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van Herpen-Meeuwissen LJM, van Onzenoort HAW, van den Bemt PMLA, Maat B, van den Bemt BJF. The Effect of Self-Administration of Medication During Hospitalization on Patient's Self-Efficacy and Medication Adherence After Discharge. Patient Prefer Adherence 2022; 16:2683-2693. [PMID: 36196066 PMCID: PMC9527028 DOI: 10.2147/ppa.s375295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The effect of self-administration of medication (SAM), in which capable hospitalized patients administer medication themselves on medication self-efficacy is inconclusive. The aim of this study was to evaluate the effect of SAM on medication self-efficacy, adherence and patient satisfaction. PATIENTS AND METHODS A prospective pre-post intervention study on the orthopedic ward of the Sint Maartenskliniek (Nijmegen) was conducted from January 2020 to July 2021. All adults admitted to this ward were eligible for participation. The primary outcome was the level of medication self-efficacy measured by the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) one week after discharge. Secondary outcomes were SEAMS-score three months after hospitalization, medication adherence measured by the Medication Adherence Rating Scale (MARS) one week and three months after hospitalization and patient satisfaction expressed on a five-point Likert scale in patients who experienced SAM. The differences in median SEAMS-scores and non-adherence pre- versus post-implementation of SAM were statistically analyzed. Patients' agreement regarding satisfaction with SAM was calculated as proportion per Likert scale answer. RESULTS Of the 197 patients participating in the study, 96 were included pre- and 101 post-implementation of SAM. Median SEAMS-scores one week after discharge were 35 [IQR 31-38] and 34 [IQR 30-36] pre- and post-intervention respectively (p = 0.08). There was no difference in the proportion of non-adherent patients at one week and three months after discharge pre- and post-intervention, 52.4%, 53.2%, 57.9% and 64.4% respectively. Of the patients that experienced SAM 32% agreed and 49% strongly agreed that they would like to self-manage medication again during a future hospitalization. CONCLUSION In this orthopedic population with high medication self-efficacy scores at discharge, SAM did not affect patients' medication self-efficacy nor medication adherence after hospitalization. Most patients preferred SAM. Additional studies should focus on the effect of SAM in other patient populations.
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Affiliation(s)
- Loes J M van Herpen-Meeuwissen
- Department of Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
- Correspondence: Loes JM van Herpen-Meeuwissen, Department of Pharmacy, Radboud University Medical Centre, PO Box 9101, Nijmegen, the Netherlands, Tel +31 624 3617744, Email
| | - Hein A W van Onzenoort
- Department of Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Barbara Maat
- Department of Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
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Mak V, Sandhu AK, Krishnan S. Using Simulation to Teach Methods for Improving Patient Literacy about Medicines. PHARMACY 2020; 8:E192. [PMID: 33081062 PMCID: PMC7720145 DOI: 10.3390/pharmacy8040192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023] Open
Abstract
Pharmacists have a role in educating patients on the self-management of their medications, using accurate medicines lists. Thus, pharmacy students need to be adequately trained and assessed in health-literacy skills to be competent for future patient-education consultations using medicines lists. Performance-based assessments using patient simulation are often utilized to examine students' competence in clinical knowledge and communication skills. Due to COVID-19, education systems changed to remote online delivery utilizing video conferencing platforms (i.e., ZoomTM), which proved challenging for performance-based assessments. These challenges include difficulty in observing non-verbal cues over ZoomTM and not having adequate internet access. Adaptations to reduce reliance on internet access were made where students submitted a video-recording task wherein they educated a simulated patient on a medicines list, under lockdown restrictions during the pandemic. A total of 304 submissions were received where students performed the role-play with a simulated patient, such as their family members, housemates or peers either at home in person or via ZoomTM. Although it was not an original goal of the task, the collaborative effort between pharmacy instructors, students and the public helped increase awareness of medicines lists through this task.
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Affiliation(s)
- Vivienne Mak
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia
| | - Anisha Kaur Sandhu
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor 47500, Malaysia; (A.K.S.); (S.K.)
| | - Sunanthiny Krishnan
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor 47500, Malaysia; (A.K.S.); (S.K.)
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Abstract
Warfarin is the most commonly prescribed anticoagulant for children in the outpatient setting in Australia. Pediatric patients likely have different challenges to warfarin adherence compared with their adult counterparts; however, little is known about warfarin adherence among this population. This study aimed to understand warfarin adherence among community-based pediatric patients by using an online survey design. The survey instrument incorporated parent or patient self-reported warfarin doses missed in the preceding month, a validated warfarin adherence assessment tool, the 13-item Self-Efficacy for Appropriate Medication use Scale (SEAMS-13), and an open-ended question asking about the challenges of warfarin adherence. The indication of warfarin administration and patient's time in therapeutic range were obtained from medical records. The study recruited outpatients managed by a tertiary pediatric hospital who had previously consented to participate in warfarin research. In total, 53 families were contacted with 43 responses (81% response rate) and 41 completed surveys. The median age of the children from participating families was 10.6 years (range, 4.1 to 18.9 y). The majority of these children (n=42) used warfarin prophylactically and only 1 child used it to treat deep venous thrombosis. The time in therapeutic range achievement of this cohort was 64.4% (95% confidence interval, 58.7-70.2). The mean SEAMS-13 score was 33.5 (95% confidence interval, 31.75-35.37) and the total missed doses was 2.5%. Participants also identified barriers and enablers of warfarin adherence. This study was the first of its kind and thus it provides baseline data for future research. The warfarin adherence of this cohort was likely optimized because of frequent clinical contact and access to self-testing. Future studies are required to examine the different approaches aiming to improve the anticoagulant adherence after the emergence of direct oral anticoagulants with a wider therapeutic index and minimal monitoring that could contribute to less clinical contact.
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Sletvold H, Sagmo LAB, Torheim EA. Impact of pictograms on medication adherence: A systematic literature review. PATIENT EDUCATION AND COUNSELING 2020; 103:1095-1103. [PMID: 31924384 DOI: 10.1016/j.pec.2019.12.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this systematic review was to investigate the potential effect of pictograms on patient adherence to medication therapies. METHOD PubMed, MEDLINE, Embase, CINAHL, and CENTRAL were searched for relevant articles. Experimental studies testing the use of pictograms in patient counselling regarding medication therapy, which quantitatively measured adherence, were included. RESULTS Seventeen studies were identified that fulfilled our inclusion criteria. These were heterogeneous with respect to study setting, population size, and the medication regimen tested. All the studies had methodological quality limitations. The pictogram interventions differed with respect to complexity, intervention length, and the measured adherence outcome. Ten studies (58.8 %) reported a statistically significant effect, of the pictogram intervention in question, on patient adherence to medication therapies. Of these, 80 % involved populations at elevated risk for non-adherence. CONCLUSION AND PRACTICE IMPLICATIONS Pictograms used in combination with written and/or oral information can have a positive impact on patient populations that are highly at risk for non-adherence when counselled on the proper use of medicines.
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Affiliation(s)
- Hege Sletvold
- Faculty of Nursing and Health Sciences, Nord University, Norway.
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Kripalani S. Structured prescription instructions and medication adherence. Am J Health Syst Pharm 2020; 77:157-158. [PMID: 31974559 DOI: 10.1093/ajhp/zxz303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sunil Kripalani
- Center for Clinical Quality and Implementation Research Department of Medicine Vanderbilt University Medical Center Nashville, TN
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Kripalani S, Hart K, Schaninger C, Bracken S, Lindsell C, Boyington DR. Use of a tablet computer application to engage patients in updating their medication list. Am J Health Syst Pharm 2019; 76:293-300. [PMID: 30753287 DOI: 10.1093/ajhp/zxy047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Failure to obtain an accurate medication history can adversely affect patient care in the emergency department (ED) and propagate errors into the inpatient and outpatient settings. Obtaining an accurate medication history in the ED is challenging, however, due to limited time, a suboptimal environment for patient interaction, and inadequate information in the electronic health record (EHR). This article describes the development and initial evaluation of the PictureRx Medication History Application, a tablet computer-based program that queries patients' prescription fill data from the Surescripts Medication History service and renders it graphically for review and editing at the point of care. Methods A quasi-experimental trial of PictureRx was performed in a large academic ED. Adult patients taking at least 1 prescription medication were prospectively eligible for the intervention. Usual care control patients were retrospectively matched 1:1. The main outcomes were updates to the patients' existing pre-visit medication list in the EHR and patient perceptions of the application. Results The medication list was updated for 101/244 (41.4%) of the intervention group and for 43/244 (17.6%) of the control group (difference 23.8%, 95% confidence interval, 16.0-31.6%). Similar differences were observed for medication additions, removals, and corrections in dose. Approximately 80% of intervention patients "strongly agreed" that the application was easy to use, aided medication list accuracy, and the graphical features assisted with recall. Conclusion A novel tablet computer-based medication history application was feasible to implement in a busy academic ED. Use of the tool was associated with more updates to patients' EHR medication list.
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Affiliation(s)
- Sunil Kripalani
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN
| | - Kimberly Hart
- Research Division, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Caitlin Schaninger
- Research Division, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Christopher Lindsell
- Research Division, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
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Monroe AK, Pena JS, Moore RD, Riekert KA, Eakin MN, Kripalani S, Chander G. Randomized controlled trial of a pictorial aid intervention for medication adherence among HIV-positive patients with comorbid diabetes or hypertension. AIDS Care 2017; 30:199-206. [PMID: 28793785 DOI: 10.1080/09540121.2017.1360993] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
As the HIV-infected population ages and the burden of chronic comorbidities increases, adherence to medications for HIV and diabetes and hypertension is crucial to improve outcomes. We pilot-tested a pictorial aid intervention to improve medication adherence for both HIV and common chronic conditions. Adult patients with HIV and diabetes (DM) and/or hypertension (HTN) attending a clinic for underserved patients and at risk for poor health outcomes were enrolled. Patients were randomized to receive either a pictorial aid intervention (a photographic representation of their medications, the indications, and the dosing schedule) or a standard clinic visit discharge medication list. Adherence to antiretroviral therapy (ART) for HIV and therapy for DM or HTN was compared. Predictors of ART adherence at baseline were determined using logistic regression. Medication adherence was assessed using medication possession ratio (MPR) for the 6-month interval before and after the intervention. Change in adherence by treatment group was compared by ANOVA. Among the 46 participants, there was a trend towards higher adherence to medications for HIV compared with medications for hypertension/diabetes (baseline median MPR for ART 0.92; baseline median MPR for the medication for the comorbid condition 0.79, p = 0.07). The intervention was feasible to implement and satisfaction with the intervention was high. With a small sample size, the intervention did not demonstrate significant improvement in adherence to medications for HIV or comorbid conditions. Patients with HIV are often medically complex and may have multiple barriers to medication adherence. Medication adherence is a multifaceted process and adherence promotion interventions require an approach that targets patient-specific barriers.
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Affiliation(s)
- A K Monroe
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - J S Pena
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - R D Moore
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - K A Riekert
- b Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - M N Eakin
- b Division of Pulmonary and Critical Care Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - S Kripalani
- c Division of General Internal Medicine and Public Health , Vanderbilt University Medical Center , Nashville , TN , USA
| | - G Chander
- a Division of General Internal Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Bailey SC, Navaratnam P, Black H, Russell AL, Wolf MS. Advancing Best Practices for Prescription Drug Labeling. Ann Pharmacother 2015; 49:1222-36. [DOI: 10.1177/1060028015602272] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Problematic prescription drug labeling has been cited as a root cause of patient misunderstanding, medication errors, and nonadherence. Although numerous studies have recently been conducted to identify and test labeling best practices, the last systematic review on this topic was conducted a decade ago. The objective of this review was, therefore, to examine, summarize, and update best practices for conveying written prescription medication information and instructions to patients. Data Sources: English-language articles published from June 2005 to June 2015 were identified in MEDLINE and CINAHL by searching the following text words: ‘ medication OR prescription OR drug’ AND ‘label OR leaflet OR brochure OR pamphlet OR medication guide OR medication insert OR drug insert OR medication information OR drug information OR instructions’ AND ‘ patient OR consumer.’ Reference mining and secondary searches were also performed. Study Selection and Data Extraction: A total of 31 articles providing evidence on how to improve written, prescription drug labeling for patient use were selected. Two reviewers independently screened articles, rated their quality, and abstracted data. Data Synthesis: Identified best practices included the use of plain language, improved formatting and organization, and more explicit instructions to improve patient comprehension. The use of icons had conflicting findings, and few studies tested whether practices improved knowledge or behaviors with patients’ actual prescribed regimens. Conclusions: Future studies are needed to determine how specific modifications and improvements in drug labeling can enhance patient knowledge and behavior in actual use. Synthesizing best practices across all patient materials will create a more useful, coordinated system of prescription information.
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Affiliation(s)
- Stacy Cooper Bailey
- Eshelman School of Pharmacy at The University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Allison L. Russell
- Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Michael S. Wolf
- Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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Mueller SK, Giannelli K, Boxer R, Schnipper JL. Readability of patient discharge instructions with and without the use of electronically available disease-specific templates. J Am Med Inform Assoc 2015; 22:857-63. [PMID: 25882030 DOI: 10.1093/jamia/ocv005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/10/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Low health literacy is common, leading to patient vulnerability during hospital discharge, when patients rely on written health instructions. We aimed to examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge. MATERIALS AND METHODS We performed a retrospective cohort study of 233 patients discharged from a large tertiary care hospital to their homes following the implementation of a web-based "discharge module," which included the optional use of diagnosis-specific templated discharge instructions. We compared the readability of discharge instructions, as measured by the Flesch Reading Ease Level test (FREL, on a 0-100 scale, with higher scores indicating greater readability) and the Flesch-Kincaid Grade Level test (FKGL, measured in grade levels), between discharges that used templated instructions (with or without modification) versus discharges that used clinician-generated instructions (with or without available templated instructions for the specific discharge diagnosis). RESULTS Templated discharge instructions were provided to patients in 45% of discharges. Of the 55% of patients that received clinician-generated discharge instructions, the majority (78.1%) had no available templated instruction for the specific discharge diagnosis. Templated discharge instructions had higher FREL scores (71 vs. 57, P < .001) and lower FKGL scores (5.6 vs. 7.6, P < .001), compared to clinician-generated discharge instructions. DISCUSSION The use of electronically available templated discharge instructions was associated with better readability (a higher FREL score and a lower FKGL score) than the use of clinician-generated discharge instructions. The main reason for clinicians to create discharge instructions was the lack of available templates for the patient's specific discharge diagnosis. CONCLUSIONS Use of electronically available templated discharge instructions may be a viable option to improve the readability of written material provided to patients at discharge, although the library of available templates requires expansion.
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Affiliation(s)
- Stephanie K Mueller
- BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kyla Giannelli
- BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert Boxer
- BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey L Schnipper
- BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA BWH Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Patient-appropriate health literacy educational materials in ophthalmology. Can J Ophthalmol 2015; 50:19-25. [DOI: 10.1016/j.jcjo.2014.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 07/30/2014] [Accepted: 08/13/2014] [Indexed: 11/21/2022]
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Hu J, Wang Z. In-home antibiotic storage among Australian Chinese migrants. Int J Infect Dis 2014; 26:103-6. [PMID: 25046273 DOI: 10.1016/j.ijid.2014.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of in-home antibiotic storage among Australian Chinese migrants and to identify the risk factors associated with storing antibiotics at home. METHODS Four hundred and sixty-nine Chinese migrants in Australia who were recruited through Chinese social websites completed an online questionnaire about antibiotic use. Logistic regression analysis was conducted to assess the associations between possible risk factors and storing antibiotics at home. RESULTS According to the web-based survey, 220 (47%) out of 469 participants reported having antibiotics stored at home. Previous use of antibiotics, bringing antibiotics in from outside Australia, and a pro-attitude to the use of leftover antibiotics were significantly associated with storing antibiotics at home after adjusting for age, gender, and household annual income. Participants who self-reported an awareness of antibiotic side effects or resistance had a slightly higher but not significant risk of storing antibiotics at home. CONCLUSIONS Approximately half of the participants in this study had antibiotics stored at home. The risk of using the antibiotics stored at home without medical consultation is of concern. Education programs need to target those with high-risk behaviours to curtail the inappropriate practice of antibiotic use and storage among Australian Chinese migrants.
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Affiliation(s)
- Jie Hu
- Centre for Chronic Disease, School of Medicine, University of Queensland, Herston, Queensland, 4029, Australia.
| | - Zhiqiang Wang
- Centre for Chronic Disease, School of Medicine, University of Queensland, Herston, Queensland, 4029, Australia
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Lin F, Vance DE, Gleason CE, Heidrich SM. Caring for older adults with mild cognitive impairment: an update for nurses. J Gerontol Nurs 2013. [PMID: 23189995 DOI: 10.3928/00989134-20121106-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mild cognitive impairment (MCI) is a mild decline in single or multiple cognitive domains, while global cognition and basic activities of daily living remain intact. Nurses play an important role in early detection of MCI and providing care to maintain maximum independence for individuals with MCI. This article seeks to provide nurses with a review of the most recent research regarding the etiology and diagnosis of MCI, related risk and protective factors, patient and family experiences, and current interventions. This update provides research evidence to inform nursing practice of MCI care.
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Affiliation(s)
- Feng Lin
- School of Nursing, University of Rochester Medical Center, HWH 2W128, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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