Enhancing older people's concordance with taking their medication

Communicative and Discursive Perspectives on the Medication Experience

Taking the ‘medication experience’ in the broad sense of what individuals hear and say about their medication, as well as how they experience it, this paper explores diverse research on medication information available to patients and their modes and capacities for interaction, including personal circles, doctors and pharmacists, labeling and promotion, websites, and the patient’s own inner conversations and self-expression. The goal is to illustrate, for nonspecialists in communication, how the actors, messages, mediums, genres, and contextual factors within a standard ethnographic and social semiotic model of discourse and communication are operating, not always effectively or beneficially, to mediate or construct a patient’s medication experience. We also suggest how disparate insights can be integrated through such a model and might generate new research questions.

Adherence and medication management by the elderly

AIMS AND OBJECTIVES

The purpose of this study was to explore the strategies used for medication management by elderly who live at home.

BACKGROUND

Non-adherence to chronic medication is a common problem among the elderly with chronic conditions. Many studies have been developed, but it did not progress in solving this multidisciplinary health care problem. The causes of non-adherence by the elderly are multiple and complex.

DESIGN

Descriptive qualitative design.

METHODS

Data were collected by two focus groups. The content of discussion was analysed from verbatim transcript and identifying categories and sub-categories emerged, leading to the construction of a diagram analysis.

RESULTS

The finding indicated the strategies and the interpretation of people aged 65 or more and with chronic illness, managing their medication. Four content categories emerged: to live with drugs, taking medication, belief about drugs and relationship with health professionals.

CONCLUSION

The study enabled us to identify and understand, by giving a 'voice' to the elderly, that living with drugs is a dynamic and complex process and that taking medication is perceived by older people as a consequence of their ageing, which requires them to include that process in their lives as a habit implying changes in their daily routines. The elderly suggest that the relationship with health professionals is essential in medication management and they reported that the information given by the nurse during consultation is very important.

RELEVANCE TO CLINICAL PRACTICE

The relationship with nurses in particular is an important issue for the older people. Understanding the factors of adherence and helping people are important areas of research in nursing. The quality of this relationship may be the key to increasing adherence in this group of people.

Testing a teaching appointment and geragogy-based approach to medication knowledge at discharge

Limited research is available on how best to provide discharge teaching for rehabilitation patients. The purpose of this study was to evaluate the effectiveness of different methods for providing education to increase patient knowledge about discharge medications. Using a convenience sample of patients and family members, a randomized, experimental study design was conducted to compare three methods for teaching about discharge medications (geragogy format plus scheduled time for teaching; geragogy format alone; standard teaching method). No differences were found in knowledge between the three teaching methods, but family members had significantly lower confidence levels before the teaching sessions than patients; patients' confidence levels increased after education (p = .002). Although the teaching method did not affect medication knowledge, family members (though not patients) experienced significant increases in confidence levels for administering discharge medications after the education.

Post-Katrina provision of health care to veterans in a mobile clinic: providers' perspectives

PURPOSE

To describe the challenges faced by healthcare providers in the aftermath of one of the worst natural disasters in the United States.

DATA SOURCES

Eight healthcare providers describe their perceptions of the care they provided to veterans at a mobile clinic in the aftermath of Hurricane Katrina. This informal report used Giorgi's phenomenological approach to gathering and analyzing information provided in written response to eight specific questions.

CONCLUSIONS

Four broad categories of challenges and concerns are discussed in this article: (a) What was important in the provision of care for the veterans, (b) the hindrances encountered, (c) factors that facilitated the care given, and (d) the perceived effects of the care they provided. Three key themes characterized the lived experience of the eight participants: uncertainty, deprivation, and stabilization. Although this was not a formal research study, the authors and participants were able to use their research backgrounds and understandings to organize and make sense of their experiences during this chaotic period.

IMPLICATIONS FOR PRACTICE

As hurricane season in the United States and the anniversary of Hurricane Katrina (August 2005) approach, it is hoped that this report on the experiences and recommendations of healthcare providers will benefit other providers in similar situations.

Potential Influences on Initiation and Persistence of Extramedical Prescription Pain Reliever Use in the US Population

OBJECTIVE

Extramedical prescription pain reliever use has generated much public concern; however, little is known regarding its epidemiology in the general population.

METHODS

Using data from the annual National Survey on Drug Use and Health (2002 and 2003), we explored demographics, drug use history, and physical/mental problems associated with recent onset use (initiated in past 24 mo, n=1528) and persistent use (initiated more than 2 y and still using within a year of the assessment, n=4400) of prescription pain relievers when taken without a clinician's prescription or not as prescribed.

RESULTS

Adolescents and young adults were more likely to initiate extramedical use as compared with older individuals. African-Americans were approximately half as likely to initiate extramedical use as compared with whites (odds ratio, OR: 0.56, 95% confidence interval, CI: 0.45, 0.70). Hispanics who began using prescription pain relievers extramedically were more likely to persist as compared with whites (OR: 1.84, 95% CI: 1.52, 2.22). Reporting lifetime use of marijuana (adjusted odds ratio, aOR: 6.86, 95% CI: 5.86, 8.03), cocaine (aOR: 5.36, 95% CI: 4.53, 6.33), and heroin (aOR: 3.87, 95% CI: 2.51, 5.97) was associated with initiation of extramedical prescription pain reliever use. Adults with mental problems were twice as likely to be recent onset users as compared with those without these symptoms, holding constant potential confounders.

DISCUSSION

This study supplies data that can improve our understanding of factors associated with the extramedical use of prescription pain relievers among 2 distinct stages of use.