Self-Efficacy, Social Activity, and Spirituality in the Care of Elderly Patients with Polypharmacy in Germany-A Multicentric Cross-Sectional Study within the HoPES3 Trial.

Noemi Sturm,Jan Valentini,Cornelia Straßner,Eckhard Frick,Regina Stolz,Ruth Mächler,Friederike Schalhorn,Joachim Szecsenyi,Johannes Krisam

doi:10.3390/healthcare9101312

Abstract

About one third of Europe’s elderly population takes ≥5 drugs. Polypharmacy increases their risk of adverse drug reactions. To ensure drug safety, innovative approaches are needed. The aim of this cross-sectional study was to explore the relationship between psychosocial factors and medication-related beliefs and behaviors. Medication lists of 297 patients were recorded according to the ATC classification. Correlations between the dependent variables, Medication Adherence (MARS) and Beliefs about Medicines (BMQ), and independent variables, General Self-Efficacy (GSE), self-efficacy for managing chronic diseases (SES6G), spiritual needs (SpNQ), patient activity (PAM), loneliness (DJG), and social networks (LSNS), were measured. Patients with higher self-efficacy (OR: 1.113; 95% CI [1.056–1.174]; p < 0.001) or self-confidence in managing their chronic condition (OR: 1.188; 95% CI [1.048–1.346]; p < 0.007) also showed higher adherence. Lonely patients (OR: 0.420; 95% CI [0.267–0.660]; p < 0.001) and those with a need for inner peace (OR: 0.613; 95% CI [0.444–0.846], p = 0.003) were more likely nonadherent. Stronger positive beliefs about medications’ usefulness weakly correlated with higher scores on the SES6G (ρ = 0.178, p = 0.003) and GSES scale (ρ = 0.121, p = 0.042), patient activity (ρ = 0.155, p = 0.010) and functioning social networks scale (ρ = 0.159, p = 0.008). A weak positive correlation was found between loneliness and the belief that drugs were harmful (ρ = 0.194, p = 0.001). Furthermore, interesting correlations were detected regarding the number of medications and overuse beliefs. Psychosocial factors, such as self-efficacy, loneliness, and spiritual needs and medication-related beliefs and behaviors seem to interrelate. Addressing these factors may improve medication management and drug safety.

Highlights

Study Design, Setting and Participants. This observational cross-sectional study was carried out on a sample of elderly patients participating in the HoPES3 study—Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity and Self-Care into Disease Management in Primary Care [35]—a cluster-randomized trial conducted in Southwestern Germany
More than two-thirds of the patients were enrolled in the Disease Management Program (DMP) for type II diabetes
The aim of this study was to explore the relationships between psychosocial factors, namely self-efficacy, loneliness, and spirituality, and medication-related beliefs and behaviors, as well as the number of medications taken according to patients’ medication lists

Summary

Introduction

Medication is used to prevent or treat a disease and the prescription of a drug is often the first therapeutic approach [1]. The prescription of multiple medications in patients suffering from more than one chronic condition has become a global healthcare issue [2,3]. Polypharmacy, often described as the regular intake of ≥5 drugs [1], has been linked to multiple negative healthcare outcomes constituting a major challenge for healthcare systems in relation to costs as well as care [4,5]. With increasing life expectancy and a shift in the population pyramid worldwide, the prevalence of chronic diseases rises, and so does the consumption of medications [1,6].

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