Medication-related Information Research Articles

How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study

BackgroundMedication-related problems are an important cause of emergency department (ED) visits, and medication errors are reported in up to 60% of ED patients. Procedures such as medication reconciliation and medication review can identify and prevent medication-related problems and medication errors. However, this work is often time-consuming. In EDs without pharmacists, medication reconciliation is the physician’s responsibility, in addition to the primary assignments of examining and diagnosing the patient. The aim of this study was to identify how much time ED physicians spend on medication-related tasks when no pharmacists are present in the EDs.MethodsAn observational time-and-motion study of physicians in three EDs in Northern Norway was conducted using Work Observation Method by Activity Timing (WOMBAT) to collect and time-stamp data. Observations were conducted in predefined two-hour observation sessions with a 1:1 relationship between observer and participant, during Monday to Friday between 8 am and 8 pm, from November 2020 to October 2021.ResultsIn total, 386 h of observations were collected during 225 observation sessions. A total of 8.7% of the physicians’ work time was spent on medication-related tasks, of which most time was spent on oral communication about medications with other physicians (3.0%) and medication-related documentation (3.2%). Physicians spent 2.2 min per hour on medication reconciliation tasks, which includes retrieving medication-related information directly from the patient, reading/retrieving written medication-related information, and medication-related documentation. Physicians spent 85.6% of the observed time on non-medication-related clinical or administrative tasks, and the remaining time was spent standby or moving between tasks.ConclusionIn three Norwegian EDs, physicians spent 8.7% of their work time on medication-related tasks, and 85.6% on other clinical or administrative tasks. Physicians spent 2.2 min per hour on tasks related to medication reconciliation. We worry that patient safety related tasks in the EDs receive little attention. Allocating dedicated resources like pharmacists to contribute with medication-related tasks could benefit both physicians and patients.

Novel opportunities for clinical pharmacy research: development of a machine learning model to identify medication related causes of delirium in different patient groups.

The advent of artificial intelligence (AI) technologies has taken the world of science by storm in 2023. The opportunities of this easy to access technology for clinical pharmacy research are yet to be fully understood. The development of a custom-made large language model (LLM) (DELSTAR) trained on a wide range of internationally recognised scientific publication databases, pharmacovigilance sites and international product characteristics to help identify and summarise medication related information on delirium, as a proof-of-concept model, identified new facilitators and barriers for robust clinical pharmacy practice research. This technology holds great promise for the development of much more comprehensive prescribing guidelines, practice support applications for clinical pharmacy, increased patient and prescribing safety and resultant implications for healthcare costs. The challenge will be to ensure its methodologically robust use and the detailed and transparent verification of its information accuracy.

Characteristics and associated factors of health information-seeking behaviour among patients with inflammatory bowel disease in the digital era: a scoping review

BackgroundHealth Information-Seeking Behaviour (HISB) is necessary for self-management and medical decision-making among patients with inflammatory bowel disease (IBD). With the advancement of information technology, health information needs and seeking are reshaped among patients with IBD. This scoping review aims to gain a comprehensive understanding of HISB of people with IBD in the digital age.MethodsThis scoping review adhered to Arksey and O'Malley's framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews frameworks (PRISMA-ScR). A comprehensive literature search was conducted in PubMed, Embase, Web of Science, PsycINFO, CINAHL, and three Chinese databases from January 1, 2010 to April 10, 2023. Employing both deductive and inductive content analysis, we scrutinized studies using Wilson's model.ResultsIn total, 56 articles were selected. Within the information dimension of HISB among patients with IBD, treatment-related information, particularly medication-related information, was identified as the most critical information need. Other information requirements included basic IBD-related information, daily life and self-management, sexual and reproductive health, and other needs. In the sources dimension, of the eight common sources of information, the internet was the most frequently mentioned source of information, while face-to-face communication with healthcare professionals was the preferred source. Associated factors were categorized into six categories: demographic characteristics, psychological aspects, role-related or interpersonal traits, environmental aspects, source-related characteristics, and disease-related factors. Moreover, the results showed five types of HISB among people with IBD, including active searching, ongoing searching, passive attention, passive searching, and avoid seeking. Notably, active searching, especially social information seeking, appeared to be the predominant common type of HISB among people with IBD in the digital era.ConclusionInformation needs and sources for patients with IBD exhibit variability, and their health information-seeking behaviour is influenced by a combination of diverse factors, including resource-related and individual factors. Future research should focus on the longitudinal changes in HISB among patients with IBD. Moreover, efforts should be made to develop information resources that are both convenient and provide credible information services, although the development of such resources requires further investigation and evaluation.

The role of electronic leaflets in improving access to medication-related information

Background: Language discrepancies may create barriers to healthcare, compromise the quality of care and worsen health outcomes. This study explored what European countries currently do to ensure that foreign patients receive sufficient information about their medications if they do not understand the country’s national language. Methods: A questionnaire was distributed to the delegates of two Council of Europe committees. The recipients were asked to provide insights on how their country facilitates access to the necessary product information when patients do not understand the national language. Results: Seventeen out of 39 delegates completed the questionnaire. The majority of the respondents indicated that all healthcare professionals experience difficulties in providing guidance and advice to foreign patients. The results also showed that different methods are used nationally to present the necessary information to foreigners. Finally, the observations from this survey suggested that electronic leaflets in the patient’s primary language could be a valuable option to improve access to medication-related information. Conclusions: Healthcare professionals seem to encounter challenges in providing foreign patients with information associated with medication use. Electronic leaflets can be one of the tools for improving communication between these patients and healthcare professionals to ensure that medicines are used safely and effectively.

Improving patient experience for people prescribed medicines with a risk of dependence or withdrawal: co-designed solutions using experience based co-design

BackgroundSignificant concerns have been raised regarding how medications with a risk of dependence or withdrawal are managed and how care is experienced by patients. This study sought to co-design solutions to improve the experience of care for patients prescribed benzodiazepines, z-drugs, opioids for chronic non-cancer pain, gabapentinoids and antidepressants.MethodTwenty patients and fifteen healthcare professionals from five different GP practices were recruited to take part. The study used Experience Based Co-Design. Patients and healthcare professionals completed semi-structured interviews and took part in feedback groups and co-design workshops to collaboratively identify priorities for improvement and to co-design solutions to improve the experience of care.ResultsPoor patient experience was common among people prescribed medications with a risk of dependence or withdrawal. Patients and healthcare professionals identified three main priority areas to improve the experience of care: (i) ensuring patients are provided with detailed information in relation to their medication, (ii) ensuring continuity of care for patients, and (iii) providing alternative treatment options to medication. Solutions to improve care were co-designed by patients and healthcare staff and implemented within participating GP practices to improve the experience of care.ConclusionGood patient experience is a key element of quality care. This study highlights that the provision of in-depth medication related information, continuity of care and alternative treatment to medication are important to patients prescribed medicines with a risk of dependence or withdrawal. Improving these aspects of care should be a priority for future improvement and delivery plans.

Study protocol of the Hungarian Longitudinal Study of Healthy Brain Aging (HuBA).

<p>Neuro&shy;cog&shy;nitive aging and the associated brain diseases impose a major social and economic burden. Therefore, substantial efforts have been put into revealing the lifestyle, the neurobiological and the genetic underpinnings of healthy neurocognitive aging. However, these studies take place almost exclusively in a limited number of highly-developed countries. Thus, it is an important open question to what extent their findings may generalize to neurocognitive aging in other, not yet investigated regions. The purpose of the Hungarian Longitudinal Study of Healthy Brain Aging (HuBA) is to collect multi-modal longitudinal data on healthy neurocognitive aging to address the data gap in this field in Central and Eastern Europe.</p>. <p>We adapted the Australian Ima&shy;ging, Biomarkers and Lifestyle (AIBL) study of aging study protocol to local circumstances and collected demographic, lifestyle, men&shy;tal&nbsp;and physical health, medication and medical history related information as well as re&shy;cor&shy;ded a series of magnetic resonance imaging (MRI) data. In addition, participants were al&shy;so offered to participate in the collection of blood samples to assess circulating in&shy;flam&shy;matory biomarkers as well as a sleep study aimed at evaluating the general sleep quality based on multi-day collection of subjective sleep questionnaires and whole-night elec&shy;troencephalographic (EEG) data.</p>. <p>Baseline data collection has al&shy;ready been accomplished for more than a hundred participants and data collection in the se&shy;cond<br>session is on the way. The collected data might reveal specific local trends or could also indicate the generalizability of previous findings. Moreover, as the HuBA protocol al&shy;so offers a sleep study designed for tho&shy;rough characterization of participants&rsquo; sleep quality and related factors, our extended multi-modal dataset might provide a base for incorporating these measures into healthy and clinical aging research.&nbsp;</p>. <p>Besides its straightforward na&shy;tional benefits in terms of health ex&shy;pen&shy;di&shy;ture, we hope that this Hungarian initiative could provide results valid for the whole Cent&shy;ral and Eastern European region and could also promote aging and Alzheimer&rsquo;s disease research in these countries.</p>.

A retrospective review of the impact of immunization eCare plans in community-based pharmacy setting

BackgroundThe Pharmacist Electronic Care (eCare) plan is an electronic documentation and billing platform that allows for exchanging and integrating pharmacy patient care information. eCare plans make it easier for pharmacists to track recommendations and referrals to both patients and providers and to bill for services. ObjectivesTo determine the impact on the type and number of vaccines administered after the completion of immunization eCare plans and to examine sociodemographic differences in patients who received immunizations were documented in an eCare plan in a community-based pharmacy setting. Practice DescriptionBremo Pharmacy is an independently owned pharmacy located in Richmond, Virginia. Bremo Pharmacy offers a medication synchronization program targeting patients for enrollment in compliance packaging and clinical services. Practice InnovationBremo Pharmacists use eCare plans to track patient and provider interactions, goals, and medication-related information. Pharmacists used eCare plans to document vaccine recommendations and interactions with patients as a tool to increase vaccinations. Evaluation MethodsReports were generated to extract data containing information from each eCare plan during the intervention period and the number and type of vaccines administered 1 and 2 years before the intervention. Percent change was used to calculate the change in vaccines administered between years. The sociodemographic data was analyzed using descriptive statistics and bivariate statistical analysis using SAS 9.0 (Cary, NC). ResultsThere were a total of 1105 immunization eCare plans completed. An increase of 136.6% in vaccines administered occurred after the implementation of the eCare plans. While the number of vaccines administered increased, no significant differences were found in vaccine uptake by gender or age. ConclusionImmunization eCare plans are a useful tool to help pharmacists increase the number of vaccines administered in an independent pharmacy.

Digital health interventions to improve adherence to oral antipsychotics among patients with schizophrenia: a scoping review

ObjectivesTo assess the current evidence on the potential of digital health interventions (DHIs) to improve adherence to oral antipsychotics among patients with schizophrenia by assessing the methodologies, feasibility and effectiveness...

Investigational drugs services pharmacists education and workflow structure.

169 Background: Per NIH U.S. National Library of Medicine, 428,103 research studies are registered globally as of September 19th, 2022. Each institution must assess its institutional readiness as the complexity and volume of clinical trial increases. Institutional readiness helps assess the capacity of an institution to adopt new technologies and policies to accept, activate, and adjust research despite the complexity of the clinical trial. Clinical research pharmacists help improve the safety and quality of the research by reviewing the scientific literature and medication-related information to develop protocols and evaluate clinical trial feasibility as part of the scientific review committee while performing supportive pharmaceutical review of the protocol, preparation, storage, dispensing, and consulting clinical coordinators and sponsors on the logistics of the trial. Investigational drug service (IDS) also oversees institutional compliance with Good Clinical Practices (GCPs) and Good Manufacturing Practices (GMPs), FDA regulations, and laws. Lack of training for pharmacists, poor safety and quality control, lack of resources, and unstandardized approach to the management of investigational drug products can lead to discrepancy, delay in care, and ultimately, harm to the patient. This study will address the deficiency of institutional readiness to conduct clinical trials with investigational agents and introduce policies and procedures needed to be followed by pharmacists or pharmacy technicians to conduct research. Methods: To explore the challenges in clinical trials and compare work efficiency, work productivity, and growth in the investigational drug service (IDS) pharmacy. This study is conducted at a single-health system compromised of 7 satellite investigational pharmacy from June 2021 to August 2022. Interventions include Epic/Beacon training, CITI training, annual compounding competencies, protocol and procedure development, and Vestigo implementation. Data for inclusion was identified from (where Dr. Ayoubi got data from) were extracted and analyzed. Results: 71% decrease in # of protocols on the priority list to amend protocols. Informatics pharmacists build 190 protocols in one year. Revenue has doubled in one year. Productivity increased as time to verify is reduced by 9.43 minutes to verify an order and time to dispense is reduced by 31.3 min. Number of clinical trials designated to each pharmacist increased from 3-4 to 20 productions per month. Number of investigational drugs ordered increased by 89 last year. Conclusions: Education and Training remain one of the main set back to clinical trials growth, and proper training and education are the pillars to conducting clinical trials in a safe manner and promote growth.

Patients’ perceptions of medication counseling and education provided by pharmacists

Objectives: Pharmacists can increase patients’ knowledge and understanding of their medications and assist them to make appropriate decisions. However, clients’ perception is a rate determining step to their accepting such Pharmacists roles. In this study we evaluated clients’ perceptions on pharmacists provided medication counseling and education. Materials and Methods: A descriptive cross-sectional survey was conducted using a 27 item, three sectioned questionnaire among 405 respondents &gt; 16years old for 10 weeks in secondary Health facility in Lagos state. Nigeria. Using Statistical Package for Social Sciences (SPSS) version 22, descriptive analysis (frequency), reliability (Cronbach alpha), correlation (spearman’s rho), association (chi-square) were conducted with P value&lt; 0.05. Three (3) was used as a logical mid-point and a positive perception was assumed if an overall mean of above 3 was obtained. Results: Majority of the respondents were female 267 (65.9%), 47.4% fall within the age range of 20-39 years, and the highest proportion of respondents (44%) have secondary school educational qualification. About half of the respondents strongly disagreed that pharmacists are responsible for providing information on disease condition and minor ailments 181(44.7%) and strongly agreed that pharmacists always indicate medication use in writing, 278 (68.6%), there was correlation between this and pharmacists usually re-emphasized information in writing using spearman’s rho (p=0.000). Most respondents strongly disagreed that pharmacy is only a business and of no benefit to patients 314 (78.9%) and 270 (66.7%) agreed that pharmacists should be an integral part of the health delivery system. Overall mean ± SD was 4.11 ± 0.841, while mean ± SD on patients’ knowledge of pharmacists’ roles and their opinion on usefulness of pharmacists counseling and education were 4.26 ± 0.839 and 3.95 ± 0.840 respectively. Overall value of 0.66 was obtained for reliability test using Cronbach’s’ alpha. There is significant association between the patients’ age and their perception on need to go back to physician for clarification on medication use after pharmacists counseling (P=0.000), also between respondents’ gender and their perception that counseling received from pharmacists has benefits to them. (P=0.007). CONCLUSION: Generally, respondents have positive perceptions on pharmacist provided medication counseling and education. Our study results showed that pharmacists are seen as important professionals in providing medication related information.

Glycemic control and its associated factors in hypertensive patients with type 2 diabetes.

Inadequate glycemic control among patients with type 2 diabetes is growing worldwide. Earlier research studies investigated the predictors of poor glycemic control among patients with diabetes, but not among hypertensive patients who have type 2 diabetes as a comorbid disease. The aim of this study was to explore the factors associated with poor glycemic control in patients with type 2 diabetes and hypertension. In the present retrospective study, the medical records of two major hospitals were used to collect sociodemographic, biomedical, disease and medication-related information about patients with hypertension and type 2 diabetes. Binary regression analysis was conducted to find the predictors of the study outcome. The data from 522 patients were collected. High physical activity (OR=2.232; 95% CI: 1.368-3.640; p<0.01), receiving insulin (OR=5.094; 95% CI: 3.213-8.076; p <0.01) or GLP1 receptor agonist (OR=2.057; 95% CI: 1.309-3.231; p<0.01) increased the odds of having controlled blood glucose. Increased age (OR=1.041; 95% CI: 1.013-1.070; p<0.01), elevated high-density lipoprotein (HDL) levels (OR=3.727; 95% CI: 1.959-7.092; p<0.01), and lower triglycerides (TGs) levels (OR=0.918; 95% CI: 0.874-0.965; p<0.01) were also associated with improved glycemic control among the study participants. Most of the current study participants showed uncontrolled type 2 diabetes. Low physical activity, not receiving insulin or GLP1 receptor agonist, younger age, low HDL and high TG levels were independently associated with poor glycemic control. Future interventions should place a strong emphasis on the value of consistent physical activity and a stable lipid profile in enhancing glycemic control, particularly in younger patients and those who are not receiving insulin or GLP1 receptor agonist therapy.

The Use of Medication for Challenging Behaviors in People with Intellectual Disabilities: The Direct Care Providers’ Perspective

ABSTRACT Background Overmedication of people with intellectual disabilities, particularly when psychotropic medications are used for challenging behavior (CB) in the absence of a psychiatric disorder, is a significant public health concern. Support staff play a pivotal role in influencing the prescribing process. Staff views and attitudes toward medication use for CB are therefore of paramount importance. Method We have conducted four focus groups involving support staff (n = 8), home managers (n = 5) and trainers (n = 3), two of which primarily explored participants’ experiences and views on using medication for CB and medication withdrawal. Results Some participants felt medication use was justified, but others saw that as a form of chemical restraint. Most agreed that polypharmacy of psychotropics might lead to side effects. Some acknowledged the lack of shared decision-making involving people with intellectual disabilities and their families. There was universal anxiety about withdrawing the medication. Conclusions All agreed on the need for more medication-related information.

Australian general practitioners' views on qualities that make effective discharge communication: a scoping review.

Transitions of patient care between hospital discharge and primary care are known to be an area of high-risk where communication is imperative for patient safety. Discharge summaries are known to often be incomplete, delayed and unhelpful for community healthcare providers. The aim of this review was to identify and map the literature which discusses Australian general practitioners' (GPs) views on the qualities that make up effective discharge communication. Medline, Scopus and the Cochrane register of controlled drug trails and systematic reviews were searched for publications until October 2021 that discussed Australian GPs' views on discharge communication from hospital to general practice. Of 1696 articles identified, 18 met inclusion and critical appraisal criteria. Five studies identified that GPs view timeliness of discharge summary receipt to be a problem. Communication of medication information in the discharge summary was discussed in six studies, with two reporting that GPs view reasons for medication changes to be essential. Five studies noted GPs would prefer to receive clinical discipline or diagnosis specific information. Four studies identified that GPs viewed the format and readability of discharge summaries to be problematic, with difficulties finding salient information. The findings of this scoping review indicate that GPs view timeliness, completeness, readability, medication related information and diagnosis/clinical discipline specific information to be qualities that make up effective discharge communication from hospital to the community. There are opportunities for further research in perspectives of effective discharge communication, and future studies on interventions to improve discharge communication, patient safety and policy in transfers of care.

Primary care pharmacists’ knowledge and perception of Inflammatory Bowel Disease: a cross-sectional study in Australia.

Purpose: Inflammatory bowel disease (IBD) management is complex and challenging, and therefore, requires a multidisciplinary approach. Whilst pharmacists may play a key role as the first point of contact for patients with initial symptoms or disease relapse, there is scant literature on pharmacists’ knowledge in IBD management. We conducted a survey to explore pharmacists’ knowledge and their perception of pharmacists and other healthcare professionals’ roles in managing patients with IBD.Design and Methodology: An online survey was distributed to pharmacists through professional organisations. The survey included questions about demographic information, concepts related to IBD management and the roles of pharmacists and healthcare professionals in managing patients with IBD.Findings: Fifty two respondents completed the survey. The overall knowledge score for the majority of respondents was categorised as ‘low’ (25-50%) to ‘average’ (51-75%). IBD concept that demonstrated the highest level of accuracy in knowledge scores among pharmacists was the importance of vaccination in IBD (94.2%). Pharmacists who had exposure to patients with IBD demonstrated better knowledge scores compared to those who did not have any exposure to IBD patients in their practice (p = 0.005). Furthermore, General Practitioners (GPs) were perceived as the key care providers to IBD patients, whilst pharmacists considered themselves as important in providing medication related information to patients. Conclusion: This study indicated that pharmacists’ knowledge of IBD and its’ management was suboptimal, but with education and training there are opportunities for pharmacists to play a more active role in managing patients with IBD.

Conceptualization and content validation of the MEDication literacy assessment of geriatric patients and informal caregivers (MED-fLAG)

BackgroundThe assessment of patients’ medication literacy skills (i.e., abilities to access, comprehend and interact with medication-related information) is an important step in assisting clinicians to plan for appropriate care. Despite several attempts by researchers to develop measures of medication literacy, an instrument tailored to the specific needs of older adults remains a significant shortfall. Therefore, an interprofessional team that included a citizen co-researcher conceptualized a new standardised measure of medication literacy—the MEDedication Literacy Assessment of Geriatric patients and informal caregivers (MED-fLAG). MED-fLAG was designed as a three-dimensional self-reported measure of functional, interactive and critical skills. This study describes the conceptualization process and provides the results of an evaluation of MED-fLAG’s content validity, acceptability, and feasibility during a hospital stay.MethodsMED-fLAG was developed in accordance with the guidance on scale development and standards for good content validity, by using the following steps: (I) conceptualization of a provisional version of MED-fLAG; (II) iterative qualitative evaluation of its content validity by older adults, informal caregivers and healthcare professionals.ResultsThe qualitative assessment of the initial 54-item MED-fLAG was conducted in 36 participants, namely 13 home-dwelling older adults and/or informal caregivers and 23 healthcare professionals. Six rounds of revisions were performed to achieve content validity and to propose a 56-item revised MED-fLAG. Participants reported benefits of using a standardized assessment of medication literacy during a hospital stay but warned about certain limitations and prerequisites. The extent to which MED-fLAG could be integrated into discharge planning needs to be further investigated.ConclusionsMED-fLAG is the first medication literacy measure tailored to the specific needs of older patients and informal caregivers. A unique feature of this measure is that it includes prescribed and non-prescribed medications, irrespective of the galenic form. Additional studies are required to evaluate the other measurement properties of MED-fLAG, and to reduce the number of items before considering its clinical application.

Effects of a nurse-led medication self-management intervention on medication adherence and health outcomes in older people with multimorbidity: A randomised controlled trial

BackgroundOlder people with multimorbidity are usually required to manage multiple medications and complex medication regimens. However, clinical guidelines for medication management almost entirely focus on a single disease. Further research is needed to assess the efficacy of medication self-management interventions for older people with multimorbidity. ObjectiveThis study aimed to evaluate the effectiveness of a nurse-led medication self-management intervention on medication adherence and health outcomes in older people with multimorbidity. DesignA single-blind, two-arm randomised controlled trial. SettingsThree community health centres in Changsha, China. ParticipantsOlder people with multimorbidity. MethodsA total of 136 participants were recruited and randomly allocated into either a 6-week nurse-led medication self-management intervention group (n = 67) or usual care group (n = 69). The intervention consisted of three one-on-one educational sessions on medication-related information, motivation and self-management skills and two follow-up phone calls. The primary outcome was medication adherence. Secondary outcomes included medication self-management capacity, treatment experiences, quality of life and utilisation of health care services. Outcomes were measured at baseline, post-intervention and 3-month follow-up. The intervention effects were assessed using generalised estimating equation models. ResultsStatistically significant improvements were found in medication adherence (β = 1.63, p = 0.034), medication knowledge (β = 2.61, p < 0.001), beliefs about harm of medication (β = −1.83, p < 0.001), medication self-efficacy (β = 3.22, p < 0.001) and satisfaction with convenience of medication use (β = 5.02, p = 0.005) for the intervention group compared with the control group immediately post-intervention. Compared with the control group at 3 months follow-up, the intervention group demonstrated significantly greater improvements in medication knowledge (β = 2.26, p < 0.001), beliefs about necessity of medication (β = 2.68, p = 0.002) and concerns about medication (β = −2.44, p = 0.002), medication self-efficacy (β = 1.87, p = 0.015) and medication burden (β = −3.96, p = 0.004). Improved medication adherence was observed in the intervention group at 3 months follow-up compared with baseline, although the differences between the groups were not significant. No statistically significant effects were found on quality of life and utilisation of health care services at either time point. ConclusionsA 6-week medication self-management intervention significantly improved medication adherence immediately post-intervention, suggesting a short-term intervention effect. A longer intervention period and continuous follow-up support may be required to achieve sustained improvements in medication adherence and health outcomes in older people with multimorbidity. RegistrationChiCTR.org.cn (ChiCTR2000030011); Start of recruitment: June 2020.

POS1526-HPR WHICH FACTORS INFLUENCE PATIENTS’ PREFERENCES FOR TELEHEALTH APPLICATIONS IN RHEUMATIC DISEASES? A QUALITATIVE STUDY

BackgroundTelehealth has the potential to improve patients’ health outcomes and patient empowerment by increasing access to care and medical information.1,2 As patients with rheumatic diseases are known to experience drug-related problems at various moments along their patient journey,3 this population can benefit from more continuous information about their medication and healthcare provider support to manage drug-related problems. To most effectively employ telehealth for this purpose, it is important that offered technologies match with patients’ needs and preferences.ObjectivesIdentify factors influencing the preference of patients with rheumatic diseases regarding telehealth applications.MethodsA qualitative descriptive study was performed in the Netherlands between May and June 2021. Using a semi-structured interview guide, patients with a rheumatic disease were interviewed face-to-face. First, patients were presented four telehealth applications (frequently asked questions page, digital human, and chatting and video calling with healthcare providers). Second, patients were asked to use each application to answer one medication-related question predefined by the research team. During the process of finding an answer to the question, patients were asked to think aloud and were questioned on which factors influenced their experience and preference for each application. Third, patients were given additional hypothetical questions after which they were asked to explain their preferred application for answering the question, to elicit additional factors influencing preference. Interviews were audio recorded, transcribed verbatim and analysed thematically.ResultsFifteen patients (aged 19 – 73 years, 53% female) participated. Three domains influenced patients’ preference for telehealth applications. First, preference for telehealth applications was influenced by factors related to individual patients such as medication-related information needs, literacy, and skills with digital applications. Second, preference was influenced by factors related to the specific applications such as speed of answer, level of interaction, extent of privacy, the perceived usefulness of an application, and usability of the application. Third, preference was influenced by factors related to the context in which telehealth applications are offered, such as the support from healthcare providers in using telehealth applications, reliability of information source, and potential of telehealth to save time for healthcare providers.ConclusionPatients’ preference for telehealth applications is influenced by patient-related, application-related and context-related factors. To effectively support patients with rheumatic diseases, telehealth applications should match with these patients’ preferences. Furthermore, it is important to offer a variety of telehealth applications as preferences differ among patients and circumstances.

Community pharmacy professionals\u2019 practice in responding to minor symptoms experienced by pregnant women in Ethiopia: results from sequential mixed methods

BackgroundIn countries with limited access to healthcare services, community pharmacists’ management of minor symptoms experienced by pregnant women could be beneficial in terms of alleviating the burden of other health professionals and cost of services. However, evidence is limited regarding the practice of community pharmacy professionals in responding to minor pregnancy-related symptoms more generally, particularly in Ethiopia.ObjectiveThe aim of this study was to evaluate actual and self-reported practice of community pharmacists in the management of minor symptoms during pregnancy in Ethiopia.MethodsA sequential mixed method study using self-reported survey from 238 community pharmacists followed by 66 simulated client visits was conducted from March to July 2020 in six towns of the Amhara regional state in Ethiopia. Independent samples t-test and one-way Analysis of Variance was used to test the mean difference of practice score among subgroups of study participants.ResultsThe self-reported survey showed that most community pharmacist would ‘always’ gather most symptom-related information particularly about ‘duration of symptoms,’ ‘frequency of symptoms,’ and ‘gestational age’ and provide medication-related information on ‘how to use the medication’ and ‘duration of use.’ The highest mean practice scores were observed in relation to information gathering about ‘gestational age’ and information provision on ‘how to use the medication.’ In contrast, the lowest mean practice scores were observed in relation to information gathering about ‘weight of the woman’ and information provision on ‘dosage form.’However, the actual practice, as revealed by the simulated client visits, demonstrated that most community pharmacists would rarely gather symptom-related information nor provide medication-related information. In addition, dispensing of non-prescribed medications to pregnant women was also common. The extent of self-reported practice differed among subgroups of study participants.ConclusionsThis study highlights extent of practice of community pharmacy professionals during the management of minor symptoms in pregnancy in Ethiopia. Discrepancies of results between self-reported and actual practices of community pharmacy professionals were observed. The inadequate actual practice of symptom-related information gathering and medication-related information provisions needs considerations of implementing interventions to minimize potential harms.

Medication literacy: A conceptual model.

Medication literacy reflects the specific literacy skills necessary to act on medication-related information. A comprehensive and clear conceptual model that reflects medication literacy is lacking. Conceptual models describe the components that represent a construct, allowing for its understanding and providing a rationale for its measurement. To propose a conceptual model to support the development of an instrument to measure medication literacy. This is a three-phase methodological study. A literature review was conducted to identify the components that should be part of the preliminary conceptual model. Subsequently, the importance of its components was judged on a Likert-5 scale. Then, the model was refined, and the dimensions and subdimensions of medication literacy were defined. Forty-five experts were included, with a mean age of 39.9 (SD=10.5) years, most of them females (86.7%) and pharmacists (80%). All components of the preliminary conceptual model were considered important to extremely important by most experts. "Dosing information", "medication name", and "processing the information received about their medication and acting upon medication instructions" were the components considered most important. In the refinement phase, we identified that the construct has four dimensions - functional literacy, communicative literacy, critical literacy, and numeracy, which include the subdimensions to access, understand, evaluate, calculate, and communicate medication-related information. The conceptual model allowed identifying the components that represent medication literacy, which will support the development of an instrument for measuring the construct in Brazil.

Medication Literacy in Hospitalized Older Adults: Concept Development.

Background:Medication literacy encompasses the cognitive and social skills necessary for individuals to obtain, comprehend, communicate, calculate, and process medication-related information necessary to make informed decisions. Personal and contextual factors are widely recognized to influence the way that individuals acquire and maintain medication literacy skills. Despite a growing number of studies on medication literacy, current definitions remain general, lacking consideration for the specificities of older adults and hospitalization.Objective:The project was conducted to identify, compare, and summarize the attributes, antecedents, and consequences of medication literacy in hospitalized older adults and to propose a refined definition.Methods:A three-phase hybrid model of concept development was performed that included a literature review and focus groups with hospital nurses. In the final analytic phase, findings from the literature and focus groups were compared, and a refined definition of the concept was elaborated.Key Results:From the synthesis of 24 publications and the narrative data of 14 hospital nurses, 19 themes were described: 4 related to attributes, 8 to antecedents, and 7 to consequences. Medication literacy of hospitalized older adults has been further defined as the degree to which older adults and/or their natural caregivers can develop and maintain multidimensional skills, namely functional, interactive, and critical medication literacy skills. Adjustment of these skills is characterized by a dynamic and potentially complex process. In practice, optimal medication literacy might be achieved through control of and involvement in the medication regimen and the decisions related to it, and/or by using practical means to facilitate medication self-management (e.g., using lists, notes, reminders).Conclusions:The proposed refined definition might enhance professionals' common understanding of the concept and its application in practice, policy, and research. Managing a medication regimen is a complex activity that requires a high level of integration and coordination of cognitive and social skills. [HLRP: Health Literacy Research and Practice. 2022;6(2):e70–e83.]Plain Language Summary:Based on the literature on medication literacy and the experiences of nurses working in hospitals, this article defines medication literacy in hospitalized older adults. This definition will help professionals to better understand challenges related to medication literacy in older patients and to propose adequate support (i.e., provide education, simplify medication prescriptions, propose practical aids such as a pillbox).