Medication Administration Hassles Research Articles

Pharmacist-led telehealth deprescribing for people living with dementia and polypharmacy in primary care: A pilot study.

People living with dementia (PLWD) have complex medication regimens, exposing them to increased risk of harm. Pragmatic deprescribing strategies that align with patient-care partner goals are needed. A pilot study of a pharmacist-led intervention to optimize medications with patient-care partner priorities, ran May 2021-2022 at two health systems. PLWD with ≥7 medications in primary care and a care partner were enrolled. After an introductory mailing, dyads were randomized to a pharmacist telehealth intervention immediately (intervention) or delayed by 3 months (control). Feasibility outcomes were enrollment, intervention completion, pharmacist time, and primary care provider (PCP) acceptance of recommendations. To refine pragmatic data collection protocols, we assessed the Medication Regimen Complexity Index (MRCI; primary efficacy outcome) and the Family Caregiver Medication Administration Hassles Scale (FCMAHS). 69 dyads enrolled; 27 of 34 (79%) randomized to intervention and 28 of 35 (80%) randomized to control completed the intervention. Most visits (93%) took more than 20 min and required multiple follow-up interactions (62%). PCPs responded to 82% of the pharmacists' first messages and agreed with 98% of recommendations. At 3 months, 22 (81%) patients in the intervention and 14 (50%) in the control had ≥1 medication discontinued; 21 (78%) and 12 (43%), respectively, had ≥1 new medication added. The mean number of medications decreased by 0.6 (3.4) in the intervention and 0.2 (1.7) in the control, reflecting a non-clinically meaningful 1.0 (±12.4) point reduction in the MRCI among intervention patients and a 1.2 (±12.9) point increase among control. FCMAHS scores decreased by 3.3 (±18.8) points in the intervention and 2.5 (±14.4) points in the control. Though complex, pharmacist-led telehealth deprescribing is feasible and may reduce medication burden in PLWD. To align with patient-care partner goals, pharmacists recommended deprescribing and prescribing. If scalable, such interventions may optimize goal-concordant care for PLWD.

Reliability and validity of the Turkish version of the Family Caregiver Medication Administration Hassles Scale

AbstractBackgroundThe Family Caregiver Medication Administration Hassles Scale (FCMAHS) was developed to evaluate the hassles and concerns experienced by family caregivers in medication administration.ObjectiveThis study aimed to evaluate the reliability and validity of the Turkish version of the Family Caregiver Medication Administration Hassles Scale (FCMAHS-TR).MethodsThe FCMAHS-TR was developed after translation, cultural adaptation, and a pilot study. The cross-sectional study was conducted among family caregivers (≥18 years) in community pharmacies. Test–retest reliability analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were performed. Hypothesis testing was used for the assessment of construct validity.ResultsThe majority (68.7%) of the family caregivers were female (n = 470). In the test–retest reliability analysis (n = 30), the ICC value was 0.917 (P < 0.001). In EFA analysis (n = 251), the Kaiser‒Meyer‒Olkin (KMO) measure was 0.799, 62.6% of the total variance was explained by five factors including eighteen items, and Cronbach’s alpha was 0.836. According to CFA (n = 219), the root mean square error of approximation (RMSEA) was 0.0654, and the comparative fit index (CFI) was 0.918. In construct validity, family caregivers with low reading ability of health-related materials and with high care burden had significantly higher median scores for all the factors of the FCMAHS-TR (P < 0.05 for all).ConclusionsThe FCMAHS-TR can be used to evaluate the hassle and concerns experienced by family caregivers in medication administration. This scale can be used by healthcare professionals to identify family caregivers who need individualized interventions for medication administration hassles.

Development of a drug distribution support device and survey of medication management burden on group home staff

ABSTRACT In Japan, the mean time spent on preparing and administering medications each day for everyone in care facilities has been reported to be 163 min. Most caregivers that administer medications to the elderly in care facilities have reported that this responsibility is a burden. We developed a drug distribution support device (DDSD) for caregivers, which was then installed in a group home and a 3-month monitoring experiment was conducted. Caregivers then answered a questionnaire survey on medication management burden pre- and post-DDSD use. The caregivers reported no difficulties associated with medication distribution using DDSD. The DDSD reduced the daily dispensing duration by an average of 3.5 min. The questionnaire survey showed no differences in items related to the reduction of errors, and the Family Caregiver Medication Administration Hassles Scale showed no reduction of burden on caregivers. However, whether the DDSD reduces medication management burden remains undetermined.

Hassles with medication management perceived by caregivers of adults who have intellectual or developmental disabilities.

Background Medication management is undertaken by caregivers of people who have intellectual or developmental disabilities. Objective The objectives were to measure the medication management hassles reported by caregivers of adults who have intellectual or developmental disabilities and to describe associations between characteristics of caregivers, medication regimens, and the person with intellectual or developmental disability and the scale score. Setting Web-based survey conducted in the United States. Method A newsletter announcement with a link to the survey was sent to members of a disability advocacy organization. Caregivers were age 18years and older who manage medications for adults with intellectual or developmental disabilities. The survey questions were used to obtain characteristics of the caregiver, the medication regimen they managed, and the care-recipient. The study was approved by the Institutional Review Board of Michigan Medicine (HUM00091002). Main outcome measure The Family Caregiver Medication Administration Hassles Scale (caregiver scale). Results Forty-two caregivers responded, with 41 being female with a mean age of 56.7years. The mean caregiver scale score was 28.9 (possible range 0-120). Highest scores (greatest hassles) were significantly associated with a greater level of support required by the care-recipient, stronger caregiver beliefs of the necessity of medication and concern about using medications, lack of previous caregiver health-care training, and being an employed caregiver rather than family member. Conclusion Medication management can contribute to caregiver stress. Pharmacists should ensure that caregivers are counseled about medication that they manage, be accessible for questions, and examine medication regimens to reduce polypharmacy and complexity of regimens.

Clinical Outcomes Associated with Medication Regimen Complexity in Older People: A Systematic Review.

To systematically review clinical outcomes associated with medication regimen complexity in older people. Systematic review of EMBASE, MEDLINE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library. Hospitals, home, and long-term care. English-language peer-reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants' overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity. Quality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool. Sixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less-complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self-administration errors, caregiver medication administration hassles, hospital discharge to non-home settings, postdischarge potential adverse drug events, all-cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication- and health-related problems, emergency department visits, or quality of life as rated by nursing staff. Research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate-quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization.

Predicting perceived medication-related hassles in dementia family caregivers.

Objective This study examined predictors of medication administration hassles reported by intergenerational dementia family caregivers. Methods A sample of 53 women who aided a cognitively impaired older adult with healthcare and who identified as inter-generational caregivers provided self-report medication management and psychosocial data. Results Hierarchical multiple regression analyses revealed that six independent variables hypothesized for this model, the total number of prescription medications managed by caregivers, educational attainment, care-recipient functional impairment, care-recipient cognitive impairment, caregiver depressive symptomatology, and self-reported feelings of preparedness for the caregiving role together significantly predicted caregiver medication administration hassles scores F(1, 48) = 4.90, p = .032, and accounted for approximately 25% of the variance of self-reported hassles (adjusted R2 = .247). Discussion Future interventions may reduce medication-related hassles by providing psychoeducation about healthcare, medication management, and strategies for coping with care-related stressors and depressed mood.

Medication administration hassles for Mexican American family caregivers of older adults

In order to take their medications at home, elders rely increasingly on their family, but little is known about the factors influencing this task. This study explored the effects of acculturation and social exchange on the hassles that Mexican American (MA) family caregivers face in administering medication to their elders. A descriptive, correlational design, with a convenience sample of 239 MA adult caregivers of elders who were on a daily prescription that was recruited in Dallas, Texas and San Diego, California, USA, was used. The caregivers' scores on the medication administration hassles scale were significantly affected by acculturation and social exchange factors that explained 36% of the variance in the scores; the social exchange block had a larger influence than did the acculturation block. Caregiving might be an outcome of dynamic family exchange relationships between the caregiving dyad. The results can help healthcare professionals to detect potentially at-risk MA families and provide them with culturally appropriate nursing interventions.

Use of the measurement of medication administration hassles with Mexican American family caregivers

This study builds on earlier work on medication administration hassles, minor daily irritants experienced by family caregivers of older relatives, by investigating the feasibility of using the Family Caregiver Medication Administration Hassles Scale (FCMAHS) for use with Mexican American caregivers. Appropriate medication administration is a critical factor in the effective management of chronic illness. When medication regimens are managed on behalf of an older care recipient, especially those with numerous medications for a variety of conditions, the caregiving task is even more complex. Relying on family support is common for older Mexican Americans. Despite this, there is little known about how Mexican Americans are handling their caregiving duties at home. A non-experimental methodological design was used to assess the psychometric properties of the FCMAHS with Mexican Americans, chosen because they are a rapidly growing population in the US. A purposive sample of 239 Mexican American adult caregivers, recruited in Dallas and San Diego, completed a brief biographical survey and the version of the FCMAHS created for Mexican Americans, i.e., the FCMAHS-MA. Principal axis factoring with orthogonal rotation was used to extract six factors which accounted for 53% of the variance in total scores - initial information seeking, safety issues, advanced information acquisition, scheduling, daily routine and prescription filling. Reliability estimates for the factors (alpha) ranged from 0.70-0.90. Test-retest reliability across a three-week interval was r = 0.64. The FCMAHC-MA shows promise as a guide for future caregiving intervention studies on family medication management for older relatives; however, it would benefit from refinement in future studies. Understanding family caregivers' hassles with medication administration is important because these hassles can accumulate and lead to caregiver strain. Culturally relevant intervention depends on accurate measurement of the hassles experienced by these caregivers.

Differences in the Ways that Family Caregivers Experience Medication Administration Hassles

Differences in the Ways that Family Caregivers Experience Medication Administration Hassles

Factors associated with medication hassles experienced by family caregivers of older adults

Objective We wished to identify potential factors associated with medication administration hassles, daily irritants, among informal caregivers who provide long-term medication assistance to persons aged 55 or older. Methods A sample of 156 informal caregivers were recruited from seven states and several types of settings. The dependent variable was scores on the Family Caregiver Medication Administration Hassles Scale (FCMAHS). Independent variables included in the analyses were medication complexity; caregiver's gender, ethnicity, relationship to recipient, length of time in caregiving, education, and employment outside the home; care recipient's physical capacity and mental capacity; and whether the caregiver and care recipient live together. After preliminary analysis to reduce the number of independent variables, the remaining variables were included in a linear model (GLM procedure). Possible interactions and residuals were considered. Results Whites and Hispanics experience greater medication administration hassles than other groups, and perceived hassle intensity increases with medication complexity. Medication administration hassle scores increase with increasing education levels up to a high school degree, after which they remain consistently high. Caregivers whose care recipients have moderate levels of cognitive functioning have higher medication administration hassles scores than those whose care recipients have very high or very low cognitive functioning. Conclusion The preliminary set of significant variables can be used to identify caregivers who may be at risk of experiencing medication administration hassles, increased stress, and potentially harmful events for their care recipients. Practice implications Family caregivers are accepting complex caregiving responsibility for family members while receiving little or no support or assistance with caregiving hassles associated with this duty. The FCMAHS offers the means to monitor how caregivers are handling the daily irritants involved with medication administration so that educational interventions can be provided before hassles lead to more serious stress and strain.

Differences in the Ways that Family Caregivers Experience Medication Administration Hassles

AbstractComplex medication regimens that result in medication administration hassles, the daily irritants that caregivers experience when assisting another person with a medication regimen, are now known to be related to increased caregiver strain. This paper reports data regarding the prevalence of the most intense individual medication administration hassles by selected caregiver characteristics (gender, race, age, employment status). The results underscore the necessity and utility of asking caregivers specific questions about multiple aspects of their medication administration responsibility, and provide insight into groups that should be targeted for information access and educational support.

Helping Family Members Manage Medication Administration Hassles

Managing the medication regimens of dependent older adults in the home is a complex issue for family caregivers. The tasks involved can include helping the older adults manage their own medications or may require involvement in the purchasing, scheduling, and administering of multiple medications for serious conditions. The hassles associated with this responsibility are now known to be associated with increased caregiver strain. In this article, we provide an overview of the body of research on medication administration hassles and offer a tool to assess family caregivers who are involved in this important aspect of care.

Development of the family caregiver medication administration hassles scale.

"Medication administration hassles" are the minor daily irritants that family caregivers experience when they assist a dependent family member with medication regimens. This study was designed to develop and test a multidimensional measure of the hassles in family caregiver medication administration. The authors employed a multiphase process (caregiver focus groups, instrument development, pilot testing, and field testing). Approximately 180 family caregivers representing diverse socioeconomic circumstances and racial or ethnic backgrounds participated in the study. The final version of the instrument consists of 24 items and four subscales: Information Seeking/Information Sharing (9 items, alpha =.92), Safety Issues (5 items, alpha =.83), Scheduling Logistics (7 items, alpha =.90), and Polypharmacy (3 items, alpha =.80). Overall scale reliability is.95, and test-retest reliability at 2 weeks is.84. Caregiver medication administration hassles represent a complex, multidimensional construct that warrants consideration in studies of contemporary family caregiver stress, strain, and burden.

Medication administration hassles reported by family caregivers of dependent elderly persons.

Even under the new long-term care mantra for increased home- and community-based care options, attention to and an understanding of the ways that family caregivers are managing complex care for dependent elderly persons, for example, with medication administration, have been slow to materialize. Twenty-three family caregivers completed semistructured, face-to-face interviews to capture the shared and idiosyncratic experiences of individuals responsible for all aspects of medication administration regimens for elderly, dependent family members. Data analysis consisted of content analysis of the verbatim interview transcripts. This article reports an emerging typology of caregiver medication administration hassles derived from the interviews. Based on 122 separate accounts, three categories of medication administration hassles were identified. The categories (with the percentage of all accounts represented by the category) include (i) scheduling logistics (29.5%), (ii) administration procedures (31.9%), and (iii) safety issues (38.6%). Primary care providers must continually reevaluate and simplify medication regimens for dependent elderly persons in the care of family members, and the family caregivers must be given adequate training and access to ongoing information support systems to help them perform safe and effective medication administration responsibilities.