Medicine Regimen Research Articles

Empowering Patients with Persistent Pain Using an Internet-based Self-Management Program

New strategies are needed to improve access to cognitive and behavioral therapies for patients with persistent pain. The purpose of this randomized, controlled trial was to determine the effectiveness of the Chronic Pain Management Program, an 8-week online intervention targeting cognitive, emotional, behavioral, and social pain determinants. Program efficacy and engagement was evaluated for 92 individuals with a diagnosis of chronic noncancer pain who had a current opioid prescription. Participants were recruited from primary care practices and Internet sites, then randomly assigned to receive access to the intervention either immediately (treatment group) or after an 8-week delay (wait-list comparison). Biweekly self-report measurements were collected using online surveys on pain, depressive symptoms, pain self-management behaviors, and health care utilization during the 8-week trial. Additional measurements of opioid misuse behaviors, pain self-efficacy, and medicine regimens were completed at baseline and week 8. Engagement was evaluated by examining completion of program learning modules. The results from analysis of variance showed that at week 8, the treatment group had significantly greater improvements on pain self-efficacy and opioid misuse measures than the wait-list comparison group. Engagement level was positively associated with improvements in pain intensity, pain interference, and pain self-efficacy. In conclusion, patients on opioids were able to engage and demonstrate positive outcomes using an Internet-based self-management program. Future efforts toward heightening engagement could further maximize impacts.

G26 Parents’ experiences of administering and manipulating medicines for children with long term chronic conditions

Aims To explore the experiences and methods used by parents to administer long term medicines to their children. Methods Semi structured qualitative interviews with parents of children who are prescribed long term medication for a chronic condition. Interviews were audio recorded and transcribed. Analysis was inductive and informed by the principles of grounded theory and constant comparison method. Results Semi structured interviews with the parents of 13 (N = 12) children between 5 to 11 years; female (n = 5) and male (n = 8). The sample is currently being extending to include the parents of up to 20 children. Parent’s accounts were variable. Some parents reported no problems administering medicines to their child but other parents described prolonged ‘battles’. Taste was cited as the main reason for a child refusing a medicine. Some methods used by parents to encourage children to comply with medication, such as rewards and reasoning are commonly used by parents giving short term medicines but these methods needed to be regularly adapted over time as their effect wore off. Parents also described ordering medicines, giving two medicines together or missing medicine doses in order to reduce ‘battles’ and increase compliance. Parents were confident in manipulating medicines (cutting, crushing or splitting tablets etc.), but had concerns about controlling the dose their child received e.g. tablets crumbling. Similarly, parents did not favour disguising medicines in food or drink as they felt this method did not work, risked losing the trust of their child, and their child potentially refusing that particular food or drink in the future. Furthermore, parents had concerns about controlling the dose of a medicine using this method. Conclusion Some parents described ‘battles’ over administering medicine to their children that had a significant and negative impact on daily family life. Taste was the major barrier to compliance. Methods perceived as favourable by clinicians, such as disguising medicines in food and drink, were not favoured by parents who employed a range of alternative strategies, some of which involved altering medicine regimens and was not supported by evidence.

Older people's experience of utilisation and administration of medicines in a health‐ and social care context

People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care. The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care. A qualitative descriptive study. Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used. The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process. Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine. A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.

Djuna Barnes and the Geriatric Avant-Garde

Though her publications were slight after she permanently moved to Greenwich Village, in New York City, in 1940, Djuna Barnes labored over scores of literary and nonliterary typescript drafts from the 1940s to the 1980s. This unpublished artwork constitutes a geriatric avant-garde that deepened her earlier investments in modernist aesthetics. Archived documents record the elderly writer performing the principles of high modernism—innovation, experimentalism, and novelty—across an unprecedented array of genres, such as the poem, the pharmacy order, the grocery list, the medicine regimen, the memo, and personal correspondence. This article reassesses gerontophobic depictions of Barnes as an aged recluse who lived a creatively fruitless late life. The underex-plored works of her senior years are a unique version of what Eve Kosofsky Sedgwick calls “a senile sublime.”

An investigation of the effects of therapeutic touch plan on acute chemotherapy-induced nausea in women with breast cancer in Isfahan, Iran, 2012-2013.

Introduction:Nausea is the worst and most prevalent chemotherapy-induced complication experienced by 70–80% of patients despite mediation therapy. Reduction of nausea is one of the most important roles of oncologist nurses. Today, complementary therapies in addition to classic medicine, because of their lower costs, receive much attention. Nonetheless, their safety and effectiveness are not yet proven. The purpose of this research was to investigate the effect of therapeutic touch plan as a complementary therapy on acute nausea in women with breast cancer in 2012–2013 in Isfahan, Iran.Materials and Methods:A quasi-experimental, single-blind, randomized control trial with three groups (control, placebo and intervention) was performed at the Isfahan Seyedolshohada (AS) Teaching Hospital, Isfahan, in 2012–2013. The intervention was therapeutic touch plan on women with breast cancer, with the three groups receiving the same medicine regimen. Information was recorded by a checklist after infusion of chemotherapy drugs. Data analysis was performed by SPSS, ANOVA and Kruskal–Wallis tests.Results:The ANOVA test showed that the therapeutic touch plan was significantly effective in reducing the duration of nausea compared with the control and placebo groups (P < 0.001). The Kruskal–Wallis test showed that the frequency of occurrence of nausea was also reduced in the intervention and placebo groups compared with the control group (P < 0.001). The therapeutic touch plan was significantly effective in delaying the onset of nausea compared with the control and placebo groups (P < 0.001).Conclusion:This research showed that the therapeutic touch plan is effective in reducing acute chemotherapy-induced nausea; thus, education and implementation of the therapeutic touch plan is proposed for clinical nurses.

Palliative and end of life care for people with diabetes: a topical issue

SUMMARY Managing diabetes is challenging, especially in palliative and end-of-life situations. The prime focus is usually on safety, comfort and quality of life rather than on achieving ‘tight’ blood glucose control. Preventing hypo- and hyper-glycemia is an important aspect of comfort and quality of life. The care plan and blood glucose targets need to be personalized to suit the individual's health and functional status, medicine regimen, risk profile and life expectancy, and, importantly, developed with the individual and sometimes their family carers. Once developed, the care plan should be monitored and reviewed regularly to accommodate changing health status and ensure the person's documented wishes are current. Key care challenges include detecting symptoms of hypo- and hyper-glycemia and determining their underlying causes so appropriate care can be initiated. Health professionals often find it difficult to decide on a management plan and when to withdraw treatment in rapidly changing circumstanc...

Medication incidents related to automated dose dispensing in community pharmacies and hospitals--a reporting system study.

IntroductionAutomated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals.MethodsThe medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR) reporting system were selected and characterized independently by two researchers.Main Outcome MeasuresPerson discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident.ResultsFrom January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4%) incidents from community pharmacies and 11,428 (75.6%) incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8%) were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2%) were related to ADD than in hospitals (41/11,428 = 0.4%). The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag.ConclusionA proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an incident.

Polypharmacy issues in older adults

Polypharmacy is a major concern in the care of older adults. People over 65 years of age frequently have multiple medical conditions and may have cancer, which requires multiple medications for treatment. The use of multiple medications increases the risk of drug-drug interactions, non-adherence, and adverse drug reactions. Polypharmacy is a term that refers to a high number of prescribed medications, usually five and above, or the use of more medications than is clinically justified. Although medications are an important factor in improving and maintaining the quality of life of older adults, polypharmacy increases the risks of morbidity and mortality, loss of functional independence, and a multiplicity of cognitive and physical problems in this population. This article examines issues related to polypharmacy in older adults and identifies nursing strategies and interventions to detect and prevent polypharmacy. Nursing strategies discussed include: (1) increasing patient knowledge of pharmacological issues, (2) increasing patient medication management competency, (3) promoting safe patient medication practices, and (4) enhancing patient education. Nurses must be familiar with medicine regimens, understand the primary factors that affect adherence, and participate in continuing education to enhance their ability to safeguard older adult patients.

Homeopathic treatment in addition to standard care in multi drug resistant pulmonary tuberculosis: a randomized, double blind, placebo controlled clinical trial

Multi drug resistant-tuberculosis (MDR-TB) [resistant to Isoniazid and Rifampicin] is a major global public health problem. In India the incidence is rising in spite of implementation of Revised National Tuberculosis Control Program. Standard MDR-TB drugs are second generation antibiotics taken for 24-27 months. The present study was undertaken to evaluate the efficacy of add on homeopathic intervention to the standard MDR-TB regimen (SR). A randomized, double blind, placebo controlled study was conducted from 2003 to 2008. 120 diagnosed MDR-TB patients (both culture positive and negative) were enrolled and randomized to receive Standard Regimen+individualized homeopathic medicine (SR+H) or Standard Regimen+identical placebo (SR+P). The medicines have been used in infrequent doses. The outcome measures were sputum conversion, changes in chest X-ray (CXR), hemoglobin, erythrocyte sedimentation rate (ESR), weight gain, and clinical improvement. There was an improvement in all the outcome measures as per intention to treat (ITT) and per protocol (PP) analyses. ITT analyses revealed sputum culture conversion from positive to negative in 23 (38.3%) in SR+H; 23 (38.3%) patients in SR+P group; (p=0.269) and 27 (55.1); 21 (42.8%), p=0.225 as PP analyses. The mean weight gain in SR+H group was 2.4±4.9 and in SR+P was 0.8±4.4; [p=0.071], reduction in ESR in SR+H was -8.7±13.2; SR+P was 3.9±15.4 [p=0.068]. The mean increase in hemoglobin was by 0.6±1.7 in SR+H & 0.3±2.3 [p=0.440] in SR+P group at 95% confidence interval. Statistically significant improvement was seen in CXR in 37 (61.7%) in SR+H and 20 (33.3%) patients in SR+P group (p=0.002). Subgroup analyses of culture positive patients showed statistically significant improvement in CXR (p=0.0005), weight gain (p=0.026), increase in hemoglobin (p=0.017) and reduction in ESR (p=0.025) with add on homeopathy. The cure rate was 11.4% more in SR+H group as compared to placebo group. Change in sputum culture conversion, was not statistically significant. Add on homeopathy in addition to standard therapy appears to improve outcome in MDR-TB. Larger scale studies using a standardized homeopathic treatment regime should be conducted.

MEDICINE NON‐ADHERENCE IN KIDNEY TRANSPLANTATION

The increasing prevalence of chronic kidney disease, the relative shortage of kidney donors and the economic- and health-related costs of kidney transplant rejection make the prevention of adverse outcomes following transplantation a healthcare imperative. Although strict adherence to immunosuppressant medicine regimens is key to preventing kidney rejection, evidence suggests that adherence is sub-optimal. Strategies need to be developed to help recipients of kidney transplants adhere to their prescribed medicines. This review has found that a number of factors contribute to poor adherence, for example, attitudes towards medicine taking and forgetfulness. Few investigations have been conducted, however, on strategies to enhance medicine adherence in kidney transplant recipients. Strategies that may improve adherence include pharmacist-led interventions (incorporating counselling, medicine reviews and nephrologist liaison) and nurse-led interventions (involving collaboratively working with recipients to understand their routines and offering solutions to improve adherence). Strategies that have shown to have limited effectiveness include supplying medicines free of charge and providing feedback on a participant's medicine adherence without any educational or behavioural interventions. Transplantation is the preferred treatment option for people with end-stage kidney disease. Medicine non-adherence in kidney transplantation increases the risk of rejection, kidney loss and costly treatments. Interventions are needed to help the transplant recipient take all their medicines as prescribed to improve general well-being, medicine safety and reduce healthcare costs.

CP-023 Effect of treatment complexity on medicines adherence and incidence of blips in HIV/HCV co-infected patients

BackgroundAnti-HCV treatment may add significant complexity to antiretroviral treatment (ART). The complexity of the medicines regimen could be a risk factor for non-adherence or increasing incidence of blips.PurposeTo determine if...

CP-137 Ensuring safe medical treatment during planned hospital admission by clinical pharmacist telephone contact

BackgroundMedicines lists are often incomplete, with a lot of discrepancies, which may lead to adverse drug events during hospitalisation and after discharge. In Denmark no single electronic system contains all...

Glucose Lowering Medicines and Older People with Diabetes: The Importance of Comprehensive Assessments and Pharmacovigilance

Diabetes is a chronic incurable disease of high prevalence in older people due to changes in glucose homeostasis, diabetes-related complications and other comorbidities that affect physical and cognitive functioning and have implications for medicines use. Polypharmacy is common and represents a significant medicine and selfcare burden, risk of medicine-related adverse events, and inappropriate prescribing. Some medicines used to treat diabetes such as insulin, sulphonylureas, warfarin and antiplatelet agents are known as ‘high risk’ medicines because of their association with adverse events. Managing medicines is a complex process that requires particular knowledge and skills and strategies to proactively identify risks and plan care to reduce the risk such as following evidence based recommendations/ guidelines, comprehensive assessment and monitoring, using decision support tools such as BEERs, STOPP and START criteria, and importantly, involving the individual and/or carers in medicine decisions to personalise medicines education and the medicine regimen.

Recent Advances towards Validating Efficacy and Safety of African Traditional Medicines

Recent Advances towards Validating Efficacy and Safety of African Traditional Medicines

Exploring motivation and confidence in taking prescribed medicines in coexisting diseases: a qualitative study

To explore the motivation and confidence of people with coexisting diabetes, chronic kidney disease (CKD) and hypertension to take their medicines as prescribed. These comorbidities are major contributors to disease burden globally. Self-management of individuals with these coexisting diseases is much more complicated than that of those with single diseases and is critical for improved health outcomes. Motivational interviewing telephone calls were made with participants with coexisting diabetes, CKD and hypertension. Patients aged ≥18 years with diabetes, CKD and systolic hypertension were recruited from outpatient clinics of an Australian metropolitan hospital between 2008-2009. An average of four motivational interviewing telephone calls was made with participants (n = 39) in the intervention arm of a randomised controlled trial. Data were thematically analysed using the modified Health Belief Model as a framework. Participants' motivation and confidence in taking prescribed medicines was thwarted by complex medicine regimens and medical conditions. Participants wanted control over their health and developed various strategies to confront threats to health. The perceived barriers of taking recommended health action outweighed the benefits of taking medicines as prescribed and were primarily related to copious amounts of medicines. Taking multiple prescribed medicines in coexisting diabetes, CKD and hypertension is a perpetual vocation with major psychosocial effects. Participants were overwhelmed by the number of medicines that they were required to take. The quest for personal control of health, fear of the future and the role of stress and gender in chronic disease management have been highlighted. Participants require supportive emotional interventions to self-manage their multiple medicines on a daily basis. Reducing the complexity of medicine regimens in coexisting diseases is paramount. Individualised psychosocial approaches that address the emotional needs of patients with regular follow-up and feedback are necessary for optimal chronic disease self-management.

Low-income patients failing to adhere to medicine regimen for rheumatoid arthritis

Low-income patients failing to adhere to medicine regimen for rheumatoid arthritis

Traditional herbal medicine in preventing recurrence after resection of small hepatocellular carcinoma: a multicenter randomized controlled trial

BackgroundDisease recurrence is a main challenge in treatment of hepatocellular carcinoma (HCC). There is no generally accepted method for preventing recurrence of HCC after resection. ObjectiveTo compare the efficacy of a traditional herbal medicine (THM) regimen and transarterial chemoembolization (TACE) in preventing recurrence in post-resection patients with small HCC. Design, setting, participants and interventionsThis is a multicenter, open-label, randomized, controlled study, which was undertaken in five centers of China. A total of 379 patients who met the eligibility criteria and underwent randomization were enrolled in this trial. One hundred and eighty-eight patients were assigned to the THM group and received Cinobufacini injection and Jiedu Granule, and the other 191 patients were assigned to the TACE group and received one single course of TACE. Main outcome measuresPrimary outcome measures were the annual recurrence rate and the time to recurrence. Incidence of adverse events was regarded as the secondary outcome measure. ResultsAmong the 364 patients who were included in the intention-to-treat analysis, 67 patients of the THM group and 87 of the TACE group had recurrence, with a hazard ratio of 0.695 (P = 0.048). Median recurrence-free survival of the patients in the THM and TACE groups was 46.89 and 34.49 months, respectively. Recurrence rates at 1, 2 and 3 years were 17.7%, 33.0% and 43.5% for the THM group, and 28.8%, 42.5% and 54.0% for the TACE group, respectively (P = 0.026). Multivariate analysis indicated that the THM regimen had a big advantage for prolonging the recurrence-free survival. Adverse events were mild and abnormality of laboratory indices of the two groups were similar. ConclusionIn comparison with TACE therapy, the THM regimen was associated with diminished risk of recurrence of small-sized HCC after resection, with comparable adverse events. Trial registrtion identifierThis trial was registered in the Chinese Clinical Trial Registry with the identifier ChiCTR–TRC-07000033.

Medication information seeking behavior of patients who use multiple medicines: How does it affect adherence?

ObjectiveThis article explores medication information seeking behavior (MISB). We aimed to develop a scale for measuring MISB and use it to explore the relationships between MISB, adherence and factors, which drive information seeking. MethodsPatients (N=910) using multiple medicines completed questionnaires. Exploratory and confirmatory factor analyses were performed. Correlations and multivariate analyses were used to investigate the relationships between variables. ResultsRespondents sought medication information mainly from health professionals and written medicines information. The medication information seeking behavior scale (MISB) had acceptable reliability and validity. Information seeking was most intense among respondents who had recent changes in their medicine regimen and worries about their medicines. Those who sought medication information from autonomous sources were more likely to be non-adherent than those who never did (OR=2.00 [1.48, 2.70]). Seeking information from health professionals had no influence on adherence. ConclusionHealth practitioners should carefully attend to patients’ questions about medicines information. When patients mention that they are worried about their medicines and have sought medication information from television, magazines, brochures or family and friends, this could be a sign that they tend towards non-adherent behavior. Practice implicationsThe MISB scale could be used to learn more about patients’ use of medication information.

Pigment Dispersion Glaucoma Induced by the Chafing Effect of Intraocular Lens Haptics in Asian Eyes

ABSTRACTPurpose: To study the possible mechanism and treatment for pigment dispersion glaucoma (PDG) caused by single-piece acrylic (SPA) intraocular lens (IOL) ciliary sulcus fixation in Asian eyes.Materials and methods: Patients referred for PDG caused by SPA IOL ciliary sulcus fixation to our hospital from April 2005 to June 2011 were included. The patients’ general information, IOL type, interval between initial surgery and PDG occurrence, examination findings, antiglaucoma medicine regimen and surgical interventions were recorded.Results: In total, six eyes from five Chinese patients were included in this study. The intraocular pressure (IOP) increased 19–30 days after cataract surgery and was not satisfactorily controlled with antiglaucoma medication. Dense pigmentation was deposited on the IOLs and on the anterior chamber angle. IOL haptic chafing was noted on the rear iris surface. IOL repositioning in the capsular bag was performed in three eyes and was combined with trabeculectomy in two eyes with progressive glaucoma. An IOL exchange with three-piece IOL ciliary sulcus fixation was performed in the other three eyes. Scanning electron microscopy of the explanted IOLs demonstrated a rough edge on the IOL haptics.Conclusions: SPA IOLs were not suitable for ciliary sulcus fixation. The chafing effect of the IOL haptics on the posterior iris pigment epithelium could induce PDG in Asian eyes. IOLs should be positioned in the capsular bag or a three-piece IOL should be used instead.

Pharmacist-detected inappropriate medicines and recommendations made regarding a change of medicines in the emergency ward

BackgroundEmergency departments have serious concerns about drug safety. Inappropriate medicines are common. Medicines charts may often remain incomplete. Physicians and nurses may not have enough time to review medicines charts...