID: PMC10665121 DOI: 10.1055/a-2178-0197] [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: 05/07/2023] [Accepted: 08/06/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE Medication discrepancies between clinical systems may pose a patient safety hazard. In this paper, we identify challenges and quantify medication discrepancies across transitions of care. METHODS We used structured clinical data and free-text hospital discharge summaries to compare active medications' lists at four time points: preadmission (outpatient), at-admission (inpatient), at-discharge (inpatient), and postdischarge (outpatient). Medication lists were normalized to RxNorm. RxNorm identifiers were further processed using the RxNav API to identify the ingredient. The specific drugs and ingredients from inpatient and outpatient medication lists were compared. RESULTS Using RxNorm drugs, the median percentage intersection when comparing active medication lists within the same electronic health record system ranged between 94.1 and 100% indicating substantial overlap. Similarly, when using RxNorm ingredients the median percentage intersection was 94.1 to 100%. In contrast, the median percentage intersection when comparing active medication lists across EHR systems was significantly lower (RxNorm drugs: 6.1-7.1%; RxNorm ingredients: 29.4-35.0%) indicating that the active medication lists were significantly less similar (p < 0.05).Medication lists in the same EHR system are more similar to each other (fewer discrepancies) than medication lists in different EHR systems when comparing specific RxNorm drug and the more general RxNorm ingredients at transitions of care. Transitions of care that require interoperability between two EHR systems are associated with more discrepancies than transitions where medication changes are expected (e.g., at-admission vs. at-discharge). Challenges included lack of access to structured, standardized medication data across systems, and difficulty distinguishing medications from orderable supplies such as lancets and diabetic test strips. CONCLUSION Despite the challenges to medication normalization, there are opportunities to identify and assist with medication reconciliation across transitions of care between institutions.
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Affiliation(s)
- Alejandro Araya
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center (UTHealth), Houston, Texas, United States
| | - Logan R. Thornton
- Division of Population Health and Evidence-Based Practice, Healthcare Transformation Initiatives, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, Texas, United States
| | - Deukwoo Kwon
- Division of Clinical and Translation Sciences, Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, Texas, United States
| | - Gayla M. Ferguson
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas, United States
| | - Linda D. Highfield
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas, United States
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas, United States
- Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, Texas, United States
| | - Kevin O. Hwang
- Division of General Internal Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, Texas, United States
| | - Holly M. Holmes
- Division of Geriatrics, Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, Texas, United States
| | - Elmer V. Bernstam
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center (UTHealth), Houston, Texas, United States
- Division of General Internal Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Kathrine G. McGovern Medical School, Houston, Texas, United States
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Park S, Kim AJ, Chae HW, Heo KN, Kim Y, Kim SH, Cho YS, Lee HJ, Lee JY. Study Protocol for the Evaluation of Multidisciplinary Medication Reconciliation Service in Adult Patients Undergoing Thoracic and Cardiovascular Surgery (The MERITS Study): A Single-Center Controlled before-and-after Study. Healthcare (Basel) 2023; 11:1778. [PMID: 37372896 DOI: 10.3390/healthcare11121778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Medication reconciliation (MR), which is widely implemented worldwide, aims to improve patient safety to reduce the medication errors during care transition. Despite its widespread use, MR has not yet been implemented in the Republic of Korea, and its effectiveness has not been studied. We aimed to evaluate the impact of a multidisciplinary MR service in older patients undergoing thoracic and cardiovascular surgery. This is a single-center, prospective, controlled, before-and-after study of adult patients taking at least one chronic oral medication. Depending on the period of each patient's participation, they will be allocated to an intervention group or control group. Patients in the intervention group will receive multidisciplinary MR, and those in the control group will receive usual care. The primary outcome is to assess the impact of the MR service on medication discrepancies between the best possible medication history and medication orders at care transition. Secondary outcomes include the incidence rate of medication discrepancies at each transition, the discrepancy rate between the sources of information, the impact of MR on medication appropriateness index score, drug-related problems, 30-day mortality, the emergency department visit rate, readmission rate after discharge, the rate and acceptability of pharmacists' intervention during hospitalization, and patients' satisfaction.
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Affiliation(s)
- Soyoung Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - A Jeong Kim
- Department of Pharmacy, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Hyun-Woo Chae
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Kyu-Nam Heo
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Yookyung Kim
- Department of Pharmacy, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Sung Hwan Kim
- Department of Pharmacy, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Yoon Sook Cho
- Department of Pharmacy, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Hyun Joo Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
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