Exploring patient experiences with prescription medicines to identify unmet patient needs: Implications for research and practice

Kucukarslan, Suzan N.; Lewis, Nancy; Shimp, Leslie A.; Gaither, Caroline A.; Lane, Daniel C.; Baumer, Andrea L.

doi:10.1016/j.sapharm.2011.08.003

Cited by 19 publications

(20 citation statements)

References 20 publications

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“…[15,16] However, findings of this study also indicate that MUR and NMS consultations are not addressing all of the patient's needs for information about their medicines. Recent work has shown that pharmacy services should take account of patients' perceptions of their illness [30] and this evaluation suggests that this should extend to their knowledge and beliefs about their medication.…”

Section: Discussionmentioning

confidence: 99%

What do patients need to know? A study to assess patients' satisfaction with information about medicines

Twigg

Bhattacharya

Clark³

et al. 2016

International Journal of Pharmacy Practice

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Objectives This study aimed to determine the information needs and reported adherence of patients prescribed medicines for chronic conditions in those who have received a community pharmacy advanced service and those who have not.Methods A questionnaire was constructed using validated tools to measure medication information satisfaction and adherence together with questions eliciting information regarding the use of pharmacy services and demographic characteristics. This questionaire was distributed from four community pharmacies to a convenience sample of 400 patients as they collected their medicines. Patients were eligible if prescribed more than one regular medicine and attending the pharmacy for longer than three months. The questionnaire was returned directly to the university.Key Findings 232 (58%) questionnaires were returned. All respondents desired further information about their prescribed medicines, particularly about potential medication problems. Dissatisfaction centred on side effects, interactions and certain medicine characteristics such as how long it will take to act. Satisfaction with information about medicines and adherence were significantly greater in a subgroup reporting that they had received an advanced pharmacy service e.g. medicine use review. ConclusionPatients who had received an advanced service reported greater adherence and satisfaction with medicine related information. This was a small, observational study, using a convenience sample of four pharmacies; in order to draw definitive conclusions, a larger study with participants randomised to receive an advanced service is required.

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Section: Discussionmentioning

confidence: 99%

What do patients need to know? A study to assess patients' satisfaction with information about medicines

Twigg

Bhattacharya

Clark³

et al. 2016

International Journal of Pharmacy Practice

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“…Cheraghi-Sohi et al 87 describe older people's individuality in the way that they manage their medication: 'Medication-taking appears to be a personalised, contingent and contextually situated type of work with participants developing highly individualised routines and strategies'. l Practitioners in health and care: doctors in particular 87,89,103 as well as pharmacists 92,94,96 and nurses 87,91 are identified as significant in medication management, following a patient-focused care model 100,102,103 as part of a health and care system in which there is co-ordination and continuity. 100,103 The immediacy of their work, face to face with older people, is highlighted in prescribing, 88,90,91 deprescribing 88,94 and information-giving.…”

Section: Systemmentioning

confidence: 99%

“…l Practitioners in health and care: doctors in particular 87,89,103 as well as pharmacists 92,94,96 and nurses 87,91 are identified as significant in medication management, following a patient-focused care model 100,102,103 as part of a health and care system in which there is co-ordination and continuity. 100,103 The immediacy of their work, face to face with older people, is highlighted in prescribing, 88,90,91 deprescribing 88,94 and information-giving. 91,94,97,100 Establishing a trusted therapeutic relationship 89,91,100 enables practitioners to extend their influence over older people's medication management decisions and actions when they are at home.…”

Section: Systemmentioning

confidence: 99%

“…100,103 The immediacy of their work, face to face with older people, is highlighted in prescribing, 88,90,91 deprescribing 88,94 and information-giving. 91,94,97,100 Establishing a trusted therapeutic relationship 89,91,100 enables practitioners to extend their influence over older people's medication management decisions and actions when they are at home. Lau et al 102 highlight the importance of practitioners engaging with older people as individuals to enable them to improve the way that they manage their medications: 'Adherence interventions should be tailored to the needs of a patient to enhance self-management capacity regarding medication use'.…”

Section: Systemmentioning

confidence: 99%

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Medication management in older people: the MEMORABLE realist synthesis

Maidment

Lawson

Wong

et al. 2020

Health Serv Deliv Res

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Background The number and proportion of older people in the UK are increasing, as are multimorbidity (potentially reducing quality of life) and polypharmacy (increasing the risk of adverse drug events). Together, these complex factors are challenging for older people, informal carers, and health and care practitioners. Objectives MEMORABLE (MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation) aimed to understand how medication management works and propose improvements. Design A realist approach informed three work packages, combining a realist review of secondary data with a realist evaluation of primary interview data, in a theory-driven, causal analysis. Setting The setting was in the community. Participants Older people, informal carers, and health and care practitioners. Interventions Studies relating to medication management and to reviewing and reconciling medications; and realist-informed interviews. Main outcome measures Not applicable. Data sources MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and EMBASE were searched (all searched from January 2009 to July 2017; searched on 1 August 2017). Supplementary articles were identified by the Research Team. Data were also obtained through interviews. Review methods Searches of electronic databases were supplemented by citation-tracking for explanatory contributions, as well as accessing topic-relevant grey literature. Following RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines, articles were screened and iteratively analysed with interview data, to generate theory-informed (normalisation process theory) explanations. Results Developing a framework to explain medication management as a complex intervention across five stages: identifying problem (Stage 1), starting, changing or stopping medications (Stage 3) and continuing to take medications (Stage 4), where older people, sometimes with informal carers, make individual decisions and follow routines that fit medication management into their day-to-day lives, engendering a sense of control. In getting diagnosis and/or medications (Stage 2) and reviewing/reconciling medications (Stage 5), older people and practitioners share decision-making in time-limited contacts: involving four steps – sense-making, relationships, action and reflection/monitoring (normalisation process theory); and conceptualising burden – through a detailed analysis of Stage 5, generating a theoretical framework and identifying five burden types amendable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Proposing interventions: risk identification – a simple way of identifying older people and informal carers who are not coping, at risk and who need appropriate help and support; and individualised information – a short, personalised record and reference point, co-produced and shared by older people, informal carers and practitioners that addresses the experience of living with multimorbidities and polypharmacy. Limitations Few studies directly address the complexity of medication management as a process and how it works. Limitations included, having identified the overall complexity, the need to focus the analysis on reviewing/reconciling medications (Stage 5), the exclusion of non-English-language literature, the focus on non-institutionalised populations and the broad definition of older people. Conclusions MEMORABLE explored the complexity of medication management. It highlighted the way interpersonal stages in the medication management process, notably reviewing/reconciling medications, contribute to the mitigation of burdens that are often hidden. Future work Co-produced studies to scope and trial the two proposed interventions; studies to extend the detailed understanding of medication management, linked to burden mitigation; and a study to clarify the medication management outcomes wanted by older people, informal carers and practitioners. Study registration This study is registered as PROSPERO CRD42016043506. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 26. See the NIHR Journals Library website for further project information.

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“…The role of doctors (52,54,56), and increasingly pharmacists (57,59,61) and nurses (52,56), was central to prescribing (53,55,56), de-prescribing (53,59) and information-giving (56,59,62,65). Trusted therapeutic relationships (54,56,65) were valued for their continuity (82), addressing fragmentation (5). Shared decision making (83)(84)(85)(86)(87)(88) was increasingly recognised for the way it enhanced practitioner contacts (9,34,89).…”

Section: Section Overviewmentioning

confidence: 99%

Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis

Maidment

Lawson

Wong

et al. 2019

Preprint

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Background Increasing numbers of older people are living in the community with multiple diagnoses and medications. Managing multiple medications produces issues of unrivalled complexity for those involved. Despite a growing body of literature on the subject, gaps remain in understanding how, why and for whom complex medication management works, and therefore how best to improve practice and outcomes. MEMORABLE, MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation, aimed to address these gaps. Methods MEMORABLE, a National Institute of Health Research funded project, used a realist approach to understand causal paths within medication management. Informed by RAMESES guidelines, MEMORABLE involved three overlapping work packages: 1) Realist Review of the literature (specifically 24 articles on medication management exploring causality); 2) Realist Evaluation (50 realist-informed interviews with older people, family carers and health and care practitioners, explaining their experiences); and 3) data synthesis and theorising from 1) and 2). Results The complexity of medication management was viewed from the perspective of ‘implementation’. This enabled the researchers to structure the medication management process into five iterative Stages; three individual Stages carried out by the older person on their own or with family carer support in which they are balancing routines, coping and risk; and two interpersonal Stages where the older person works with a practitioner-prescriber-reviewer, perhaps with carer involvement. Applying Normalisation Process Theory to this process, four steps were identified within each Stage: 1) sense making - information, clarification; 2) action - shared decision making; 3) reflection/monitoring; and 4) relationships that are enduring, based on collaboration and mutual trust. In a detailed analysis of Stage 5: Reviewing/reconciling medications, adopting the lens of ‘burden’, MEMORABLE identified five burdens amenable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Two initial improvement propositions were then set out for development through further research: a risk screening tool and individualised information.Conclusions By adopting a realist approach and synthesising rich data from evidence and experiential accounts, MEMORABLE has established a transferable evidence and experience-based, theoretical framework, focused on burden, to explore and explain the real world complexity of medication management for and with older people.

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Exploring patient experiences with prescription medicines to identify unmet patient needs: Implications for research and practice

Cited by 19 publications

References 20 publications

What do patients need to know? A study to assess patients' satisfaction with information about medicines

What do patients need to know? A study to assess patients' satisfaction with information about medicines

Medication management in older people: the MEMORABLE realist synthesis

Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis

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