Medication management is among the most commonly cited reasons for moving to assisted living and is closely associated with resident quality of life. Yet, the issue has received little research attention. Using data from the state-wide study, “Job Satisfaction and Retention of Direct Care Staff in Assisted Living”, this thesis examines medication management practices and accompanying regulations across 45 facilities in Georgia. A combination of quantitative and qualitative analyses is used to examine surveys with 370 direct care workers (DCWs) and in-depth, qualitative interviews with 41 DCWs and 44 administrators. Findings suggest that medication practices are not uniform and vary across settings and frequently, within facilities, in some cases violating regulations. Facility size, administrative philosophy, staff training and backgrounds, resident frailty, communication between staff, and ambiguous regulations, influence medication management. Future improvement will depend on clarifying and modifying existing regulations in ways that are achievable in practice and protect residents’ rights.

Background Stroke is a serious condition that can have significant impact on an individual’s health and is a significant burden on public health and public finances. Secondary preventive drug treatment after stroke is important for decreasing the risk of recurrent strokes. Non-adherence to drug treatment hampers the treatment effect, especially in long-term preventive treatments. The aim of this thesis was to study the use of secondary preventive drugs after stroke among Swedish stroke patients in terms of inequalities in implementation in clinical practice and patient adherence to treatment over time. Methods Riks-Stroke, the Swedish stroke register, was used to sample stroke patients and as a source of information on background characteristics and medical and health care-related information including information on prescribed preventive drugs. The patients that were included had a stroke between 2004 and 2012. Individual patient data on prescriptions filled in Swedish pharmacies were retrieved from the Swedish Prescribed Drug Register and used to estimate patient adherence to drug treatment. Data on education, income, and country of birth were included from the LISA database at Statistics Sweden. A questionnaire survey was used to collect information about patients’ perceptions about stroke, beliefs about medicines, and self-reported adherence. Results Results showed that a larger proportion of men than women were prescribed statins and warfarin after stroke. There was also a social stratification in the prescribing of statins. Patients with higher income and a higher level of education were more likely to be prescribed a statin compared to patients with low income and low level of education. Statins were also more often prescribed to patients born in Nordic countries, Europe, or outside of Europe compared to patients born in Sweden. Primary non-adherence (not continuing treatment at all within 4 months of discharge from hospital) was low for preventive drug treatment after stroke. Data on filled prescriptions, however, indicated that the proportion of patients who continued to use the drugs declined during the first 2 years after stroke. For most drugs, refill adherence in drug treatment was associated with female sex, good self-rated health, and living in institutions and (for antihypertensive drugs and statins) having used the drug before the stroke. For statins and warfarin, a first-ever stroke was also associated with continuous drug use. Self-reported adherence 3 months after stroke also showed associations with patients’ personal beliefs about medicines; non-adherent patients scored higher on negative beliefs and lower on positive beliefs about medicines. Conclusion Inequalities between men and women and between different socioeconomic groups were found in the prescribing of secondary preventive drugs after stroke. Only a small proportion of Swedish stroke patients did not continue treatment after discharge from hospital, but the proportion of non-adherent patients increased over time. Poor adherence to preventive drug treatment after stroke is a public health problem, and improving adherence to drug treatment requires consideration of patients’ personal beliefs and perceptions about drugs.

Thesis (Ph.D.)--University of Wollongong, 2005. / Typescript. This thesis is subject to a two year embargo until 17/11/2007 and may only be viewed and copied with the permission of the author. For further information please Contact the Archivist. Includes bibliographical references: leaf 226-249.

Thesis (M.H.A.)--University of Michigan, 1960.

Thesis (M.H.A.)--University of Michigan, 1960.

Thesis (Ph. D.)--Marquette University, 2009. / Richard Fehring, Margaret Bull, Claudia Nassaralla, Advisors.

Thesis (M.S.)--University of Wisconsin--Madison, 1983. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves p. 97-102).

Class of 2015 Abstract / Objectives: To compare provider acceptance rates of medication therapy management (MTM) interventions initiated by a MTM center for potential drug-related problems in 2012. Interventions included cost-savings to patients, adherence to clinical guidelines, medication adherence, and safety initiatives. Methods: This retrospective cross-sectional project measured the provider acceptance rates of MTM interventions for Medicare Part D beneficiaries. Intervention count and acceptance rates were analyzed from the center’s MTM software and database that utilizes prescription claims analysis post-intervention to determine intervention success. A chi-square test was used to assess the statistical significance between the interventions. An alpha level of 0.5 was determined a-priori. This was a quality improvement project, and Institutional Review Board approved this project as exempt status. Results: The total percent of recommendations accepted was 35% (159,795 out of 455,898). The rate of acceptance was highest for safety interventions (51%), followed by cost (35%), adherence (12%), and guidelines (8%). The acceptance rates for the four intervention types were statistically different from each other (p-value <0.0001). Within each intervention type, the most frequently accepted interventions were: removal of medications from the Beer’s Criteria (8% of safety related changes); changes from a brand name, non-oral medication like eye drops and nasal sprays, to a generic within the same class (15% of cost-saving related changes); improved adherence to hypertension and diabetic medications (29% of adherence related changes); and adding an antihypertensive agent to diabetic patients (62% of clinical guideline related changes). Conclusions: Safety initiatives had the highest acceptance percentage of all four intervention types. Approving more safety interventions with medication use may reduce the risk of morbidity and mortality. Pharmacists providing MTM services may want to increase focus on drug safety as providers are accepting more safety interventions. More research is needed to determine why providers approve the other recommendations at lower rates.

Medication errors make up a staggering portion of medical error in the United States. These medication errors are most likely to occur at transitions in care. Children with medical complexity (CMC) often rely on multiple medications to maintain their health, making accurate medication ordering of utmost importance to avoid exacerbating chronic conditions or unnecessary harm. Because of their increased medication usage, CMC have an increased risk of medication ordering error (MOE). To better inform the medication reconciliation process for CMC, we examine the prevalence, category, and risk factors of MOE at hospital admissions for this patient population. A retrospective cohort analysis of 1,237 hospitalized CMC from two tertiary pediatric teaching hospitals with clinical care services for CMC was performed on data from November 1, 2015 to October 31, 2016. Pharmacists and advance nurse practitioners identified MOEs at admissions through medical record review, patient history at interview, and inpatient team discussions. Identified MOEs were classified as one of seventeen different categories, some of which include duplications, omissions, or incorrect frequency, dose, or route. Statistical analysis was performed using Fisher’s exact test, chi-squares, and generalized linear mix models to examine the relationships between MOEs at admission and patient characteristics, such as ethnicity, number of chronic conditions, or number of medications taken at admission. A total of 115 admission MOEs were identified in 73 hospitalized CMC. The two most common MOE types were wrong dose (41.7%) and omitted medication (33.9%). The median number of medications ordered at admission was 10 (IQR 6-14). Medications most commonly associated with an MOE were cholecalciferol (n=9) and baclofen (n=9). As for patient characteristics, the median age at admission was 5 years ([Interquartile Range [IQR] 1-12). Of the total sample, 96.8% had a complex chronic condition and 72.8% were technology dependent. Children who are Black, require medical technology, or take more than 15 medications during hospitalization were found to have higher MOE rates. Multivariable analysis revealed the highest odds of MOE in children taking baclofen (Odds Ratio [OR] 2.6 [95% Confidence Interval {CI} 1.4-4.7]). MOEs at admission are prevalent among hospitalized CMC. Further study on medication safety in CMC is needed to inform medication reconciliation processes and better prevent patient harm. / 2019-07-03T00:00:00Z

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