Thesis (MSc. (Med.)(Pharmacy))--University of Limpopo, 2009. / ABSTRACT Background: When a patient is discharged from the hospital, the doctor may prescribe medication to be used at home which is called TTO (To Take Out) medication. Failure by the patient to collect TTO medication might be intentional or may indicate a lack of appropriate structures and procedures at the hospital to provide such care on discharge, and/or failure by the health care professionals to reach concordance with the patient to ensure that he/she continues to take medications as prescribed. Objectives: The purposes of this study were to examine the prevalence of primary non-compliance with medication in this private hospital and to explore its association with various factors contributing to its existence. Methodology: The study was conducted at a private hospital in Gauteng, South Africa. The study focused on discharged patients who did not redeem their TTO medication. Thus only patients discharged from the hospital within a thirty day period between 25 May 2009 and 23 June 2009 were included in the study. For each subject the discharge medication prescription was reviewed and the following determined: number of items prescribed, number of items dispensed at the hospital pharmacy, whether any items were non-dispensed, whether any items were partially dispensed and reason for any item non-dispensed or partially dispensed. A telephone call was made to those subjects for whom a discharge medication script was prescribed, but no medication was dispensed at discharge. Information was collected from the patients to identify possible reasons for not redeeming discharge medication. Results: In total 1365 records were evaluated. TTO medication was prescribed for 1161 (85%) patients discharged. All items were redeemed in full by 854 (74%) of the patients, 118 (10%) patients redeemed no discharge medication, 101 (9%) patients redeemed only some items prescribed, 74 (6%) patients redeemed all items partly, 14 (1%) patients redeemed some items partly and some not at all and for seven v patients details were not known. Four reasons and five types of medication together accounted for 54% of the total value not redeemed. The four reasons include the following: medical aid TTO rules, patient unaware of TTO being prescribed, ward stock given, patient still had stock at home, and the types of medication included: blood and haematopoietic agents, analgesics, antimicrobials, agents of the gastrointestinal tract and unclassified. Conclusion: Some patients reported that they took own decision not to redeem the medication and some still had stock at home, a fact that should lead healthcare providers to ensure that they reach concordance with their patients.

The prevalence of medication errors in a major teaching hospital was investigated using several methodologies. The existing ward stock drug distribution system was assessed and a new system designed based on a novel use of failure mode and effects analysis. The existing system was compared to the new unit supply individual patient dispensing system on two wards in terms of medication errors, nursing time, pharmacy time, drug costs, drug security and nurses' opinion. A review of a one year sample of reports submitted under the existing incident reporting scheme was also undertaken. Errors were categorised according to drug group, error type, reason cited for the error, and probability ranking (probability of occurrence, detection and harm). In addition, a "no-blame" medication error reporting scheme was implemented and assessed.Results of the study showed that in the newly designed individual patient dispensing system there was a reduction in nursing time associated with medication activities of approximately 29%, an increase in pharmacy staff time of 64%, a reduction in drug costs and an increase in drug security. Using the disguised observer methodology a reduction in medication errors by 23.5% (including timing errors) and 7.3% (excluding timing errors) was seen on Ward A. Similarly a reduction of 21.1% (including timing errors) and 9.8% (excluding timing errors) was observed on Ward B. Significant support for the individual patient dispensing system was given by nursing staff. Of the errors self-reported under the existing incident/accident reporting scheme the most common type of error was omissions (32.2%), the most common drug group was cardiovascular drugs (19.8%), and the most common cause of the error cited was a faulty check (42.3%). The probability ranking showed that 75% of errors reported scored between 12 and 17 points (from a possible 30 points). In ++ / the no-blame error reporting system, an error rate of 2.1% was detected in the existing system and 1.7% in the failure mode analysis designed phase.

Psychotropic medications commonly used with children have been associated with side effects significant enough to warrant warnings from the Food and Drug Administration. The risks of these side effects are potentially increased in children who are long-term survivors of childhood cancer because of damage to the heart and central nervous system (CNS) due to chemotherapy and radiation therapy. There are few empirical studies addressing whether children treated for cancer have greater exposure to psychotropic medications than the general population, the reasons for use of psychotropic medications in cancer survivors, or whether risks associated with cancer treatment are considered when psychotropic medications are used. The specific aims of this study were: (1) to examine the prevalence of psychotropic medication use among children treated for cancer, (2) to obtain descriptive data regarding variables associated with medication usage, and (3) to develop a model to predict which children are likely to be prescribed psychotropic medication. A cross-sectional sample of 69 children, ages two to 17 years, who were undergoing treatment or had successfully completed treatment for leukemia/lymphoma, central nervous system (CNS) tumors, or other non-CNS related cancers were recruited. Caregivers completed measures of psychosocial functioning, medication use, and developmental history. Medical history was also obtained. Results indicated that 15% of subjects were taking psychotropic medication, specifically stimulants and antidepressants. The Classification and Regression Trees (CART) algorithm was used to develop a predictive model. Results indicated gender, age, and presence of school difficulty explained a total of 46% of the variance in psychotropic medication use in the pediatric cancer population; children treated for cancer who were male, age 10 or older and had reported school difficulty were more likely to be prescribed psychotropic medication. No cancer variables were found to influence psychotropic medication use. Several limitations likely influenced results including limited sample size, inclusion of multiple diseases in the non-CNS involved solid tumor diagnosis group, and recruitment limited to three sites. Results indicate a need for continuous examination of psychotropic medication use and possible side effects in the childhood cancer population.

Dissertation (Ph.D.)--Auburn University, 2009. / Abstract. Vita. Includes bibliographic references.

This study assessed the utility of the theory of planned behavior components [attitude (A), subjective norm (SN), perceived behavioral control (PBC)] in predicting patients’ willingness to work with a peer supporter for medication management, determined if prior experience (PE) with peer support adds to the prediction of willingness, assessed the importance of peer supporter characteristics, and explored patients’ communication preferences. This study also explored medication outcomes important to patients. A 72-item survey was administered to 130 adult patients with diabetes, hypertension, and/or hyperlipidemia. Willingness was measured with a 7-point scale (1-very unwilling to 7-very willing). A (6 items), SN (6 items), and PBC (4 items), were measured with 7-point scales [−3 (e.g., very unlikely) to +3 (e.g., very likely)]. Variable relationships were examined using multiple regression analysis. A plurality of respondents were white (45.3%) and most were female (56.2%). Their mean age was 58.6±11.5 years. Overall, respondents indicated a moderate willingness level (mean=4.76±1.65). A (β = 0.341, P < 0.001), SN (β=0.168, P=0.122), PBC (β=-0.043, P=0.692), and PE (β=0.290, P<0.001), together with age and ethnicity, accounted for 35.8 percent of the variance in willingness (F=9.041, df=8,109, P<0.001). The most important peer supporter characteristic was having experiential knowledge (mean=4.20±0.94; range: 1-very unimportant to 5-very important). Most preferred to communicate by telephone (82.3%) and at a frequency of once a month (34.4%). The most important outcome was preventing future health problems (mean=4.63±0.83; range: 1-very unimportant to 5-very important). Among patients who reported hypertension and hyperlipidemia as most bothersome, “clinical values” was the most endorsed method of judging/deciding control. Among patients who reported diabetes as most bothersome, “how my body responds” was the most endorsed method. A and PE were significant predictors of willingness, and PE significantly increased the explanatory power of the regression model. Peer support programs should focus on informing patients of the value of working with a peer supporter in order to positively modify their beliefs and attitudes. Several findings can be used to tailor peer support programs, including selecting peer supporters who have experiential knowledge, providing telephone-based communication options, and assessing outcomes most important to patients. / text

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