scholarly journals Development, Testing and Results of a Patient Medication Experience Documentation Tool for Use in Comprehensive Medication Management Services

Pharmacy ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 71 ◽  
Author(s):  
Stephanie Redmond ◽  
Nicole Paterson ◽  
Sarah J. Shoemaker-Hunt ◽  
Djenane Ramalho-de-Oliveira
Keyword(s):  
Subjective Experience ◽  
Medication Management ◽  
Teaching Tool ◽  
Patient Centered ◽  
Patient Medication ◽  
Raising Awareness ◽  
Medication Experience ◽  
Documentation Tool ◽  
Drug Therapy Problems

The medication experience is an individual’s subjective experience of taking a medication in daily life and can be at the root of drug therapy problems. It is recommended that the patient-centered approach to comprehensive medication management (CMM) starts with an understanding of the patient’s medication experience. This study aims to develop a medication experience documentation tool for use in CMM services, and to understand the usefulness and challenges of using the tool in practice. The tool was developed based on previous research on patients’ medication experiences. It was tested in two rounds by ten CMM pharmacists utilizing the tool as they provided care to patients. Focus groups were conducted to revise the tool after each round and to understand pharmacists’ experiences. The tool was tested for 15 weeks in 407 patient encounters. There was at least one medication experience documented in the electronic medical record 62% of the time. Pharmacists found the tool helpful in raising awareness of the medication experience and motivational interviewing strategies, planning for follow-up visits, as a teaching tool, and making pharmacists realize the fluidity of the medication experience. The tool offered pharmacists a better way to recognize and address medication experiences affecting medication taking behaviors.

scholarly journals Evaluation of a Revised Home Medication Experience Questionnaire (HOME-Qv2)

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 169
Author(s):  
Matthew J. Witry ◽  
Olajide O. Fadare ◽  
Kassi Pham
Keyword(s):  
Pharmacist Intervention ◽  
Chronic Illnesses ◽  
Prescription Medications ◽  
Home Medication ◽  
Patient Medication ◽  
Patient Responses ◽  
Medication Experience ◽  
Patient Disclosure ◽  
Experience Questionnaire

The Home Medication Experience Questionnaire (HOME-Qv2) was developed to identify patient medication experience issues for pharmacist intervention. The study objectives were to (1) evaluate patient responses to the HOME-Qv2 medication experience questionnaire and (2) describe recommendations made by pharmacists in response to the identified medication experience issues and adoption of recommendations. The study sample was comprised of older adults, 55 years and above, who have one or more chronic illnesses for which they routinely take 4+ prescription medications. The HOME-Qv2 was administered to patients and a pharmacist made recommendations based on the responses. At 3 months, the research team followed up with participants via telephone, during which the HOME-Qv2 was again administered and participants shared their adoption of recommendations. Twenty-four patients completed the questionnaire, and twenty-one were available for follow-up. At 3 months, there was a significant decrease in patient self-reported HOME-Qv2 medication experience issues. There were 31 interventions/recommendations provided by the pharmacists, and 64.5% reported adopted. The HOME-Qv2 appears to facilitate patient disclosure of medication experience issues and informed targeted pharmacist recommendations.

scholarly journals Implementing a Pharmacist-Led Medication Management Pilot to Improve Care Transitions

2012 ◽  
Vol 3 (2) ◽  
Author(s):  
Rachel Root ◽  
Pamela Phelps ◽  
Amanda Brummel ◽  
Craig Else
Keyword(s):  
Primary Care ◽  
Drug Therapy ◽  
Health System ◽  
Medication Management ◽  
Care Transitions ◽  
Care Visit ◽  
Discharge Medication ◽  
Drug Therapy Problems ◽  
The Continuum

Purpose: The purpose of this project was to design and pilot a pharmacist-led process to address medication management across the continuum of care within a large integrated health-system. Summary: A care transitions pilot took place within a health-system which included a 150-bed community hospital. The pilot process expanded the pharmacist's medication management responsibilities to include providing discharge medication reconciliation, a patient-friendly discharge medication list, discharge medication education, and medication therapy management (MTM) follow-up. Adult patients with a predicted diagnosis-related group (DRG) of congestive heart failure or chronic obstructive pulmonary disease admitted to the medical-surgical and intensive care units who utilized a primary care provider within the health-system were included in the pilot. Forty patients met the inclusion criteria and thirty-four (85%) received an intervention from an inpatient or MTM pharmacist. Within this group of patients, 88 drug therapy problems (2.6 per patient) were identified and 75% of the drug therapy recommendations made by the pharmacist were accepted by the care provider. The 30-day all-cause readmission rates for the intervention and comparison groups were 30.5% and 35.9%, respectively. The number of patients receiving follow-up care varied with 10 (25%) receiving MTM follow-up, 26 (65%) completing a primary care visit after their first hospital discharge, and 23 (58%) receiving a home care visit. Conclusion: Implementation of a pharmacist-led medication management pilot across the continuum of care resulted in an improvement in the quality of care transitions within the health-system through increased identification and resolution of drug therapy problems and MTM follow-up. The lessons learned from the implementation of this pilot will be used to further refine pharmacy care transitions programs across the health-system.   Type: Original Research

Pharmacist-patient medication communication during admission and discharge in specialty hospital settings: implications for person centered healthcare

2015 ◽  
Vol 4 (2) ◽  
pp. 90-105
Author(s):  
Sandra Braaf ◽  
Sascha Rixon ◽  
Allison Williams ◽  
Danny Lieu ◽  
Elizabeth Manias
Keyword(s):  
Participant Observation ◽  
Medication Management ◽  
Community Pharmacists ◽  
Structured Interviews ◽  
Patient Centered ◽  
Patient Medication ◽  
Specialty Hospital ◽  
Oncology Care ◽  
Transition Points ◽  
Medication Incidents

Background Hospital admission and discharge are critical transition points for patients’ medication management. Effective communication between pharmacists and patients at these transition points has the potential to mitigate medication incidents. Previous research has examined communication among community pharmacists and patients. Limited research has explored the complexities of communication between hospital pharmacists and patients during admission and discharge interactions.Objective To explore the complexities of pharmacist-patient medication communication during medication admission and discharge in specialty hospital settings.Methods The study was conducted at a metropolitan Australian public hospital. An exploratory qualitative design was used involving the methods of semi-structured interviews and participant observation. Interviews and observations were undertaken in five specialty settings: cardiothoracic care, intensive care, emergency care, oncology care and perioperative care. A comprehensive thematic analysis of the data was performed.Results Twelve pharmacists and 69 patients participated in interviews and observations for the study. Over 200 hours of observational data were collected. In total, 26 medication admissions and 35 medication discharges were observed. Pharmacists regulated communication with patients by using structured communication tools. When providing or gathering information, pharmacists controlled the level of patient engagement. Words used in pharmacist-patient communication were sometimes ambiguous and occasionally miscommunication resulted. Patients sought minimal information from pharmacists.Conclusions Pharmacists need to apply patient-centered principles, and encourage active patient involvement, in admission and discharge conversations.

scholarly journals Impact of a Medication Adherence Packaging Service on Patient-Centered Outcomes at an Independent Community Pharmacy

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 11
Author(s):  
Catherine Phi ◽  
Lucas A. Berenbrok ◽  
Joni C. Carroll ◽  
Ashley Firm ◽  
Melissa Somma McGivney ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Medication Adherence ◽  
Community Pharmacy ◽  
Medication Management ◽  
Patient Centered ◽  
Verbal Responses ◽  
Patient Medication ◽  
Perceived Quality Of Life ◽  
The Impact

The purpose of this project was to evaluate the impact of a comprehensive medication adherence packaging (RxMAP) service on patient medication-taking behaviors and patient-centered outcomes. Adult patients who utilized a single independent community pharmacy, enrolled in the RxMAP service for at least two consecutive cycles, and managed their own medications were eligible. The RxMAP service consists of multi-dose blister packaging in 28-day cycles, medication synchronization, monthly touchpoint calls, and delivery/mailing. A 13-item telephonic survey was administered, and patients’ verbal responses were captured by audio-recording and detailed note taking. Descriptive statistics were used to quantify the results and illustrative quotes representing the interview domains were selected. There were 42 patients who completed the survey: 88% reported they missed fewer doses compared to before using RxMAP; 71% were more likely to take their medications on time each day; 86% were more confident with managing their medications; and 74% were more independent. Finally, 64% of patients stated their overall quality of life was better now compared to before using the packaging service. These results demonstrate that medication adherence packaging services can positively impact patients’ medication-taking behaviors, increase their confidence in medication management, and improve perceived quality of life.

scholarly journals Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092879
Author(s):  
Katarina Fehir Šola ◽  
Iva Mucalo ◽  
Andrea Brajković ◽  
Ivona Jukić ◽  
Donatella Verbanac ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Therapy ◽  
Medication Management ◽  
Institutional Care ◽  
Nursing Home Residents ◽  
Median Number ◽  
Cross Sectional ◽  
High Prevalence ◽  
Care Facilities ◽  
Drug Therapy Problems

Objective The aim of this study was to determine the frequency and type of drug therapy problems (DTPs) in older institutionalized adults. Method We conducted a cross-sectional observational study from February to June 2016 at a 150-bed public nursing home in Croatia, where comprehensive medication management (CMM) services were provided. A rational decision-making process, referred to as the Pharmacotherapy Workup method, was used to classify DTPs. Results Data were prospectively collected from 73 residents, among which 71% were age 75 years or older. The median number of prescribed medications per patient was 7 (2–16) and polypharmacy (> 4) was recorded for 54 (74.0%) patients. A total 313 DTPs were identified, with an average of 4.3 ± 2 DTPs per patient. The most frequent DTP was needing additional drug therapy (n = 118; 37.7%), followed by adverse drug reaction (n = 55; 17.6%). Lactulose (14.4%), tramadol (6.7%), and potassium (6.4%) were the medications most frequently related to DTPs. Conclusion The high prevalence of DTPs identified among older institutionalized adults strongly suggests the need to incorporate new pharmacist-led CMM services within existing institutional care facilities, to improve the care provided to nursing home residents.

scholarly journals Optimising medication management in children and young people with ADHD using a computerised test (QbTest): a feasibility randomised controlled trial

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Laura Williams ◽  
Charlotte L. Hall ◽  
Sue Brown ◽  
Boliang Guo ◽  
Marilyn James ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Young People ◽  
Controlled Trial ◽  
Medication Management ◽  
Control Group ◽  
Global Functioning ◽  
Children And Young People ◽  
Link Type ◽  
Randomised Controlled

Abstract Background Medication for attention deficit hyperactivity disorder (ADHD) should be closely monitored to ensure optimisation. There is growing interest in using computerised assessments of ADHD symptoms to support medication monitoring. The aim of this study was to assess the feasibility and acceptability of a randomised controlled trial (RCT) to evaluate the efficacy of one such computerised assessment, the Quantified Behavior (Qb) Test, as part of medication management for ADHD. Methods This feasibility multi-site RCT conducted in child and adolescent mental health and community paediatric settings recruited participants aged 6–15 years diagnosed with ADHD starting stimulant medication. Participants were randomised into one of two arms: experimental (QbTest protocol) where participants completed a QbTest at baseline and two follow-up QbTests on medication (2–4 weeks and 8–10 weeks later) and control where participants received treatment as usual, including at least two follow-up consultations. Measures of parent, teacher, and clinician-rated symptoms and global functioning were completed at each time point. Clinicians recorded treatment decision-making and health economic measures were obtained. Data were analysed using multi-level modelling and participants (children and parents) and clinicians were interviewed about their experiences, resulting data were thematically analysed. Results Forty-four children and young people were randomised. Completion of study outcome measures by care-givers and teachers ranged from 52 to 78% at baseline to 47–65% at follow-up. Participants reported the questionnaires to be useful to complete. SNAP-IV inattention scores showed greater reduction in the intervention than the control group (− 5.85, 95% CI − 10.33, − 1.36,). Engagement with the intervention ranged from 100% at baseline, to 78% follow-up 1 and 57% follow-up 2. However, only 37% of QbTests were conducted in the correct time period. Interview data highlighted that the objectivity of the QbTest was appreciated by clinicians and parents. Clinicians commented that the additional time and resources required meant that it is not feasible to use QbTest for all cases. Conclusion The trial design and protocol appear to be feasible and acceptable but could be improved by modifying QbTest time periods and the method of data collection. With these changes, the protocol may be appropriate for a full trial. Adding QbTest may improve symptom outcome as measured by SNAP-IV. Trial registration ClinicalTrials.gov, NCT03368573, prospectively registered, 11th December 2017, and ISRCTN, ISRCTN69461593, retrospectively registered, 10th April 2018

scholarly journals Reframing the Medication Experience in Pharmacy Using Seminal Concepts of Patient-Centered Care—Implications for Practice

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 9
Author(s):  
Brian Isetts ◽  
Anthony Olson ◽  
Jon Schommer
Keyword(s):  
Therapeutic Relationship ◽  
Secondary Analysis ◽  
Patient Centered Care ◽  
National Sample ◽  
Patient Specific ◽  
Structured Interviews ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care ◽  
Medication Experience

Team-based, Patient-Centered Care is essential to chronic disease prevention and management but there are differing ideas about the concept’s meaning across healthcare populations, settings and professions. This commentary’s objective is to empirically evaluate the theoretical relationships of the [a] Medication Experience, [b] Patient-Centeredness and other relevant component concepts from pharmaceutical care (i.e., [c] Therapeutic Relationship, [d] Patient-specific preferences for achieving goals of therapy and resolving drug therapy problems) so as to provide practice-based insights. This is achieved using a secondary analysis of 213 excerpts generated from in-depth semi-structured interviews with a national sample of pharmacists and patients about Patient-Centeredness in pharmacist practice. The four component concepts (i.e., a–d) related to the objective were examined and interpreted using a novel 3-archetype heuristic (i.e., Partner, Client and Customer) revealing common practice-based themes related to care preferences and expectations in collaborative goal setting, enduring relationships, value co-creation and evolving patient expectations during challenging medical circumstances. Most practice-based insights were generated within the Partner archetype, likely reflecting high congruence with pharmacist and patient responses related to the Medication Experience and Therapeutic Relationship. The practice-based insights may be especially useful for new practitioners and students accelerating their advancement in providing effective and efficient Patient-Centered Care.

scholarly journals Patient-Centered Integrated Motor Imagery Delivered in the Home With Telerehabilitation to Improve Walking After Stroke

2012 ◽  
Vol 92 (8) ◽  
pp. 1065-1077 ◽  
Author(s):  
Judith E. Deutsch ◽  
Inbal Maidan ◽  
Ruth Dickstein
Keyword(s):  
Motor Imagery ◽  
Assisted Living ◽  
Chronic Phase ◽  
Patient Centered ◽  
Balance Confidence ◽  
Obstacle Clearance ◽  
Gait Parameters ◽  
Walking Recovery ◽  
Therapy Sessions

Background and Purpose This case report describes the clinical reasoning process used to examine a person after stroke and intervene with a novel integrated motor imagery treatment designed for the rehabilitation of walking and delivered in the home through telerehabilitation. The integrated motor imagery treatment consisted of patient-centered goal setting and physical practice combined with motor and motivational imagery. Case Description The patient was a 38-year-old woman who had had a diffuse left subarachnoid hemorrhagic stroke 10 years earlier. She lived independently in an assisted living complex and carried a straight cane during long walks or in unfamiliar environments. Examination revealed a slow gait speed, reduced walking endurance, and decreased balance confidence. Although she was in the chronic phase, patient-centered integrated motor imagery was predicted to improve her community mobility. Treatment sessions of 45 to 60 minutes were held 3 times per week for 4 weeks. The practiced tasks included transitioning from sitting to standing, obstacle clearance, and navigation in interior and exterior environments; these tasks were first executed and then imagined at ratios of 1:5. Task execution allowed the creation of a scene based on movement observation. Imagery scenarios were customized to address the patient's goals and observed movement problems. Motivational elements of arousal, problem solving, and reward were embedded in the imagery scenarios. Half of the sessions were provided on site, and the remaining sessions were delivered remotely. Seven sessions were delivered by the clinician in the home, and 5 sessions were delivered using telerehabilitation. Outcomes Improvements in motor imagery ability, gait parameters, and balance were observed after training. Most gains were retained at the 3-month follow-up. Compared with on-site delivery, the telerehabilitation sessions resulted in less therapist travel time and cost, as well as shorter therapy sessions. Discussion The delivery of integrated motor imagery practice for walking recovery was feasible both on site and remotely.

scholarly journals Evaluation of a computer-based nutrition education tool

2004 ◽  
Vol 7 (2) ◽  
pp. 271-277 ◽  
Author(s):  
Katrin Kreisel
Keyword(s):  
Student Teachers ◽  
Nutrition Education ◽  
Repeated Measures ◽  
Nutrition Knowledge ◽  
Primary School Children ◽  
Teaching Tool ◽  
School Based ◽  
Computer Based ◽  
Dependent Samples

AbstractObjective:To evaluate the efficacy and feasibility of using a computer-based teaching tool (http://www.coolfoodplanet.org) for nutrition and lifestyle education developed for primary school children.Design:This was a 2-week school-based intervention in third and fourth grades. The study design was multi-factorial with repeated measures of nutrition knowledge, at three points in time, of dependent samples from control and intervention groups. Control schools (n=7) used ‘traditional’ nutrition education materials and intervention schools (n=8) additionally used the computer-based educational tool. Qualitative information was collected in focus group discussions with student teachers and pupils, and by observing the nutrition lessons.Setting/subjects:Pupils aged 8–11 years (n=271) from participating schools in Vienna, Austria.Results:Nutrition knowledge increased significantly in both intervention and control schools, irrespective of the teaching tool used (P<0.001). The significant effect was maintained at 3 months' follow-up. There was no detectable difference in nutrition knowledge post intervention or at follow-up between the two study groups. In intervention schools, younger pupils (8–9 years) had better nutrition knowledge than older pupils (10–11 years) (P=0.011).Conclusion:This computer-based tool increases the possibilities of school-based nutrition education. If the tool's weaknesses identified during the formative evaluation are eliminated, it has the potential to make learning about nutrition more enjoyable, exciting and effective. This is of great importance considering that ‘healthy’ nutrition is not necessarily a topic that easily attracts pupils' attention and in view of the potential long-term health benefits of early and effective nutrition education.

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