Medication Knowledge Research Articles

Barriers to osteoporosis management and adherence to Clinical Practice Guideline: a comparative study between tertiary East Coast hospitals and a Fracture Liaison Services (FLS)-accredited hospital in Malaysia.

Osteoporosis management poses a substantial healthcare challenge, necessitating effective strategies and Clinical Practice Guidelines (CPG) adherence. The study employed a self-administered online questionnaire via Google Forms. Orthopedic clinicians from all study sites were invited to participate via messaging platforms. A total of 135 participants completed the questionnaire and the data was proceeded to statistical analyses. The study identified significant barriers, including inadequate knowledge of current osteoporosis guidelines and medications (p = 0.014), limited choice of anti-osteoporosis medication (p < 0.001), insufficient post-fracture care staff (p < 0.001), patients' financial constraints due to socioeconomic status (p = 0.027), and lack of doctor-patient time (p = 0.042). FLS demonstrated superior performance in CPG adherence in areas such as clinical diagnosis of osteoporosis without BMD assessment (p = 0.046), timely treatment initiation (p < 0.001), treatment monitoring using BMD (p = 0.004), reassessment treatment after 3-5years of bisphosphonate therapy (p = 0.034) and considering anabolic agents in very high-risk patients (p = 0.018). The findings highlight an essential opportunity for improvement and emphasize the necessity for robust strategies and strict adherence to Clinical Practice Guidelines (CPG), especially within tertiary East Coast hospitals. The exemplary efficacy demonstrated by the FLS model strongly advocates for its broader integration across multiple hospitals, promising substantial advancements in osteoporotic patient care outcomes throughout Malaysia.

Events related to medication errors and related factors involving nurses’ behavior to reduce medication errors in Japan: a Bayesian network modeling-based factor analysis and scenario analysis.

This study aimed to identify the relationships between medication errors and the factors affecting nurses’ knowledge and behavior in Japan using Bayesian network modeling. It also aimed to identify important factors through scenario analysis with consideration of nursing students’ and nurses’ education regarding patient safety and medications. We used mixed methods. First, error events related to medications and related factors were qualitatively extracted from 119 actual incident reports in 2022 from the database of the Japan Council for Quality Health Care. These events and factors were then quantitatively evaluated in a flow model using Bayesian network, and a scenario analysis was conducted to estimate the posterior probabilities of events when the prior probabilities of some factors were 0%. There were 10 types of events related to medication errors. A 5-layer flow model was created using Bayesian network analysis. The scenario analysis revealed that “failure to confirm the 5 rights,” “unfamiliarity with operations of medications,” “insufficient knowledge of medications,” and “assumptions and forgetfulness” were factors that were significantly associated with the occurrence of medical errors. This study provided an estimate of the effects of mitigating nurses’ behavioral factors that trigger medication errors. The flow model itself can also be used as an educational tool to reflect on behavior when incidents occur. It is expected that patient safety education will be recognized as a major element of nursing education worldwide and that an integrated curriculum will be developed.

Factors influencing central nervous system medication deprescribing and behavior change in hospitalized older adults.

Central nervous system (CNS) medications are linked to higher morbidity and mortality in older adults. Hospitalization allows for deprescribing opportunities. This qualitative study investigates clinician and patient perspectives on CNS medication deprescribing during hospitalization using a behavioral change framework, aiming to inform interventions and identify recommendations to enhance hospital deprescribing processes. This qualitative study focused on hospitalists, primary care providers, pharmacists, and patients aged ≥60 years hospitalized on a general medicine service and prescribed ≥1 CNS medications. Using semi-structured interviews and focus groups, we aimed to evaluate patient medication knowledge, prior deprescribing experiences, and decision-making preferences, as well as provider processes and tools for medication evaluation and deprescribing. Rapid qualitative analysis applying the Capability, Opportunity, Motivation, and Behavior (COM-B) framework revealed themes influencing deprescribing behavior in patients and providers. A total of 52 participants (20 patients and 32 providers) identified facilitators and barriers across deprescribing steps and generated recommended strategies to address them. Clinicians and patients highlighted the opportunity for CNS medication deprescribing during hospitalizations, facilitated by multidisciplinary teams enhancing clinicians' capability to make medication changes. Both groups also stressed the importance of intensive patient engagement, education, and monitoring during hospitalizations, acknowledging challenges in timing and extent of deprescribing, with some patients preferring decisions deferred to outpatient clinicians. Hospitalist and pharmacist recommendations centered on early pharmacist involvement for medication reconciliation, expanding pharmacy consultation and clinician education on deprescribing, whereas patients recommended enhancing shared decision-making through patient education on medication adverse effects, tapering plans, and alternatives. Hospitalists and PCPs also emphasized standardized discharge instructions and transitional care calls to improve medication review and feedback during care transitions. Clinicians and patients highlighted the potential advantages of hospital interventions for CNS medication deprescribing, emphasizing the necessity of addressing communication, education, and coordination challenges between inpatient and outpatient settings.

Development and preliminary validation of the personalized cystic fibrosis medication questionnaire (PCF-MQ)

BackgroundA personalized approach to assessing medication knowledge may identify opportunities for education to support self-management of cystic fibrosis (CF). This project describes the development, scoring, and preliminary validity of the Personalized CF Medication Questionnaire (PCF-MQ), designed to assess knowledge of prescribed CF medication purpose, administration, and dose and frequency. MethodsParticipants completed the PCF-MQ, the Knowledge of Disease Management (KDM-CF), and the Cystic Fibrosis-Medication Beliefs Questionnaire (CF-MBQ). Prescribed regimens were abstracted from medical records. Eligibility criteria were age 12 years and older, diagnosed with CF, and prescribed a CF medication. Statistical analyses were conducted using R software. Spearman rho was used to test correlations between measures. ResultsSixty people with CF (pwCF) were enrolled; three people reported a regimen that substantially deviated from the medical record and were excluded from the analyses. The mean (SD) age was 20.2 (7.3) years, 54 % were female, and 74 % had a FEV1pp ≥70 %. The mean (SD) PCF-MQ total score was 77.8 (12.3) and knowledge scores ranged from a low of 58.3 for levalbuterol to 100 for ivacaftor. The PCF-MQ total score correlated with the KDM total score and subscales (Spearman Rho= 0.32–0.59, p < 0.05) and was not correlated with the CF-MBQ subscales (p > 0.05)). ConclusionsThe PCF-MQ was correlated with another measure of general CF knowledge, but not health beliefs; because of the small sample size, this should be considered preliminary evidence of its validity. Advantages over existing CF knowledge measures include its practicality for use to help assess pwCF's knowledge about their prescribed regimen.

Factors Influencing Insulin Adherence among Outpatients with Type 2 Diabetes Mellitus and the Impact of Pharmaceutical Intervention: A Randomized Clinical Trial

Aims. This study aimed to identify and analyze the factors significantly influencing long-term insulin medication adherence among outpatients and to evaluate whether pharmaceutical interventions targeting these factors can improve patient medication adherence and glycemic control. Methods. A cohort of 180 patients was recruited from a tertiary hospital in Nanjing, China. Factors potentially influencing insulin adherence were scrutinized employing the KAP (knowledge, attitude/belief, and practice) health behavior model. Baseline characteristics were extracted from the hospital information system, while patient knowledge of the disease and medication, medication adherence, medication beliefs, and management self-efficacy were assessed, respectively, using self-developed questionnaires, MMAS-8, C-DMSES, and BMQ scales. Univariate and multivariate analyses were conducted to determine the impact of these factors on insulin adherence. Following this, participants were randomly allocated to either the intervention or control group. The intervention group received three months of weekly telephone sessions and educational interventions targeting facets such as medication knowledge and beliefs, while the control group received standard care. After the intervention, insulin adherence and glycemic control conditions of both groups were collected and re-evaluated. Results. After excluding lost-to-follow-up patients, 152 individuals were analyzed (intervention: 75 and control: 77). Multivariate analyses revealed factors influencing insulin adherence, including age, diabetes duration, health insurance status, HbA1c level, disease and medication knowledge, diabetes management self-efficacy, and medication beliefs (P&lt;0.05). Before targeted pharmaceutical care, no significant differences existed in insulin adherence, HbA1c levels, management self-efficacy, knowledge, or medication beliefs between intervention and control groups (P&gt;0.05). However, subsequent pharmaceutical intervention notably improved adherence, HbA1c levels, self-efficacy, knowledge, and medication beliefs (P&lt;0.05). Conclusion. This study examines the impact of glycemic control, health insurance status, management self-efficacy, level of knowledge, and medication beliefs on improving insulin medication adherence in patients with type 2 diabetes mellitus. Targeted pharmaceutical intervention can enhance medication adherence, improve glucose control, and promote rational insulin use. This trial is registered with ChiCTR2300074444.

An assessment of pharmacist counselling on the patients’ knowledge of ophthalmic medications

Background: Pharmacist counselling helps patients achieve their treatment goals by improving their medication knowledge, including ocular drugs. The visual system transmits 80% of sensory information; hence, eye health is crucial. Routine pharmacist counselling has been carried out to gain ophthalmic medication knowledge for every patient dispensed with a prescription in the outpatient pharmacy Surabaya eye clinic. However, the result of this counselling on patients’ knowledge has not been evaluated. Objective: The aim of this study is to measure the level of patients’ knowledge of ophthalmic medications. Methods: A cross-sectional study was carried out for one month by interviewing patients. A well-structured questionnaire of 15 questions was developed to assess the patient’s knowledge. The level of knowledge was classified as high, moderate, or low. Results: This study involved a total of 80 patients. The study showed that patients with a high, moderate, or low level of knowledge were represented by 33(41.25%), 45(56.25%), and 2(2.5%) patients, respectively. Demographic characteristics (gender and educational level) did not affect patients’ knowledge of ophthalmic medication (p &gt; 0.05). The knowledge of potential side effects of ophthalmic drugs was least understood. Conclusion: There is a need for improvement in the performance of pharmacist counselling since most patients have moderate to low knowledge of ophthalmic medications.

Assessment of Medication Burden and Knowledge Regarding Polypharmacy among elderly Patients at Sohag University Hospital

Assessment of Medication Burden and Knowledge Regarding Polypharmacy among elderly Patients at Sohag University Hospital

Knowledge attitude and convenience on self-medication practices among university students in Bangladesh exploration using structural equation modeling approach

Self-medication is a prevalent practice among university students globally and is a significant public health concern. However, previous research has been limited in scope, focusing primarily on adolescents or the general public, leaving a gap in understanding the causal relationships associated with self-medication; thus, this study aimed to investigate the factors influencing self-medication practices among university students in Bangladesh by developing a comprehensive causal model. Data from 417 students across five public universities were collected using the simple random walk technique by a team of 10 members. The study utilized constructs of knowledge, attitude, and convenience related to self-medication as independent variables, while self-medication practice as the dependent variable. One-way ANOVA and structural equation modeling (SEM) were employed to develop a causal model of self-medication practice among university students in Bangladesh. The findings revealed that students with better medication knowledge and adverse drug reactions (ADRs) were more likely to practice self-medication. A positive attitude towards self-medication and ADRs was also significantly associated with higher self-medication practice scores. Additionally, those who perceived self-medication as convenient and prescribed medication as inconvenient had higher self-medication practice scores. The attitude towards self-medication had the most substantial negative effect on self-medication practice, followed by the inconvenience of prescribed medication and the convenience of self-medication. The model explained 87% of the variance in self-medication practice, indicating a good fit for the data. University students in Bangladesh possess intermediate knowledge of medication and primary knowledge of ADRs. They exhibit a positive attitude towards self-medication and ADRs. Physical convenience favors self-medication, while the inconvenience of prescribed medication contributes to its lower preference. Policymakers should focus on evidence-based guidelines to reduce the extent of unnecessary self-medication practice and to enhance the quantity and accessibility of prescribed medications to address the issue effectively.

A cross- sectional study to assess medication safety, knowledge, attitude, and practices regarding nutrition and medication among pregnant women

Objective: To assess pregnant women's knowledge, attitude, and practice regarding nutrition and medication usage, analyse the prescribing pattern, and categorize them based on the Food and Drug Administration (FDA) guidelines. Methods: A cross-sectional study was conducted with 264 pregnant women in the obstetrics and gynaecology department of a tertiary care hospital from October 2022 to August 2023. A knowledge, attitude, and practice (KAP) questionnaire was prepared in English language by the researchers and validated by an expert panel consisting of 12 members. The validated questionnaire was then translated into regional languages, Kannada and Malayalam. The reliability of the questionnaire was assessed with test-retest method with a representative sample population of 30 subjects (10 subjects for each language). The subjects' knowledge, attitude, and practice were evaluated using the validated KAP questionnaire. The safety of the medication was assessed using the FDA drug safety classification for pregnancy. Results: The mean scores for nutritional and medication usage knowledge, attitude, and practice were 4.14±1.15, 4.50±1.09, and 3.00±1.47, respectively. Among 30 prescribed medications, 3 belong to category A (no risk in human studies), 8 belong to category B (no risk in animal studies), 18 belong to category C (risk cannot be ruled out) and 1 drug is not classified. A significant association was observed between medication knowledge and practice (r=0.159, P=0.010). Conclusions: Most of the study population knows the need to maintain good dietary and medication practices during pregnancy. Counselling pregnant women regarding diet and medication usage is crucial in maternal care.

Effect of an in-hospital medication self-management intervention (SelfMED) on medication adherence in polypharmacy patients postdischarge: protocol of a pre–post intervention study

IntroductionHealthcare providers usually manage medication for patients during hospitalisation, although patients are expected to self-manage their medication after discharge. A lack of self-management competencies is found to be associated with...

Drug prescription awareness among dental students in Kerala: a survey of current knowledge and awareness

Background: Prescribing medicine is a core skill for dentists, impacting patient safety and requiring knowledge of medications, dosages, and risks. This study evaluates dental students' awareness of these critical aspects in Kerala, India. Methods: This study aimed to assess drug prescription awareness among dental students in Kerala, India, highlighting current knowledge, standard practices, and areas for improvement. Results: Dental pain emerged as the most commonly treated condition (57.7%), with Amoxicillin reigning as the antibiotic of choice (69.2%-76.3%). Textbooks reigned supreme as the primary source of prescription information (66.4%-58.3%), even as most participants (78.1%-72.4%) acknowledged the WHO prescribing guidelines. While interns demonstrably boasted greater confidence in their knowledge, nearly half of all participants grappled with a lack of confidence in drug dosage and frequency. Incorrect dosage stood out as the Achilles' heel of prescription practices (71.9%-77.6%). Strengths included awareness of the correct route of delivery (61.6%-74.4%) and adherence to WHO guidelines. Conclusions: Dental students in Kerala demonstrate fair drug prescription awareness but have gaps in knowledge regarding dosage, frequency, and duration. Textbooks are the primary information source, highlighting the need for more in-depth education and reliance on evidence-based resources. Targeted interventions focused on these areas could enhance prescribing practices and patient safety.

P087 Role of a physiotherapy independent prescriber in a Paediatric Rheumatology setting

Abstract Background/Aims To assess the benefit of having a Physiotherapy Independent Prescriber (PIP) within a Paediatric Rheumatology service at University Hospitals Southampton (UHS). Legislative change in the UK in 2013 enabled physiotherapists to independently prescribe certain drugs that assist in patient management. Independent prescribing by physiotherapists is a relatively contemporary development in role change and purpose. The clients seen by the paediatric rheumatology physiotherapists within our service frequently require medication prescription as part of their review and management. Having the ability to independently prescribe reduces the need for additional medical or nursing input, so improving efficiency and patient experience within the clinic. Methods In our Paediatric Rheumatology service within UHS, our PIP is able to assess and manage the repeat prescriptions for routine follow-up patients with Juvenile Idiopathic Arthritis (JIA), plus alter medication prescriptions in response to clinical findings. The medications the PIP can change/prescribe include Methotrexate, Oral steroids, Non-steroidal anti-inflammatory drugs, Folic Acid and proton-pump inhibitors. This facilitates a greater number of patients to be seen as they do not require appointments with multiple professionals at routine reviews. A satisfaction questionnaire was completed by patients who accessed this service over a 6-month period. Results Over a six-month period of 25 morning clinics, a total of 23 satisfaction questionnaires were completed by those who had medication prescribed by the PIP. Of these, 100% were satisfied with the service they received and the outcome of the appointment. In particular, highest scores were given for communication by the therapist and having knowledge and understanding of medications prescribed. Conclusion Having a PIP in our Paediatric Rheumatology Clinic is well-received by service users and improved patient-experience by limiting the need for multiple appointments and reducing time spent in clinic. Disclosure E. Bhullar: None.

Nursing students' and faculty's experiences of first medication administration: A phenomenological inquiry

BackgroundLearning medication administration is essential for nursing students, but the first time can be stressful and shape their clinical development. Previous research primarily focused on student knowledge and technical aspects. PurposeThis phenomenological study helped explore the lived experiences of nursing students and faculty during student's first medication administration in the clinical setting to gain a deeper understanding of their thoughts, feelings, and perspectives. MethodSemi-structured interviews were conducted with female student and faculty informants (N = 12). Using a phenomenological study, data were analyzed using van Manen's hermeneutic six-step research activity method. ResultsFive overarching themes were found: administrating medication, (un)preparedness for complexities in the clinical environment, transformative experience, overcoming fears, and reaping the rewards. ConclusionFirst-time medication experiences are greater than an exercise in skill proficiency and may be improved if faculty provides more structured learning experiences and take sufficient time for student preparation in relating medication knowledge to the skill, technology usage, and supporting students' attitudes toward nurse-patient interactions. These are essential aspects of the medication administration learning process as nursing programs shift toward competency-based education. Clinical faculty also need support in their role as educators and to be facilitated to find this time, considering their multiple responsibilities.

Improving Drug- and Disease-related Knowledge of Patients with Chronic Kidney Disease: Randomized Controlled Trial from a Sri Lankan Outpatient Clinic

ABSTRACT Context: During past decades, the prevalence of chronic kidney disease (CKD) has increased significantly. Individuals with CKD are on complex drug regimens. Enhancing patients’ disease and medication knowledge can be achieved by pharmacist-conducted patient education. Aims: This study aimed to assess disease-specific knowledge changes in patients with stage 4 or 5 CKD after providing patient education. Settings and Design: A randomized controlled clinical trial was conducted at an outpatient renal clinic, Teaching Hospital, Anuradhapura, Sri Lanka. Subjects and Methods: The clinic admission register was used as the sampling frame. Patient consent was obtained, and demographic data were collected at commencement. Four counseling sessions were provided to the intervention group (IG) by “clinic-based pharmacist,” at commencement, and 2, 6, and 10 months, post-recruitment. The control group (CG) received usual care. A validated “drug and disease knowledge questionnaire” was interviewer administered to both groups at 6 months and a “drug and disease information booklet” was provided to IG. The same questionnaire was readministered at 12 months to reassess disease-specific knowledge. CG received an education booklet at 12 months. Statistical Analysis Used: The Mann–Whitney U test was used to analyze initial and 12 months in-between group data. The Wilcoxon signed-rank test was used to analyze initial and 12-month data within CG and IG. Results: One hundred patients were enrolled in CG and 101 in IG. The demographic profile of the two groups was broadly similar. Median drug and disease knowledge questionnaire scores were similar at 6 months at 23.00 (19.25–26.00) in CG and 24.00 (20.00–27.00) in IG (P &gt; 0.05). At 12-month scores were 22.00 (18.00–25.50) in CG compared to 35.00 (31.00–37.00) in IG (P &lt; 0.05). Conclusions: The provision of medication counseling and a “drug and disease information booklet” is beneficial in improving disease-specific knowledge in patients with CKD.

Impact of omitting annual reviews for COPD on patient reported care quality– outcomes from the Asthma+Lung COPD patient passport

BackgroundRegular clinical reviews of people with COPD provide an opportunity to optimise management and are recommended in national and international guidelines. However, there are limited data about the relationship between...

A qualitative exploration of the role of a palliative care pharmacist providing home-based care in the rural setting, from the perspective of health care professionals.

Pharmacists are often not recognised as a core part of palliative care teams, despite their ideal placement to assist with the burden of medication management. This study explored the role of pharmacists working in the rural palliative care team, in the home-based setting. Health care professionals working with palliative care patients in rural South Australia participated in semi-structured interviews. Data were analysed using thematic analysis. Data from 20 participants identified 10 themes. Theme 1: This model of care gives patients a choice. Theme 2: The pharmacist is a trusted source of support and information. Theme 3: Patient, carer and family distress is reduced. Theme 4: Enables patients to stay at home by improving medication knowledge and decreasing burden; 4.1-Patient, carer and family's understanding about medication management is improved, 4.2-Patient, carer and family travel is decreased, 4.3-Burden associated with getting to the doctor is decreased. Theme 5: Communication between all parties is enhanced; 5.1-Enhanced communication between the patient and health care team, 5.2-Enhanced communication within the health care team. Theme 6: Patient, carer and family burden of coordinating prescriptions and medications is reduced. Theme 7: Benefits health care professionals by improving medication knowledge, reducing workload and stress; 7.1-Understanding about medications and their management is improved, 7.2-Workload is reduced, 7.3-Work-related stress is reduced. Theme 8: The disparity of care between rural and urban patients is reduced. Theme 9: Helps to address rural workforce shortages. Theme 10: Challenges of this model of care; 10.1-A need for greater pharmacist capacity to meet demand, 10.2-A need for increased and sustained funding for the pharmacist role, 10.3-Large amount of travel to get to patients. Rural health care professionals are supportive of pharmacists working as part of the palliative care team in home-based settings and identified many benefits of this model of care.

Pharmacist-led intervention to improve treatment outcomes in type 2 diabetes: a randomized controlled trial

Abstract Objectives Pharmacists’ contribution to medication therapy management in type 2 diabetes (T2D) is under-reported in Nigeria. This study evaluated the effectiveness of a pharmacy-based intervention on knowledge, pharmacy refills, medication adherence, and glycemic control among patients with T2D. Methods A two-arm prospective, randomized, controlled trial among 309 T2D patients over 25 weeks duration was conducted in a tertiary hospital. The intervention group (n = 155) received weekly health education and follow-up sent as phone-based short message service (SMS), alongside standard care. Control group (n = 154) received only standard care. Primary (HbA1c reduction) and secondary (refill adherence, knowledge, and medication adherence) outcomes were assessed and compared in both groups at baseline and endline. Key findings Intervention improved glycemic control (HbA1c reduction) directly (t = 8.253, P &amp;lt; .001) and indirectly through improved pharmacy refill adherence as 115 (76%) of the intervention group were refill adherent (Proportion of Days Covered [PDC] &amp;gt; 80%). For controls, mean baseline and endline knowledge scores were 2.798 and 2.816, respectively (t = 1.19092, P &amp;gt; .005), while the intervention group had 2.732 and 4.462, respectively (t = 9.76157, P &amp;lt; .005) on a 5-point Likert scale. Baseline and endline adherence scores for control group were 3.41 and 3.50, respectively (t = 0.92477, P &amp;gt; .05), while the intervention group had 3.35 and 6.72, respectively (t = 17.87981, P &amp;lt; .05) on the 8-point Morisky Medication Adherence Scale (MMAS-8). Conclusion Pharmacist-led intervention significantly improved medication refills, glycemic control, knowledge, and medication adherence. Pharmacists should exploit mobile telephony for health education and follow-up services to improve treatment outcomes in medication therapy management of T2D.

Impact of a Mock OSCE on Student Confidence in Applying the Pharmacists' Patient Care Process.

The Medical and Pharmacy Student Collaboration (MAPSC) student organization at the University of Southern California, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, created an extracurricular, peer-led, virtual group mock objective structured clinical examination (MOSCE) to expose first-year pharmacy students (P1s) to the Pharmacists' Patient Care Process (PPCP). The purpose of this study is to evaluate the impact of a MAPSC MOSCE on P1s self-reported confidence in applying the PPCP and on patient communication, medication knowledge, and clinical skills. An anonymous, optional, self-reported survey was administered to P1s before and after the event, where they rated their confidence on a scale of 0-100 (0 = not confident, 100 = certainly confident). The statistical analysis was a paired two-tailed t-test with a significance level of p < 0.05. A total of 152 P1s and 30 facilitators attended the MOSCE. One hundred thirty-nine students met the inclusion criteria and were included in the data analysis. There was a statistically significant difference in the change in self-reported confidence for all PPCP components and learning outcomes. The results of our study strongly indicate that introducing P1 students to the PPCP through a MAPSC MOSCE format is a valuable experience.

Knowledge, experiences, and perceptions of medications for opioid use disorder among Black Kentuckians

Background Opioid overdoses have continued to increase at higher rates among Black Americans compared to people from other racial groups. Despite demonstrated effectiveness of MOUD in reducing risk of opioid overdose, Black Americans face decreased access to and uptake of MOUD. The current study aimed to examine the knowledge, perceptions, and experiences with MOUD among a sample of Black adults who use prescription opioids nonmedically in order to inform tailored efforts to improve MOUD uptake. Methods Data were derived from a larger study assessing cultural and structural influences on drug use and drug treatment among people who use prescription opioids nonmedically. Semi-structured qualitative interviews were conducted with 34 Black men and women across four generational cohorts: born 1955–1969; 1970–1979; 1980–1994; and 1995–2001. Participant responses were analyzed using thematic analysis. Results Nearly half of participants (44.1%) reported no knowledge or experience with MOUD. Among participants who had any knowledge about MOUD, four major themes regarding their perceptions emerged: MOUD Helps with Recovery; Not Needed for Level of Drug Use; Side Effects and Withdrawal; Equivalence with Illicit Drug Use. The majority reported negative perceptions of MOUD (52.6%), and the youngest cohort (born 1995–2001) had a higher proportion of negative perceptions (80%) relative to other age cohorts (born 1980–1994: 50%; 1970–1979: 75%; 1955–1969: 16.6%). Discussion Findings indicate a significant knowledge gap and clear points of intervention for improving MOUD uptake. Interventions to improve communication of health information in ways that are culturally relevant and tailored by age group can be used in conjunction with efforts to improve MOUD access among Black individuals who use opioids nonmedically.

Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE): protocol for a helix-counterbalanced randomised controlled trial

IntroductionClinical practice guidelines recommend against the routine use of psychotropic medications in residential aged care facilities (RACFs). Knowledge brokers are individuals or groups who facilitate the transfer of knowledge into practice. The objective of this trial is to evaluate the effectiveness and cost-effectiveness of using knowledge brokers to translate Australia’s new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care.Methods and analysisThe Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) trial is a helix-counterbalanced randomised controlled trial. The 12-month trial will be conducted in up to 19 RACFs operated by four Australian aged care provider organisations in Victoria, New South Wales, Western Australia and Queensland. RACFs will be randomised to receive three levels of implementation strategies (knowledge broker service, pharmacist-led quality use of medications education activities and distribution of the Guidelines and supporting materials) across three medication contexts (antipsychotics, benzodiazepines and antidepressants). Implementation strategies will be delivered by an embedded on-site aged care pharmacist working at a system level across each participating RACF. All RACFs will receive all implementation strategies simultaneously but for different medication contexts. The primary outcome will be a composite dichotomous measure of 6-month RACF-level concordance with Guideline recommendations and good practice statements among people using antipsychotics, benzodiazepines and antidepressants for changed behaviours. Secondary outcomes will include proportion of residents with Guideline concordant use of antipsychotics, benzodiazepines and antidepressants measured at the RACF-level and proportion of residents with psychotropic medication use, hospitalisation, falls, falls with injury, polypharmacy, quality of life, activities of daily living, medication incidents and behavioural incidents measured at the RACF-level.DiscussionThe EMBRACE trial investigates a novel guideline implementation strategy to improve the safe and effective use of psychotropic medications in RACFs. We anticipate that the findings will provide new information on the potential role of knowledge brokers for successful and cost-effective guideline implementation.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623001141639. Registered 6 November 2023 — retrospectively registered, https://www.anzctr.org.au/TrialSearch.aspx.