"There Is Method to This Madness" A Qualitative Investigation of Home Medication Management by Older Adults

Home self-management of type 2 diabetes with diabetes technologies in northern France: a focused ethnographic study protocol

INTRODUCTION

Type 2 diabetes is a chronic condition associated with impaired glucose tolerance and a high prevalence of comorbidity, polypharmacy and medication safety incidents. Little is known about the patient work associated with using diabetes management technologies by patients and their informal caregivers at home. This study aims to apply a systems engineering approach to better understand this work.

METHODS AND ANALYSIS

This is a qualitative focused ethnographic study using interview and photography. Adults, living independently at home, with type 2 diabetes who have been using insulin as part of their treatment regimen for a minimum of 6 months and who are using at least one diabetes management technology without support of a professional at home are eligible for inclusion. Participants will be recruited through advertisements on social media, in diabetes clinics and by contacting associations of persons living with diabetes and diabetes specialists. Participant consent will be taken, interviews will be undertaken in the participant's home, audio-recorded and photographs securely saved. The Systems Engineering Initiative for Patient Safety (SEIPS) model will frame the data coding and we will develop new codes to accommodate data outside the SEIPS model. Results will be interpreted to produce a description of work processes, work system elements and interactions that support or jeopardise the achievement of safety. This protocol will follow the consolidated criteria for reporting qualitative research checklist for the reporting of qualitative research interviews.

ETHICAL CONSIDERATIONS AND DISSEMINATION

This protocol was approved by the University of Lille's Behavioural Sciences Ethics Committee. The study will comply with data protection legislation: the protocol has been declared by the Data Protection Officer of the University of Lille to the National Commission on Informatics and Liberty. We plan to disseminate our findings via presentations at relevant patient/public, professional, academic and scientific meetings, and publish in a peer-reviewed journal.

Identification of Barriers for Active Disease Management and of Medication-Related Problems through Therapeutic Patient Education in Older Home-Care Patients

Combining therapeutic patient education (TPE) with a medication review service could foster the adoption of appropriate lifestyles by patients and support care-providers in identifying strategies to improve the quality of prescribed care. This study aimed to identify barriers experienced by patients in managing their diseases and medication-related problems. This was a monocentric, case series, observational study involving home-care patients from the Local Health Authority ASL TO4. Patients were enrolled for a TPE intervention where drug therapies and patient habits were collected through narrative interviews. Medication review was performed to identify potentially inappropriate prescriptions (PIPs). Twenty patients (13 females) with a mean age of 74.7 years were enrolled. Patients had an average of 4.3 diseases and 80.0% of them were treated with ≥5 daily medications. The main PIPs involved ibuprofen, furosemide and pantoprazole. The qualitative analysis of the interviews identified seven macro-themes relating to different aspects of medication management: therapy; diseases; patient; patient journey; professionals; family and caregivers; drug information. The results of this study revealed some critical aspects related to the treatment path and healthcare professionals. These results will be used to plan educational interventions for polypharmacy patients to improve medication adherence and the understanding and management of diseases.