Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality (Vogelmeier et al., 2017). Adherence to prescribed medications and adequate medication inhalation technique (MIT) is critical for optimal management of COPD, as is the proper use of the medication delivery device.O’Conor et al. (2019) found that lower health literacy (HL) was associated with both poor medication adherenceand MIT. HL, according to the Process-Knowledge Model, consists of both processing capacity and knowledge (Chin et al., 2017). COPD most commonly occurs in older adults (Cazzola, Donner, & Hanania, 2007). Older adults tend to have lower processing capacity (Chin et al., 2017). The purpose of this study was to determine if HL was associated with medication refill adherence (MRA)and/or MIT. Fifty-seven participants completed a questionnaire package that included demographic questions, measures of HL, and assessments of MRA and MIT. A subset of twenty patients participated in qualitative interviews. Results indicated that lower HL was associated with both lower MRA and poor MIT, and qualitative findings revealed the need for further information. Future research should focus on testing educational materials that have been designed and/or reformatted to meet the lower processing capacity of older adults.

Background: Medication adherence is critical for optimal management of chronic obstructive pulmonary disease (COPD) and is influenced by patient, treatment and societal factors. Currently, little is known about the patient perspectives of older adult Canadians with COPD regarding medication adherence. Therefore, the purpose of this study was to explore the lived experiences of older Canadian adults with COPD regarding medication adherence and management. Methods: Semi-structured interviews were conducted with 20 community-dwelling older adults with COPD, and iterative thematic analysis was performed. Results: Six themes emerged from these data: (1) continuity of care, (2) importance of pharmacy for information and care, (3) medication self-management, (4) “there needs to be more information,” (5) drug costs a concern and (6) “it’s a lonely battle.” Conclusion: Findings suggested a need for improved continuity of care, disease-related information provision and means of addressing psychosocial needs. Holistic approaches to patient education and self-management, with consideration for varying health literacy, are needed.

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Background: Sodium polystyrene sulfonate (SPS) is one of the most commonly used treatments for mild hyperkalemia. Other treatments include insulin, sodium bicarbonate, and salbutamol, which may be given alone or in combination. The results of research examining treatment effectiveness for mild hyperkalemia (e.g., the ability of SPS to achieve normokalemia) thus far have been inconsistent. Given that the effectiveness of treatment for mild hyperkalemia is debatable, new research is needed. Objective: To determine whether treatment of hospitalized patients with mild hyperkalemia (using SPS or another approach, relative to no treatment) was associated with achievement of normokalemia (serum potassium < 5.1 mmol/L). Methods: For this retrospective, quasi-experimental study, hospitalized patients with index serum potassium level between 5.1 and 6.4 mmol/L were identified. Post-index serum potassium level within 24 hours was dichotomized (< 5.1 or ≥ 5.1 mmol/L). Pre-index serum creatinine and serum potassium levels were recorded as the average of the first 5 values immediately before the index potassium value. For each patient, treatment was categorized as no treatment, SPS treatment, or other treatment strategy. Results: Among the 1944 patients included in the analysis, the average age was 66.8 (standard deviation 13.5) years; 605 (31.1%) of the patients were women and 1339 (68.9%) were men. Logistic regression results indicated that patients who were female and/or had higher pre-index serum potassium were less likely to return to normokalemia within 24 hours after the time of the index serum potassium value. Treatment category was not a statistically significant predictor of the achievement of normokalemia. Most patients with mild hyperkalemia (> 74.5% in each treatment category) achieved normokalemia, whether or not they received treatment. Conclusions: The findings of this study suggest that although follow-up is required for mild hyperkalemia in hospitalized patients, active treatment may be unnecessary. RÉSUMÉ Contexte : Le sulfonate de polystyrène de sodium (SPS) est l’un des traitements les plus communément utilisés pour l’hyperkaliémie légère. D’autres traitements comprennent l’insuline, le bicarbonate de sodium et le salbutamol, qui peuvent être administrés seuls ou ensemble. Les résultats des recherches se penchant sur l’efficacité des traitements de l’hyperkaliémie légère (p. ex., la capacité du SPS à rétablir la normokaliémie) sont contradictoires jusqu’à présent. Étant donné que l’efficacité du traitement de l’hyperkaliémie légère est discutable, de nouvelles recherches sont nécessaires. Objectif : Déterminer si le traitement des patients hospitalisés, présentant une hyperkaliémie légère, (à l’aide de SPS ou d’une autre approche, comparativement à l’absence de traitement) était associé à l’atteinte de la normokaliémie (potassium sérique < 5,1 mmol/L). Méthodes : Des patients hospitalisés, dont l’indice de concentration sérique de potassium se situait entre 5,1 et 6,4 mmol/L, ont été identifiés pour participer à cette étude rétrospective quasi expérimentale. La concentration sérique de potassium mesurée dans les 24 heures après le diagnostic d’hyperkaliémie légère a été dichotomisée (< 5,1 ou ≥ 5,1 mmol/L). Les indices de concentrations sériques de créatinine et de potassium avant le diagnostic d’hyperkaliémie légère ont été obtenus par la moyenne des cinq premières valeurs situées immédiatement avant celle de la concentration de potassium. Le classement du traitement de chaque patient était le suivant : Aucun traitement, Traitement par SPS ou Autre stratégie de traitement. Résultats : L’âge moyen des 1944 patients inclus dans l’analyse était de 66,8 ans (écart type 13,5); 605 (31,1 %) d’entre eux étaient des femmes et 1339 (68,9 %) des hommes. Les résultats de la régression logistique indiquaient que les patientes, donc les femmes, qui avaient un indice sérique de potassium plus élevé au moment du diagnostic, avaient moins de chances de retourner à la normokaliémie dans les 24 heures après l’instant de la mesure de la valeur de l’indice sérique de potassium. La catégorie de traitement n’était pas une variable prédictive statistiquement significative de l’atteinte de la normokaliémie. La plupart des patients présentant une hyperkaliémie légère (> 74,5 % dans chaque catégorie de traitement) atteignaient la normokaliémie, qu’ils aient reçu ou non un traitement. Conclusions : Les résultats de cette étude laissent entendre que, malgré la nécessité d’un suivi des patients hospitalisés en cas d’hyperkaliémie légère, un traitement actif pourrait s’avérer inutile.