Daily Medication Management Research Articles

Patient and Provider Decision Making About HIV Postexposure Prophylaxis Following Sexual Violence: A Qualitative Analysis.

To explore patient and health care provider HIV postexposure prophylaxis (PEP) decision making following sexual assault, semistructured interviews regarding HIV PEP provision with 15 patients and 10 health care providers were conducted. A qualitative, descriptive, thematic analysis approach was used. Four themes were derived: (a) medical concerns; (b) emotional, trauma, and support factors; (c) daily medication management; and (d) ensuring access to HIV PEP. How participants described these themes and the importance placed on factors within each theme varied between the two groups. Altering provider communication so that HIV PEP discussions better align with patient decision-making factors (e.g., trauma and ability to take in information, how to manage side effects) could facilitate improvement in HIV PEP decision making following sexual assault for patients. High-level policy changes would improve HIV PEP access for sexual assault patients without necessitating the extraordinary efforts individual providers currently undertake.

Exploring the Value of Real-Time Medication Adherence Monitoring: A Qualitative Study

Smart adherence products enable the monitoring of medication intake in real-time. However, the value of real-time medication intake monitoring to different stakeholders such as patients, their caregivers, clinicians, and insurers is not elucidated. The aim of this study was to explore the value different stakeholders place on the availability of smart adherence products and access to real-time medication intake data. A qualitative study design using semi-structured one-on-one virtual interviews was utilized. Schwartz's theory of values provided the foundation for the interview questions, data were analyzed using Braun and Clark's thematic analysis framework, and findings were mapped back to the constructs of Schwartz's theory of values. A total of 31 interviews with patients, caregivers, healthcare providers, and representatives of private or public insurance providers were conducted. Three themes and ten subthemes were identified. Themes included perceptions of integrating smart medication adherence technologies and real-time monitoring, technology adoption factors and data management. Stakeholders place different values based on the motivators and goals that can drive product use for daily medication management. Stakeholders valued the availability of real-time medication taking data that allow clinicians to make timely data-driven recommendations to their patients that may improve medication management for patients and reduce the caregiver burden.

Associations between short-term exposure of ambient particulate matter and hemodialysis patients death: A nationwide, longitudinal case-control study in China

BackgroundLong-term exposure to particulate air pollutants can lead to an increase in mortality of hemodialysis patients, but evidence of mortality risk with short-term exposure to ambient particulate matter is lacking. This study aimed to estimate the association of short-term exposure to ambient particulate matter across a wide range of concentrations with hemodialysis patients mortality. MethodsWe performed a time-stratified case-crossover study to estimate the association between short-term exposures to PM2.5 and PM10 and mortality of hemodialysis patients. The study included 18,114 hemodialysis death case from 279 hospitals in 41 cities since 2013. Daily particulate matter exposures were calculated by the inverse distance–weighted model based on each case's dialysis center address. Conditional logistic regression were implemented to quantify exposure-response associations. The sensitivity analysis mainly explored the lag effect of particulate matter. ResultsDuring the study period, there were 18,114 case days and 61,726 control days. Of all case and control days, average PM2.5 and PM10 levels were 43.98 μg/m3 and 70.86 μg/m3, respectively. Each short-term increase of 10 μg/m3 in PM2.5 and PM10 were statistically significantly associated with a relative increase of 1.07 % (95 % confidence interval [CI]: 0.99 % - 1.15 %) and 0.89 % (95 % CI: 0.84 % - 0.94 %) in daily mortality rate of hemodialysis patients, respectively. There was no evidence of a threshold in the exposure-response relationship. The mean of daily exposure on the same day of death and one-day prior (Lag 01 Day) was the most plausible exposure time window. ConclusionsThis study confirms that short-term exposure to particulate matter leads to increased mortality in hemodialysis patients. Policy makers and public health practices have a clear and urgent opportunity to pass air quality control policies that care for hemodialysis populations and incorporate air quality into the daily medical management of hemodialysis patients.

"RESUME-HFC"-EXPLORING AN ALTERNATIVE MODEL OF HEART FAILURE CARE FOR PATIENTS WITH SUBSTANCE USE DISORDER AND/OR MENTAL HEALTH NEEDS

<h3>BACKGROUND/PURPOSE</h3> "RESUME-HFC" – Exploring an alternative model of heart failure care for patients with substance use disorder and/or mental health needs. Heart failure (HF) care often requires multidisciplinary care, including intensive patient education, testing and follow-up. Literature shows that patients with substance use disorder (SUD) and/or mental health needs have difficulty adhering to the requirements of a regimented care model and recommends an individualized, flexible follow-up schedule. Our experience has shown that these patients often attended HFC haphazardly, if at all. We proposed an alternative model of heart failure care whereby these patients were seen by a HF specialist Nurse Practitioner (NP) who assessed the patient's ability to manage medications, appointments and learning needs on an individual basis, and tailored a care plan around these potential barriers. For patients that had had previous referrals but did not attend appointments, the NP would go to the emergency department or inpatient unit to meet patient and discuss the referral to our clinic, in hopes of approving attendance. Key elements in the care plan included utilizing community support workers to bring patients to appointments, connecting with community pharmacy for daily medication management, connecting with primary care provider/clinic to discuss plan and requesting outreach if indicated. We conducted a pilot study to explore the feasibility of providing this alternative model of outpatient care for patients with HF and SUD and/or mental health needs who are unlikely or unable to attend the HFC. We also sought to determine if outcomes are impacted by this alternative model. <h3>METHODS/RESULTS</h3> Using a pre-test/post-test design with patients as their historical controls we collected data on ED visits, hospitalizations, quality of life, ejection fraction and mortality for 1 year pre- and 1 year post-index visit. 23 of 26 patients completed the study (lost to follow-up = 1; death = 1 (unknown cause); moved = 1). There was a statistically significant reduction in total hospitalizations (2.8 vs 1.4, p = 0.017), length of stay (11.5 vs 0, p = 0.009), increase in quality of life (4.27 vs 6.73, p = 0.04 and a clinically significant increase in ejection fraction (33% vs 45%, p NS). <h3>CONCLUSION/IMPLICATIONS FOR PRACTICE</h3> This NP-led model of care that provided individually tailored, flexible management of HF in those with SUD and/or mental health needs can be feasible, if appropriately resourced. This model of care shows promise for HF management in this complex patient population.

Acceptance of Pharmaceutical Services by Home-Dwelling Older Patients: A Case Study in a Portuguese Community Pharmacy

Background: Aging-related comorbidities predispose older adults to polypharmacy and consequently an increased risk of adverse drug reactions and poor compliance. Pharmacists’ interventions can have a beneficial impact on the improvement of clinical outcomes. Thus, this work aimed to assess the acceptance of Portuguese home-dwelling older adults regarding a pharmaceutical service paid by patients for medication management and pharmacotherapy follow-up. We also intended to analyze medication, characterize the medication consumption profile, and identify the main difficulties of our sample during their daily medication management. Methods: A questionnaire on adherence and medication therapy management was applied to polymedicated patients ≥65 years old, in a community pharmacy. Results: Of the 88 participants, 92.2% would be willing to pay for a pharmacotherapy management service, and 75.6% answered that they would be willing to pay for an individual medication preparation service. In addition, 45.7% of the participants were categorized as lower adherents to a medication therapeutic regimen. Our sample reported that during their daily lives, they felt difficulty: to remember to take their pills (17%), to manage so many medicines (15.9%), and to swallow the pills (9.1%). Conclusions: Polymedicated older adults are willing to pay for a service to improve the management of their medicines, suggesting that they recognize the role of pharmacists in medication management. This study provides useful information for the conceptualization of a pharmacotherapy management service that includes medication review and a pharmacotherapy follow-up.

Medication Management Among Older Adults With Multiple Chronic Conditions: What Role Do Caregivers Play?

Many older adults manage multiple chronic conditions (MCC) that require adherence to complex medication regimens. Few studies have investigated the degree to which caregivers support medication-related behaviors. We conducted semi-structured qualitative interviews with 25 caregivers of older adults with MCC to characterize caregiver medication assistance. Two coders used content and constant comparative analysis to analyze transcripts. The mean age of caregivers was 61 years; the majority were female (68%) and identified as non-white (Black, 52%; Hispanic, 8%). Caregivers were predominantly spouses (n=10), or children (n=11). Older adults were on average 73 years old, managing 5 chronic conditions and prescribed 7 medications. Caregivers acknowledged the importance of medications to the older adult’s health, but their involvement in daily medication management was limited. Some caregivers preferred that the older adult continue these tasks to maintain autonomy, especially when caring for older adults who valued maintaining independence. Caregivers assumed medication responsibilities after older adults experienced sudden changes in health or upon observing non-adherence (e.g. full pill bottles). Older adults with higher medication burden (12+ medicines) adopted inefficient, cumbersome medication management practices; caregivers suggested simplified strategies, but the older adults refused to adopt recommended strategies. To combat resistance from the older adult, caregivers disguised assistance and deployed workaround strategies to monitor medication-taking behaviors. These findings suggest older adults and caregivers share a value of promoting independence of medication management, up until safety is seriously questioned. Additionally, there is a breakdown in communication at the time when older adults may benefit from increased caregiver involvement.

Daily Medication Management and Adherence in the Polymedicated Elderly: A Cross-Sectional Study in Portugal.

The presence of age-related comorbidities prone elderly patients to the phenomenon of polypharmacy and consequently to a higher risk of nonadherence. Thus, this paper aims to characterize the medication consumption profile and explore the relationship of beliefs and daily medication management on medication adherence by home-dwelling polymedicated elderly people. A questionnaire on adherence, managing, and beliefs of medicines was applied to polymedicated patients with ≥65 years old, in primary care centers of the central region of Portugal. Of the 1089 participants, 47.7% were considered nonadherent. Forgetfulness (38.8%), difficulties in managing medication (14.3%), concerns with side effects (10.7%), and the price of medication (9.2%) were pointed as relevant medication nonadherence-related factors. It was observed that patients who had difficulties managing medicines, common forgetfulness, concerns with side effects, doubting the need for the medication, considered prices expensive, and had a lack of trust for some medicines had a higher risk of being nonadherent. This study provides relevant information concerning the daily routine and management of medicines that can be useful to the development of educational strategies to promote health literacy and improve medication adherence in polymedicated home-dwelling elderly.

Ecological validity of performance-based measures of executive functions: Is face validity necessary for prediction of daily functioning?

Predicting patients' ability to engage in instrumental activities of daily living (IADLs) is an important part of neuropsychological evaluation of older adults. Executive functioning (EF) is the neurocognitive domain most strongly associated with performance of IADLs. However, performance-based tests of EF have long been criticized for having poor ecological validity, largely because of their imperfect association with functional outcomes and their low face validity. However, past research has not examined whether high face validity improves a test's ability to predict IADLs. The present study examined this question. Fifty community-dwelling older adults completed 2 measures of EF that have been previously shown to be related to performance on IADL tasks: the Pillbox Test (a test with high face validity) and the Push-Turn-Taptap task (PTT; a test with low face validity). As an outcome variable, weekly pill counts were conducted across 8 weeks as an index of real-world daily medication management. Hierarchical linear regression analyses and receiver operating characteristic (ROC) curve analyses using medication management as the dependent variable revealed that the PTT outperformed the Pillbox Test both in accounting for variance in medication management and in classifying participants according to their medication management accuracy. The present study does not support the notion that face validity, in and of itself, improves the ability of performance-based EF tests to predict functional outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Executive Function - 3 Self-Reported Complexity of Daily Life Moderates the Association Between Executive Functioning and Daily Medication Management in Community Dwelling Older Adults

Executive Function - 3 Self-Reported Complexity of Daily Life Moderates the Association Between Executive Functioning and Daily Medication Management in Community Dwelling Older Adults

Interruptions In Private Health Insurance And Outcomes In Adults With Type 1 Diabetes: A Longitudinal Study.

Type 1 diabetes mellitus, which often originates during childhood, is a lifelong disease that requires intensive daily medical management. Because health care services are critical to patients with this disease, we investigated the frequency of interruptions in private health insurance, and the outcomes associated with them, for working-age adults with type 1 diabetes in the United States in the period 2001-15. We designed a longitudinal study with a nested self-controlled case series, using the Clinformatics Data Mart Database. The study sample consisted of 168,612 adults ages19-64 with type 1 diabetes who had 2.6 mean years of insurance coverage overall. Of these adults, 24.3percent experienced an interruption in coverage. For each interruption, there was a 3.6percent relative increase in glycated hemoglobin. The use of acute care services was fivefold greater after an interruption in health insurance compared to before the interruption and remained elevated when stratified by age, sex, or diabetic complications. An interruption was associated with lower perceived health status and lower satisfaction with life. We conclude that interruptions in private health insurance are common among adults with type 1 diabetes and have serious consequences for their well-being.

Humanistic outcomes and patient acceptance of the pharmacist-led medication review "Polymedication Check" in primary care in Switzerland: a prospective randomized controlled trial.

BackgroundSince 2010, Swiss pharmacists have been offering their patients a Polymedication Check (PMC), a new cognitive pharmacy service in the form of a medication review for patients taking ≥4 prescribed medicines for a period >3 months. While a first publication of this project reported on the impact of the PMC on patients’ adherence, the present paper focuses on humanistic outcomes.MethodsThis randomized controlled trial was conducted in 54 Swiss community pharmacies. After recruitment, the intervention group underwent a PMC in the pharmacy (T-0) and 28 weeks after T-0 (T-28), while the control group did not receive the PMC until 28 weeks after the study started (T-28). A clinical psychologist, blinded to the intervention, interviewed the patients 2 weeks (T-2) and 16 weeks (T-16) after T-0. Interviewer and patient both rated patient’s knowledge of own medicines use. Furthermore, patients reported satisfaction with their pharmacy and appraisal of their medicines use. The availability of a written medication plan was assessed at T-16. Acceptance of the service was measured using a patient’s self-report questionnaire at T-28.ResultsGeneral linear model analysis for knowledge about medicines revealed a significant effect on the factor “group” (P=5.86, p=0.016), indicating that the intervention group had higher ratings for knowledge about their medication at T-2 and T-16 compared to controls. The majority (83%) of patients judged the counseling by the pharmacist as being helpful for their daily medication management. Availability of a written medication plan was comparable in both groups (52.5% vs 52.7%, p>0.05).ConclusionFor the first time, the benefits of a complex pharmacist-led intervention were evaluated in Swiss primary care with a randomized controlled trial. The PMC increased patients’ subjective knowledge of their medicines compared to no medication review. The effect remained sustainable over time. Recommendations resulting from the pharmacist-led service were highly appreciated by the patients.

Development and Testing of a Measure of Caregiver Confidence in Medical Sign/Symptom Management.

Evaluation of efforts to support family caregivers of people with dementia in their daily medical management responsibilities requires a measure of caregiver self-efficacy (confidence). This article describes the development and psychometric properties of the Caregiver Confidence in Sign/Symptom Management (CCSM) scale, the only available instrument in this area. Measurement development included literature and expert panel review, cognitive testing, and field testing. The CCSM is a 25-item measure (α = .92) composed of confidence in relation to 4 subscales: knowledge of signs/symptoms (α = .83), management of cognitive signs/symptoms (α = .85), management of medical signs/symptoms (α = .87), and general medication management/responsiveness (α = .85), all of which relate to caregiver role strain. The CCSM is a reliable and valid instrument to assess caregiver confidence in sign/symptom management and is useful to determine caregiver needs and outcomes of related interventions. Additionally, it furthers understanding of the role of self-efficacy in caregiver quality of life.

Decision-making around antithrombotics for stroke prevention in atrial fibrillation: the health professionals' views.

Background For stroke prevention in patients with atrial fibrillation (AF), the decision-making around antithrombotic therapy has been complicated by older age, multiple comorbidities, polypharmacy and the different pharmacological properties of warfarin and the nonvitamin K antagonist oral anticoagulants (NOACs). The complexity of decision-making has been associated with a reluctance by health professionals to use antithrombotic therapy, leading to poor clinical outcomes. In order to improve stroke prevention in patients with AF, the contemporary perspectives of health professionals on the decision-making around antithrombotic therapy needs exploration. Objective To elicit emerging themes describing health professionals' perspectives on the decision-making around antithrombotic therapy for stroke prevention in patients with AF. Setting Sydney metropolitan area of New South Wales, Australia. Method A qualitative study based on face-to-face interviews was conducted from August to October 2014. Seven pharmacists, seven specialists, six general practitioners and six nurses practising in the Sydney metropolitan area and managing antithrombotic therapy for AF were interviewed until theme saturation was achieved in each subgroup. Interview transcripts were analysed using manual inductive coding. Main outcome measure Emerging themes describing health professionals' perspectives on the decision-making around antithrombotic therapy for stroke prevention in patients with AF. Results Three overarching themes emerged. (1) Comprehensive assessment is necessary for decision-making but is not always implemented. Health professionals mostly focused on stroke risk assessment, not on the bleeding risk and medication safety issues. (2) Health professionals from different disciplines have different preferences for antithrombotic therapies. Although the majority of health professionals considered warfarin as the first-line therapy, NOACs were preferred by neurologists and haematologists. (3) Health professionals focused on different aspects of the decision making process: GPs and specialists were concerned about the appropriate prescription of antithrombotics, while pharmacists and nurses focused on daily medication management by patients. Conclusion The decision-making process appears to be partially preference based rather than systematic, and health professionals from various disciplines focus on different parts of the decision-making process.

Social Support and Self-Esteem Effects on Psychological Adjustment in Children and Adolescents with Insulin-Dependent Diabetes Mellitus

Insulin-dependent juvenile diabetes mellitus (Type I diabetes) is a chronic disorder resulting from the inadequate production or utilization of insulin. The ongoing chronic strains of juvenile diabetes, such as the complex daily medical management requirements, acute exacerbations of the disease, and physical complications interact synergistically to produce a negative impact on psychological adjustment. In the present study, family and peer social support and self-esteem were investigates as mediating variables in the chronic strain-psychological adjustment relationship. Hierarchical multiple regression analyses were utilized to test the model. For children, the model accounted for 46 percent of the variance in internalizing behavior problems and 35 percent of the variance in externalizing behavior problems. For adolescents, the model accounted for 54 percent of the variance in internalizing behavior problems and 25 percent of the variance in externalizing behavior problems. The results are discussed in terms of their implications for primary and secondary prevention efforts for chronically ill children and adolescents who are at increased risk for psychological adjustment problems.