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Wabe N, Urwin R, Seaman K, Timothy A, Raban MZ, Westbrook J. Analysis of longitudinal patterns and predictors of medicine use in residential aged care using group-based trajectory modelling: The MEDTRAC-Polypharmacy longitudinal cohort study. Br J Clin Pharmacol 2024. [PMID: 39183449 DOI: 10.1111/bcp.16220] [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: 12/18/2023] [Revised: 07/21/2024] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
AIMS Polypharmacy serves as a quality indicator in residential aged care facilities (RACFs) due to concerns about inappropriate medication use. However, aggregated polypharmacy rates at a single time offer limited value. Longitudinal analysis of polypharmacy patterns provides valuable insights into identifying potential overuse of medicines. We aimed to determine long-term trajectories of polypharmacy (≥9 medicines) and factors associated with each polypharmacy trajectory group. METHODS This was a longitudinal cohort study using electronic data from 30 RACFs in New South Wales, Australia. We conducted group-based trajectory modelling to identify and characterize polypharmacy trajectories over 3 years. We evaluated the model fitness using the Bayesian Information Criterion, entropy (with a value of ≥0.8 considered ideal) and several other metrics. RESULTS The study included 2837 permanent residents (median age = 86 years, 61.7% female and 47.4% had dementia). We identified five polypharmacy trajectory groups: group 1 (no polypharmacy, 46.0%); group 2 (increasing polypharmacy, 9.4%); group 3 (decreasing polypharmacy, 9.2%); group 4 (increasing-then decreasing polypharmacy, 10.0%), and group 5 (persistent polypharmacy, 25.4%). The model showed excellent performance (e.g., entropy = 0.9). Multinomial logistic regressions revealed the profile of each trajectory group (e.g., group 5 residents had higher odds of chronic respiratory disease compared with group 1). CONCLUSIONS Our study identified five polypharmacy trajectory groups, including one with over a quarter of residents following a persistently high trajectory, signalling concerning medication overuse. Quality indicator programs should adopt tailored metrics to monitor diverse polypharmacy trajectory groups, moving beyond the current one-size-fits-all approach and better capturing the evolving dynamics of residents' medication regimens.
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Affiliation(s)
- Nasir Wabe
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Rachel Urwin
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Karla Seaman
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Andrea Timothy
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Magdalena Z Raban
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
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Mortelmans L, Goossens E, De Cock AM, van den Bemt P, Dilles T. Nurses' responses to patients' medication self-management problems in hospital and the use of recommendations. Br J Clin Pharmacol 2024. [PMID: 39086169 DOI: 10.1111/bcp.16204] [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: 03/05/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
This study aimed to describe the use of recommendations as a guide for healthcare providers to support patients experiencing medication self-management problems and to evaluate their feasibility, user-friendliness and usefulness. Between March and August 2023, 58 hospitalized patients completed a self-assessment on medication self-management problems. The problems addressed in this self-assessment were based on a list of frequently encountered medication self-management problems from previous research. Consequently, 18 nurses responded to the reported problems using the recommendations. Nurses evaluated the feasibility, user-friendliness and usefulness of these recommendations through a survey. A total of 217 medication self-management problems were reported by 58 patients. Nurses intervened in 52% of the problems using the recommendations. According to nurses, the recommendations were user-friendly and feasible but required a substantial time investment. Considering these pilot-based results, the recommendations have the potential to be a valuable resource for nurses in practice, though this potential requires further exploration.
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Affiliation(s)
- Laura Mortelmans
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Eva Goossens
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Patient Care, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Anne-Marie De Cock
- Department of Geriatrics, ZNA, Antwerp, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Patricia van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Tinne Dilles
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Vasilevskis EE, Trumbo SP, Shah AS, Hollingsworth EK, Shotwell MS, Mixon AS, Simmons SF. Medication Discrepancies among Older Hospitalized Adults Discharged from Post-Acute Care Facilities to Home. J Am Med Dir Assoc 2024; 25:105017. [PMID: 38754476 PMCID: PMC11335011 DOI: 10.1016/j.jamda.2024.105017] [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: 12/20/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES The epidemiology of medication discrepancies during transitions from post-acute care (PAC) to home is poorly described. We sought to describe the frequency and types of medication discrepancies among hospitalized older adults transitioning from PAC to home. DESIGN A nested cohort analysis. SETTING AND PARTICIPANTS Included participants enrolled in a patient-centered deprescribing trial, for patients (aged ≥50 years and taking at least 5 medications) transitioning from one of 22 PACs to home. METHODS We assessed demographic and medication measures at the initial hospitalization. The primary outcome measure was medication discrepancies, with the PAC discharge list serving as reference for comparison to the participant's self-reported medication list at 7 days following PAC discharge. Discrepancies were categorized as additions, omissions, and dose discrepancies and were organized by common medication classes and risk of harm (eg, 2015 Beers Criteria). Ordinal logistic regression assessed for patient risk factors for PAC discharge discrepancy count. RESULTS A total of 184 participants had 7-day PAC discharge medication data. Participants were predominately female (67%) and Caucasian (83%) with a median of 16 prehospital medications [interquartile range (IQR) 11, 20]. At the 7-day follow-up, 98% of participants had at least 1 medication discrepancy, with a median number of 7 medication discrepancies (IQR 4, 10) per person, 4 (IQR 2, 6) of which were potentially inappropriate medications as defined by the Beers Criteria. Higher medication discrepancies at index hospital admission and receipt of caregiver assistance with medications were 2 key predictors of medication discrepancies in the week after PAC discharge to home. CONCLUSIONS AND IMPLICATIONS Older patients transitioning home from a PAC facility are at high risk for medication discrepancies. This study underscores the need for interventions targeted at this overlooked transition period, especially as patients resume responsibility for managing their own medications after both a hospital and PAC stay.
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Affiliation(s)
- Eduard Eric Vasilevskis
- Division of Hospital Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA; Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.
| | - Silas P Trumbo
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Avantika Saraf Shah
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily Kay Hollingsworth
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amanda S Mixon
- Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Sandra Faye Simmons
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA; Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Mortelmans L, Goossens E, Dilles T. Effect of an in-hospital medication self-management intervention (SelfMED) on medication adherence in polypharmacy patients postdischarge: protocol of a pre-post intervention study. BMJ Open 2024; 14:e083129. [PMID: 38749699 PMCID: PMC11097838 DOI: 10.1136/bmjopen-2023-083129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Healthcare providers usually manage medication for patients during hospitalisation, although patients are expected to self-manage their medication after discharge. A lack of self-management competencies is found to be associated with low adherence levels and medication errors harming patients' health. Currently, patients seldom receive support or education in medication self-management. When self-management is allowed during hospitalisation, it is rarely provided using a structured, evidence-based format. Therefore, an in-hospital medication self-management intervention (ie, SelfMED) was developed based on current evidence. To date, empirical data demonstrating the effect of SelfMED on medication adherence are lacking. This study primarily aims to evaluate the effect of the SelfMED intervention on medication adherence 2 months postdischarge in polypharmacy patients, as compared with usual care. METHODS AND ANALYSIS A multicentre pre-post intervention study will be conducted. The study will start with a control phase investigating usual care (ie, medication management entirely provided by healthcare providers), followed by an intervention period, investigating the effects of the SelfMED intervention. SelfMED consists of multiple components: (1) a stepped assessment evaluating patients' eligibility for in-hospital medication self-management, (2) a monitoring system allowing healthcare providers to follow up medication management and detect problems and (3) a supportive tool providing healthcare providers with a resource to act on observed problems with medication self-management. Polymedicated patients recruited during the control and intervention periods will be monitored for 2 months postdischarge. A total of 225 participants with polypharmacy should be included in each group. Medication adherence 2 months postdischarge, measured by pill counts, will be the primary outcome. Secondary outcomes include self-management, medication knowledge, patient and staff satisfaction, perceived workload and healthcare service utilisation. ETHICS AND DISSEMINATION The ethics committee of the Antwerp University Hospital approved the study (reference no: B3002023000176). Study findings will be disseminated through peer-reviewed publications, conference presentations and summaries in layman's terms. TRIAL REGISTRATION NUMBER ISRCTN15132085.
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Affiliation(s)
- Laura Mortelmans
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Eva Goossens
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Patient Care, Antwerp University Hospital (UZA), Antwerp, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Tinne Dilles
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Solh Dost L, Gastaldi G, Schneider MP. Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes. BMC Health Serv Res 2024; 24:620. [PMID: 38741070 DOI: 10.1186/s12913-024-10784-9] [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: 06/28/2023] [Accepted: 02/26/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Continuity of care is under great pressure during the transition from hospital to outpatient care. Medication changes during hospitalization may be poorly communicated and understood, compromising patient safety during the transition from hospital to home. The main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients' perspectives of their medications from hospital to two months after discharge. METHODS Patients with type 2 diabetes, with at least two comorbidities and who returned home after discharge, were recruited during their hospitalization. A descriptive qualitative longitudinal research approach was adopted, with four in-depth semi-structured interviews per participant over a period of two months after discharge. Interviews were based on semi-structured guides, transcribed verbatim, and a thematic analysis was conducted. RESULTS Twenty-one participants were included from October 2020 to July 2021. Seventy-five interviews were conducted. Three main themes were identified: (A) Medication management, (B) Medication understanding, and (C) Medication adherence, during three periods: (1) Hospitalization, (2) Care transition, and (3) Outpatient care. Participants had varying levels of need for medication information and involvement in medication management during hospitalization and in outpatient care. The transition from hospital to autonomous medication management was difficult for most participants, who quickly returned to their routines with some participants experiencing difficulties in medication adherence. CONCLUSIONS The transition from hospital to outpatient care is a challenging process during which discharged patients are vulnerable and are willing to take steps to better manage, understand, and adhere to their medications. The resulting tension between patients' difficulties with their medications and lack of standardized healthcare support calls for interprofessional guidelines to better address patients' needs, increase their safety, and standardize physicians', pharmacists', and nurses' roles and responsibilities.
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Affiliation(s)
- Léa Solh Dost
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
| | - Giacomo Gastaldi
- Division of Endocrinology, Diabetes, Hypertension and Nutrition, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marie P Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
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Baby B, McKinnon A, Patterson K, Patel H, Sharma R, Carter C, Griffin R, Burns C, Chang F, Guilcher SJ, Lee L, Fadaleh SA, Patel T. Tools to measure barriers to medication management capacity in older adults: a scoping review. BMC Geriatr 2024; 24:285. [PMID: 38532328 PMCID: PMC10967066 DOI: 10.1186/s12877-024-04893-7] [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: 09/18/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Medication management capacity is a crucial component of medication adherence, particularly among older adults. Various factors, including physical abilities, cognitive functions, sensory capabilities, motivational, and environmental factors, influence older adults' ability to manage medications. It is, therefore, crucial to identify appropriate tools that allow clinicians to determine which factors may impact medication management capacity and, consequently, nonadherence to medications. PURPOSE 1)To identify tools that measure physical, cognitive, sensory (vision, hearing, touch), motivational, and environmental barriers to medication self-management in older adults, and 2) to understand the extent to which these tools assess various barriers. METHODS The scoping review was conducted using Arksey and O'Malley's scoping review framework and the PRISMA Extension for Scoping Reviews checklist. In June 2022, the relevant literature was identified by searching PubMed (MEDLINE), Ovid Embase, Ovid IPA, EBSCOhost CINAHL, APA PsycINFO, and Scopus. RESULTS AND DISCUSSION In total, 7235 studies were identified. Following the removal of duplicates, 4607 articles were screened by title and abstract, of which 4253 did not meet the inclusion criteria. Three reviewers reviewed the full texts of the remaining 354 articles; among them, 41 articles, 4 theses and 1 conference abstract met the inclusion criteria. From the included studies, 44 tools were identified that measured a combination of physical, cognitive, sensory, motivational, and environmental barriers (n=19) or only cognition (n=13), vision (n=5), environmental factors (n=3), auditory (n=1), and motivational factors (n=1). The review also examined the psychometric properties of the identified tools and found that most of them had reported validity and reliability data. Several tools have demonstrated promise in assessing a combination of barriers with validity and reliability. These tools include the Self-Medication Assessment Tool (SMAT), ManageMed Screening (MMS), Self-Medication Risk Assessment Tool (RAT), HOME-Rx revised, and Medication Management Ability Assessment (MMAA). CONCLUSION This scoping review identified 44 validated tools to measure various challenges that older adults encounter with medication management. However, no tool measures all five barriers (physical, cognitive, sensory, motivational, and environmental) to medication-taking at home. Therefore, utilizing a combination of tools would be most appropriate to measure these different aspects comprehensively. Further research is needed to develop a new comprehensive tool that simultaneously measures various barriers to medication self-management.
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Affiliation(s)
- Bincy Baby
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Hawa Patel
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Rishabh Sharma
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Caitlin Carter
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Ryan Griffin
- National Research Council Canada, Ottawa, ON, Canada
| | - Catherine Burns
- Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Feng Chang
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Sara Jt Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Sara Abu Fadaleh
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
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Mortelmans L, Dilles T. The development and evaluation of a medication diary to report problems with medication use. Heliyon 2024; 10:e26127. [PMID: 38375256 PMCID: PMC10875575 DOI: 10.1016/j.heliyon.2024.e26127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose The study aimed to develop and evaluate a medication diary for patients to report problems with medication use to enable shared-decision making and improve medication adherence. Methods Based on a search for existing diaries, a review of the content, and a list of medication self-management problems compiled from previous research, a paper and pencil version of a medication diary was developed. The diary was reviewed for clarity and overall presentation by five healthcare providers and nine patients. Afterwards, user-friendliness was evaluated by 69 patients with polypharmacy discharged from hospital during a quantitative prospective study. Results The medication diary consists of several parts: (1) a medication schedule allowing patients to list their medicines, (2) information sheets allowing patients to write down specific medication-related information, (3) a monthly overview to indicate daily whether medication-related problems were experienced, (4) problem sheets elaborating on the problems encountered, (5) space for specific medication-related questions for healthcare providers to facilitate shared-decision making. The review phase resulted in minor textual adjustments and one extra problem in the problem sheet. Most participants, who tested the medication diary for two months, found the diary user-friendly (80%) and easy to fill in (89%). About 40% of participants reported problems with medication use. Half of the patients indicated that the diary can facilitate discussing problems with healthcare providers. Conclusion The medication diary offers patients the opportunity to report problems regarding their medication use in a proven user-friendly manner and to discuss these problems with healthcare providers. Reporting and discussing problems with medication use can serve as a first step towards making shared decisions on how to address the problems encountered.
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Affiliation(s)
- Laura Mortelmans
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Tinne Dilles
- Department of Nursing Science and Midwifery, Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Kanai M, Minamisawa M, Motoki H, Seko Y, Kimura K, Okano T, Ueki Y, Yoshie K, Kato T, Saigusa T, Ebisawa S, Okada A, Ozasa N, Kato T, Kuwahara K. Prognostic Impact of Hyperpolypharmacy Due to Noncardiovascular Medications in Patients After Acute Decompensated Heart Failure - Insights From the Clue of Risk Stratification in the Elderly Patients With Heart Failure (CURE-HF) Registry. Circ J 2023; 88:33-42. [PMID: 37544741 DOI: 10.1253/circj.cj-22-0712] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Hyperpolypharmacy is associated with adverse outcomes in older adults, but because literature on its association with cardiovascular (CV) outcomes after acute decompensated heart failure (ADHF) is sparse, we investigated the relationships among hyperpolypharmacy, medication class, and death in patients with HF. METHODS AND RESULTS We evaluated the total number of medications prescribed to 884 patients at discharge following ADHF. Patients were categorized into nonpolypharmacy (<5 medications), polypharmacy (5-9 medications), and hyperpolypharmacy (≥10 medications) groups. We examined the relationship of polypharmacy status with the 2-year mortality rate. The proportion of patients taking ≥5 medications was 91.3% (polypharmacy, 55.3%; hyperpolypharmacy, 36.0%). Patients in the hyperpolypharmacy group showed worse outcomes than patients in the other 2 groups (P=0.002). After multivariable adjustment, the total number of medications was significantly associated with an increased risk of death (hazard ratio [HR] per additional increase in the number of medications, 1.05; 95% confidence interval [CI], 1.01-1.10; P=0.027). Although the number of non-CV medications was significantly associated with death (HR, 1.07; 95% CI, 1.02-1.13; P=0.01), the number of CV medications was not (HR, 1.01; 95% CI, 0.92-1.10; P=0.95). CONCLUSIONS Hyperpolypharmacy due to non-CV medications was associated with an elevated risk of death in patients after ADHF, suggesting the importance of a regular review of the prescribed drugs including non-CV medications.
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Affiliation(s)
- Masafumi Kanai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | | | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Yuta Seko
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Kazuhiro Kimura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Yasushi Ueki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
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Pereira F, Meyer-Massetti C, Del Río Carral M, von Gunten A, Wernli B, Verloo H. Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study. BMJ Open 2023; 13:e072738. [PMID: 37730411 PMCID: PMC10514617 DOI: 10.1136/bmjopen-2023-072738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs). DESIGN Explanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously. SETTING Hospital and community healthcare in the French-speaking part of Switzerland. PARTICIPANTS The quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge. RESULTS Quantitative results from older adults' profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices. CONCLUSION By linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders' perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.
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Affiliation(s)
- Filipa Pereira
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Clinical of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - María Del Río Carral
- Institute of Psychology, Research Center for the Psychology of Health, Aging and Sports Examination (PHASE), University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Boris Wernli
- Swiss Centre of Expertise in the Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Mortelmans L, Goossens E, De Cock AM, Petrovic M, van den Bemt P, Dilles T. The Development of Recommendations for Healthcare Providers to Support Patients Experiencing Medication Self-Management Problems. Healthcare (Basel) 2023; 11:healthcare11111545. [PMID: 37297685 DOI: 10.3390/healthcare11111545] [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: 04/27/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Medication self-management problems such as the inability to correctly obtain, understand, organize, administer or monitor medication can result in negative patient outcomes. However, supportive tools for healthcare providers to assist patients with medication self-management problems are lacking. This study aimed to develop recommendations for healthcare providers to support patients with polypharmacy who experience medication self-management problems. A three-phase study was conducted starting with (1) the mapping of medication self-management problems, followed by (2) a scoping review providing a list of relevant interventions and actions for each respective problem and (3) a three-round modified e-Delphi study with experts to reach consensus on the relevance and clarity of the recommended interventions and actions. The cut-off for consensus on the relevance and clarity of the recommendations was set at 80% expert agreement. Experts could propose additional recommendations based on their professional experience and expertise. The experts (n = 23) involved were healthcare professionals (i.e., nurses, pharmacists, and physicians) with specific expertise in medication management of patients with polypharmacy. Simultaneous with the second e-Delphi round, a panel of patients with polypharmacy (n = 8) evaluated the usefulness of recommendations. Results obtained from the patient panel were fed back to the panel of healthcare providers in the third e-Delphi round. Descriptive statistics were used for data analysis. Twenty medication self-management problems were identified. Based on the scoping review, a list of 66 recommendations for healthcare providers to support patients with the identified medication self-management problems was composed. At the end of the three-round e-Delphi study, the expert panel reached consensus on the relevance and clarity of 67 recommendations, clustered according to the six phases of the medication self-management model by Bailey et al. In conclusion, this study resulted in a guidance document including recommendations that can serve as a resource for healthcare providers to support patients with polypharmacy in case of medication self-management problems. Future research should focus on the evaluation of the feasibility and user-friendliness of the guide with recommendations in clinical practice.
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Affiliation(s)
- Laura Mortelmans
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
| | - Eva Goossens
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
- Department of Patient Care, Antwerp University Hospital (UZA), 2610 Antwerp, Belgium
| | - Anne-Marie De Cock
- Department of Geriatrics, ZNA, 2020 Antwerp, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, 2610 Antwerp, Belgium
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, 9000 Ghent, Belgium
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, 9000 Ghent, Belgium
| | - Patricia van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Tinne Dilles
- Centre for Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Department of Nursing Science and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
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Dilles T, Mortelmans L, Loots E, Sabbe K, Feyen H, Wauters M, Haegdorens F, De Baetselier E. People-centered care and patients' beliefs about medicines and adherence: A cross-sectional study. Heliyon 2023; 9:e15795. [PMID: 37251820 PMCID: PMC10208933 DOI: 10.1016/j.heliyon.2023.e15795] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction People-centered care (PCC) strategies are believed to improve overall health outcomes. Medicines use is essential for the treatment of many patients with chronic conditions. Non-adherence rates are high and result in poor health outcomes, and increased healthcare utilization and costs. This study aimed to explore the relationship between PCC and adherence to medicines for persons with chronic medicines use, as well as the extent to which patients' beliefs about medicines are influenced by their level of perceived PCC. Methods A cross-sectional survey design was performed with adults using at least 3 chronic medicines per day. To measure the degree of medicines adherence, patients' ideas about medication, and PCC, four validated questionnaires were used: The Medication Adherence Report Scale (MARS-5), Beliefs about medicines questionnaire (BMQ), Client-Centered Care Questionnaire (CCCQ) and the Shared Decision Making Questionnaire (SDM-Q-9). Socio-demographics, health status, and drug-related burden were questioned as potential factors to impact the relationship between PCC and adherence. Results A sample of 459 persons participated. The mean score on the CCCQ (adjusted to pharmacotherapy) was 52.7 on 75 (sd = 8.83, range [18-70]). The top 20% scored 60 or more, the 20% lowest scores were 46 or less. Adherence levels were high, with a mean score of 22.6 on 25 on the MARS-5, and 88% scoring 20 or more. An increase in PCC corresponded to a higher chance of medicines adherence (OR 1.07, 95%CI [1.02-1.12]), corrected for age, the burden due to chronic diseases, the impact of side effects on daily life, and participants' beliefs about medicines. PCC showed positive correlations with the necessity of medicines use (r = 0.1, p = 0.016) and the balance between necessity and concerns (r = 0.3, p < 0.001); and negative correlations with levels of concerns (r = -0.3, p < 0.001) and scores on harmfulness (r = -0.3, p < 0.001) and overuse of medicines (r = -0.4, p < 0.001). Conclusion Patients with chronic medicine use perceived an average high level of people-centeredness in the pharmaceutical care they received. This PCC was weakly positively associated with adherence to their medicines. The higher PCC was evaluated, the more patients believed in the necessity of the medicines use and the better the balance between necessity and concerns. The people-centeredness of pharmaceutical care showed several shortcomings and can still be improved. As such, healthcare providers are advised to actively engage in PCC, and not to wait passively for information provided by the patient.
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Yang C, Lee DTF, Chair SY. Validation and adaption of an Information-Motivation-Behavioral Skills model of medication adherence in older patients with multimorbidity. PATIENT EDUCATION AND COUNSELING 2023; 113:107756. [PMID: 37156122 DOI: 10.1016/j.pec.2023.107756] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/25/2022] [Accepted: 04/14/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To test and adapt the Information-Motivation-Behavioral Skills (IMB) model in explaining medication adherence for older patients with multimorbidity. METHODS Older patients with at least three chronic conditions (N = 254) were recruited from community health centers in Changsha, China. All participants completed a self-administrated questionnaire assessing adherence information, personal motivation, social motivation, behavioral skills, medication adherence, depressive symptoms, medication treatment satisfaction, treatment burden, and disease burden. Structural equation modeling was used to examine the hypothesized models and relationships between variables. RESULTS The final extended IMB model could explain 52.0% of the variance in adherence. Personal motivation (β = 0.29, p < 0.001), behavioral skills (β = 0.36, p < 0.001), and medication treatment satisfaction (β = 0.23, p = 0.001) had a positive direct effect on adherence. Information, social motivation, personal motivation, medication treatment satisfaction, and treatment burden could also affect adherence indirectly through multiple pathways. CONCLUSION This study demonstrated that an extended IMB model could be used to conceptualize determinants of medication adherence among older patients with multimorbidity. PRACTICAL IMPLICATIONS Adherence improvement programs might be more effective if targeting psychosocial factors, including adherence information, motivation, behavioral skills, treatment burden, and medication treatment satisfaction.
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Affiliation(s)
- Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Diana Tze Fan Lee
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Effects of a nurse-led medication self-management intervention on medication adherence and health outcomes in older people with multimorbidity: A randomised controlled trial. Int J Nurs Stud 2022; 134:104314. [DOI: 10.1016/j.ijnurstu.2022.104314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022]
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Mortelmans L, Goossens E, Dilles T. Beliefs about medication after hospital discharge in geriatric patients with polypharmacy. Geriatr Nurs 2021; 43:280-287. [PMID: 34963073 DOI: 10.1016/j.gerinurse.2021.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To describe beliefs about medication in geriatric patients with polypharmacy post-discharge and to evaluate the impact of discharge management on patients' medication beliefs. METHODS A cross-sectional study was conducted between November 2019 and March 2020 in twelve general hospitals in Belgium. Four hundred geriatric patients with polypharmacy were surveyed at hospital discharge and two to five days post-discharge using the Beliefs about Medicines Questionnaire and self-developed questionnaires. RESULTS According to participants, the benefits of medication outweighed the disadvantages as the mean necessity score (19.4/25) outweighed the mean concern score (11.9/25). Patients receiving help with medication management post-discharge had stronger necessity-, concern- and overuse-related beliefs. No patient- or discharge management-related factors were significant predictors of medication beliefs. CONCLUSIONS Assessing patients' medication beliefs and identifying and addressing patients' concerns, can be an opportunity to improve medication use, to prevent non-adherence and to enhance safe medication practices at home.
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Affiliation(s)
- Laura Mortelmans
- Department of Nursing and Midwifery Science, Centre For Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.
| | - Eva Goossens
- Department of Nursing and Midwifery Science, Centre For Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium; Research Foundation Flanders (FWO), Egmontstraat 5, 1000 Brussels, Belgium; Department of Patient Care, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Tinne Dilles
- Department of Nursing and Midwifery Science, Centre For Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
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