Effective Medication Management Research Articles

Effective Medication Management

The effectiveness of a drug treatment is based on its efficacy, tolerability, safety, and acceptability. Effective medication management implies that the process of selecting and managing prescribed drugs results in an optimal patient outcome. Effectively prescribing medications includes gaining a mastery of drug knowledge, learning the nuts and bolts of treatment using medication, and appreciating the fundamental importance of psychotherapeutic and psychoeducational processes in medication management. Nurses have an essential role in providing effective medication management, given their direct level of patient contact and their collaborative relationship with physicians.

Medication Management and Neuropsychological Performance in Parkinson's Disease

Medication non-adherence is associated with chronic disease and complex medication schedules, and Parkinson's disease (PD) patients also frequently have cognitive impairments that may interfere with effective medication management. The current study quantitatively assessed the medication management skills of PD patients and probed the neurocognitive underpinnings and clinical correlates of this skill. A total of 26 men with PD completed a neuropsychological battery and a modified version of the Hopkins Medication Schedule (HMS), a standard test of a person's ability to understand and implement a routine prescription medication. Estimated adherence rates from performance on the HMS were low. Memory, executive functioning, and processing speed were strongly related to different components of the HMS. A range of neuropsychological abilities is associated with the ability to understand and implement a medication schedule and pillbox in individuals with PD.

Nurse students' medication competence — An integrative review of the associated factors

The aim of this review was to identify factors associated with nurse students' medication competence. Registered nurses play an important role in safe and effective medication management. Previous nursing literature has highlighted deficiencies in nurse students' medication competence, yet little is known about specific factors which are associated with their medication competence. Integrative literature review. Nineteen articles met the selection criteria for this review. The main competence area the reviewed articles focused on was medication calculation skills of nurse students. However, a total of twelve factors were identified to be associated with nurse students' medication competence. They constitute three main categories: factors associated with individual nurse students' particular circumstances, the clinical learning environment, and the educational institution. Individual factors such as students' attitudes towards mathematics and their self-confidence seem to be associated most strongly with medication competence. First, based on this review, the focus in medication competence research has been strongly on nurse students' medication calculation skills. Therefore, in future research and practice, attention needs to be paid to other competency areas as well, such as medication administration and patient medication education skills. Second, overall, only a limited amount of research exists that explores what factors are associated with medication competence.

Institutional Profile: University of California San Diego PharmaCogenomics Education Program (PharmGenEd™): Bridging the gap Between Science and Practice

Clinical application of evidence-based pharmacogenomics information has the potential to help healthcare professionals provide safe and effective medication management to patients. However, there is a gap between the advances of pharmacogenomics discovery and the health professionals' knowledge regarding pharmacogenomics testing and therapeutic uses. Furthermore, pharmacogenomics education materials for healthcare professionals have not been readily available or accessible. Pharmacogenomics Education Program (PharmGenEd™) is an evidence-based pharmacogenomics education program developed at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences and the School of Medicine (CA, USA), with funding support from the Centers for Disease Control and Prevention. Program components include continuing education modules, train-the-trainer materials and shared curriculum modules based on therapeutic topics, and virtual communities with online resources.

Impact of a Medication Management System on Nursing Home Admission Rate in a Community-Dwelling Nursing Home–Eligible Medicaid Population

Background Community-dwelling frail elderly have an increased need for effective medication management to reside in their homes and delay or avoid admission to nursing homes. Objective The objective of this study was to examine the impact of a medication management system on nursing home admission within the community-dwelling frail elderly. Methods This prospective cohort study compared nursing home admission rates in intervention and control clients of a state Medicaid home and community-based waiver program. Groups were matched on age (±5 years), race, gender, and waiver program start date (±120 days). The medication management service consisted of 2 parts: 1) prescription medicines dispensed from the client's local pharmacy in a calendar card, and 2) a coordinating service by a health educator to address medication-related problems as they arose. The primary dependent variable was admission to a nursing home. Results A total of 273 clients agreed to participate, enrolled, and had at least 1 prescription dispensed. The matched control group was composed of 800 other clients. The client sample was 72 years of age, 73% (785/1073) non-white, 75% (804/1073) female, and enrolled in the waiver program approximately 50 months. The 2 groups were similar on all demographic variables examined. Six clients (2.2%) in the intervention group and 40 clients (5.0%) in the control group were admitted to a nursing home at least once during the study period. Logistic regression was used to test the model predicting at least 1 nursing home admission. Control group clients were 2.94 times more likely to be admitted to a nursing home than clients in the intervention group. Conclusions The medication management service implemented within this study was effective in reducing nursing home admissions in a group of frail community-dwelling elderly.

Misuse of over-the-counter medications among community-dwelling older adults and associated adverse drug events

Objectives The objective of this study was to examine the rates of occurrence of misuse of over-the-counter (OTC) medications in community-dwelling older adults. In addition we examined whether those who misused OTC medications had higher numbers of adverse drug events (ADEs). Methods The study was a cross-sectional study conducted in retirement homes and senior community centres in Houston, Texas, USA. Participants were community-dwelling older adults who (1) resided in retirement homes or visited senior community centres, (2) were responsible for managing their own medication regimens and (3) consumed OTC medications. Information regarding the use of OTC medications, conditions for which the OTC medication was used, ADEs and demographics was obtained using a combination of a self-administered questionnaire and a series of open-ended questions. Key findings Data were analysed using descriptive statistics, and chi-square and t tests. The response rate for the study was 66.5%. Approximately 18% of respondents misused OTC medications, and 23% experienced at least one ADE following consumption of OTC medications. Occurrence of ADEs was higher in patients who misused OTCs compared to those who did not. Conclusions Analyses indicated that older adults participating in this study misused OTC medications. As expected, those who misused OTC medications had higher numbers of ADEs. Results from this study highlight the need to monitor the appropriateness of use of OTC medications in community-dwelling older adults. This will enable more effective medication management in the older adult population.

Perioperative medication management: General principles and practical applications

An extensive medication history, including the use of nonprescription agents and herbal products, is the foundation of effective perioperative medication management. Decisions about stopping or continuing medications perioperatively should be based on withdrawal potential, the potential for disease progression if therapy is interrupted, the potential for drug interactions with anesthesia, and the patient's short-term quality of life. In general, medications with withdrawal potential should be continued perioperatively, nonessential medications that increase surgical risk should be discontinued before surgery, and clinical judgment should be exercised in other cases.

Family Caregiver Skills in Medication Management for Hospice Patients: A Qualitative Study to Define a Construct

To propose a theoretical construct of family caregiver skills in effective medication management for home hospice patients. Semistructured face-to-face interviews were conducted with 22 hospice providers (14 nurses, 4 physicians, and 4 social workers) and 23 family caregivers (10 daughters, 4 wives, 2 husbands, and 7 others) of elderly patients (>or=60 years old) who were receiving home services from four hospice care programs in the Chicago metropolitan area. Although both groups identified similar skill sets, hospice providers emphasized technical skills such as administering medications, and family caregivers valued management skills such as organizing medications, coordinating with hired caregivers, and providing care to patients who resisted treatment. We defined effective medication management in hospice as caregivers' ability to effectively relieve symptoms with pharmacological interventions by successfully utilizing skills related to teamwork (coordinate with hospice providers and with other family or hired caregivers), organization (acquire, store, track, and discard medications), symptom knowledge (recognize and interpret common symptoms), medication knowledge (understand the basics of pharmacology and medication administration), and personhood (understand and respond to the patient's needs). The proposed construct of medication management skills in hospice will help guide future development of training interventions and clinical assessment tools.

An Intervention for Treating Alcohol Dependence: Relating Elements of Medical Management to Patient Outcomes With Implications for Primary Care

Alcohol dependence, frequently seen in medical settings, is a major problem that affects the health and well-being of many individuals and their families. The purpose of this study was to examine the relationship between treatment outcomes and patient and clinician factors specifically associated with a medically oriented intervention given for the treatment of alcohol dependence. The intervention was developed for the National Institute on Alcohol Abuse and Alcoholism-sponsored COMBINE Study, a randomized controlled trial combining 2 medications, naltrexone and acamprosate, with Medical Management, with or without specialty alcohol treatment. We examined the effect of patient adherence to treatment (number of Medical Management visits, total minutes in treatment, alliance or therapeutic relationship with the clinician, patient satisfaction with treatment, and clinician adherence to the Medical Management protocol) on abstinence from alcohol, amount of heavy drinking, and clinical improvement during treatment. More Medical Management visits attended and less total time spent in Medical Management treatment was associated with more days of abstinence from alcohol, reductions in heavy alcohol drinking, and a higher likelihood of clinical improvement. The patients' positive perceptions of their alliance with their clinician and their satisfaction with treatment was significantly associated with more days of abstinence from alcohol during treatment. Two clinician factors clinician confidence in the Medical Management treatment and flexibility in delivering Medical Management were also associated with better patient outcomes. Medically trained clinicians with minimal specialty training in alcohol dependence treatments were able to deliver a brief and effective medication management intervention that was designed to be consistent with primary care practice.

Does Consideration of Medicare Use Affect VA Evaluations of Treatment for New Episodes of Depression?

This report evaluates whether consideration of out-of-system use affects Veterans Affairs (VA) health system assessments of depression treatment. We measured effective medication management and optimal practitioner contacts among veterans whose VA data indicated a new episode of depression. Among 3,567 VA patients who were Medicare age-eligible, VA data indicated that 69% received recommended antidepressant coverage and 9% received recommended practitioner contacts. After including Medicare data, 295 patients (8%) no longer met inclusion criteria. Among the remainder, 3% received Medicare depression treatment and 0.5% were re-classified as having recommended contacts. Medicare use does not substantially supplement VA depression treatment.

Complexities of communicating about managing medications—An important challenge for nurses: A response to Latter et al. (2007)

Recent papers in the International Journal of Nursing Studies (Latter et al., 2007; Courtenay et al., 2007) remind us that nurses have enormous responsibilities in managing medications and their competence is constantly tested in an ever-changing arena. Communication is central to safe and effective medication management. In this context, communication refers to verbal and written interactions that occur among nurses and between nurses and other health professionals, and between health professionals and patients. Complexities of communication can either impede or enhance the ways in which medications are managed. Nurses need to be actively aware of these complexities and participate in implementing strategies that enhance communication for the benefit of patient care. The management of medications involves a number of interconnected steps, and the administration of medications, which is commonly designated as the main area of responsibility for nurses, is only one aspect of a complex process. These steps include: prescribing or deciding on a treatment regimen (Courtenay et al., 2007), planning goals of care, administering medications, and evaluating therapeutic and undesirable outcomes of care (Manias and Bullock, 2002). In adopting these steps in clinical practice, it is important for nurses to take account of how communication occurs in their collaboration with other health professionals and with patients and family

Improving Medication Management of Depression in Health Plans

Improving Medication Management of Depression in Health Plans

Managing medication

Medication management in care homes is fraught with problems. Linda Nazarko explains the benefits of prescribers, pharmacists and staff working together for effective medication management.

THE UNDERGRADUATE CURRICULUM “MEDICINE IN OLD AGE AND THE OLD PERSON”— EXPERIENCES IN TEACHING MEDICAL STUDENTS AT THE UNIVERSITY OF HAMBURG, GERMANY

To the Editor: Geriatric medicine has not been an obligatory part of the undergraduate medical education in Germany, until recently. It was not until 2002 that the new law on medical board certification directed that “medicine in old age and the old person” be part of the clinical curriculum. However, there are no obligatory recommendations on which issues should be taught. At the University of Hamburg, a geriatric curriculum has been incorporated.1 It should provide an understanding of the need for prerequisite assessment and the inappropriateness of diagnostic and therapeutic nihilism, recognizing as well limitations and potential risks of medical interventions in old patients. Experienced geriatric staff members engaged in teaching were responsible for the educational concept and wrote the curriculum to achieve maximum congruence and adherence to the items in focus (Table 1). This choice of topics was based strictly on the faculty's expertise after extensive discussions of its probable benefit for young doctors. Furthermore, the time budget as directed by the university had to be adhered to. The lectures are complementary to the seminars' contents. All seminars are of the same didactical structure, aiming to involve the students through tasks and practical exercises in small groups (5–6 students) that address clinical problems or explicit questions. An interdisciplinary seminar includes a 15-minute introductory presentation about theoretical aspects and the practical implications of “telling bad news,” followed by one-to-one (patient-to-physician) supervised practical student exercises using case vignettes. Thereafter, another 15-minute presentation, reinforcing the previous presentation, addresses communication needs focusing on older patients (including caregivers and team aspects), problems with consent decision-making, the end of life, and dying. These are discussed in the whole seminar group (18–20 students) referring to relevant publications (e.g., 2). The consideration of communication problems is a prerequisite for effective medication management and concordance,3 which are addressed in a special seminar (Table 1). Another example is prevention, in which effective communication and establishing a trustful relationship are mandatory to meet the “unreported needs” of older persons.4 Then, a second round of one-to-one supervised student exercises takes place using case vignettes before the seminar is finally discussed together. The dedicated geriatric problem-oriented learning (POL) addresses a complex case vignette (a patient coming into the emergency department after a fall) using the classic seven-step POL strategy. The bedside teaching is accomplished using a clinical round. Thereafter, students visit individual patients for history taking and physical examination to create a “problem list” and to answer a five-item questionnaire. The examinations consist of a written test based on multiple choice and essay questions, and a 9-minute Objective Structured Clinical Examination (OSCE) with volunteer older persons (aged ≥75). Both examinations must be passed separately (≥60% of each maximum score). Beginning in the autumn of 2004 and continuing through 2005, 597 students (5 trimesters, 12 weeks each) received this instruction, of whom 562 (94.1%) were examined and 524 (87.8%) evaluated the curriculum. Approximately 8% of the students had no clinical experiences during their previous studies. Nevertheless, 551 (98%) passed the examinations, reaching a mean rating of 2.26 for total score (1=very good). The results were constantly better on written tests than on the OSCE (variation of mean ratings over time 1.81–2.51 vs 1.85–2.76). This may reflect successful acquisition of knowledge, although its practical application in an OSCE situation is more difficult. Nonetheless, half of the students reached very good and good results on the OSCE. The student evaluations of the curriculum exhibited mean ratings for single items and the total value of the geriatric curriculum (mean 4.68±1.22; 6=excellent) that were constantly above the ratings of all clinical blocks (mean 3.70±1.36) and were among the top group of all 33 clinical specialties. Issues of geriatric medicine are ideally suited for patient- or problem-centered teaching and learning. It is possible to raise students' interest, irrespective their previous level of clinical knowledge. In response to the students' demand for more-intensive clinical practice-based education, geriatric clinical clerkships are implemented now. Financial Disclosure: Jennifer Anders was a postgraduate geriatric research fellow supported by a grant from the Robert Bosch Stiftung, Stuttgart (Forschungskolleg Geriatrie). Author Contributions: W. von Renteln-Kruse, A. Rösler, and J. Anders contributed to the educational concept, analysis and interpretation of data, and the manuscript and were active teachers. M. Michaelis and P. Dieckmann contributed to the educational concept and were active teachers. O. Tesch and J. Vogel were active teachers. M. de Wit contributed to the concept of an interdisciplinary seminar and was an active teacher. M. Ehrhardt was an active teacher in an interdisciplinary seminar. Sponsor's Role: None.

From Depression to Dehydration

From Depression to Dehydration

Opportunities for Improving Post-Hospital Home Medication Management Among Older Adults

SUMMARY Effective post-hospital home medication management among older adults is a convoluted, error-prone process. Older adults, whose complex medication regimens are often changed at hospital discharge, are susceptible to medication-related problems (e.g., Adverse Drug Events or ADEs) as they resume responsibility for managing their medications at home. Human error theory frames the discussion of multi-faceted, interacting factors including care system functions, like discharge medication teaching that contribute to post-hospital ADEs. The taxonomy and causes of post-hospital ADEs and related risk factors are reviewed, as we describe in high-risk older adults a population that may benefit from targeted interventions. Potential solutions and future research possibilities highlight the importance of interdisciplinary teams, involvement of clinical pharmacists, use of transitional care models, and improved use of informational technologies.

An iconoclastic perspective on progress in pharmacy practice.

Progress in pharmacy practice is examined and areas for improvement are identified. Data from surveys of hospital and health system pharmacy practice from 1957 to 1994 show that the steady progress from 1974 to 1985 was not sustained over the past decade. Changing to a profession in which all practitioners provide pharmaceutical care will be difficult when practice in hospitals, where the most acutely ill patients are treated, does not meet the profession's recommended standards. Many pharmacists may be resigned to a reality in which their services are viewed as ancillary. The number of medication misadventures that occur indicates that there is an unmet need for effective medication management. Pharmaceutical care offers the promise of better patient outcomes as well as "reprofessionalization" of pharmacists. To elevate the level of pharmacy practice, individual practitioners need will; too much attention has been given to skill. Many new practitioners have earned Pharm. D. degrees but not received enough nurturing from colleagues to develop into innovators who will continue the profession's progress. It is crucial that the pharmacy practice and education communities cooperate to prepare pharmacists to function in the changing health care system. Also, professional organizations must set aside their fragmented interests and focus together on pharmacists' survival. The restructuring and economic pressures in health care may offer pharmacists the opportunity for progress, since improving drug use would help to decrease health problems and cost.