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

Background In 2010, a pilot program was implemented by the Medication Assessment Consultants (MAC) to provide comprehensive medication management (CMM) services to patients in the community of Saskatoon, Saskatchewan. Clinical pharmacists working as consultants, independent of any retail pharmacy or health system organization, delivered the program. The goal of the MAC CMM service was to optimize therapeutic outcomes for individual patients through improved medication use, and to reduce the risk of adverse drug reactions (ADRs). Purpose The purpose of this study was to evaluate the independent consultant pharmacist model for delivering comprehensive medication management (CMM) services employed by the Medication Assessment Consultants (MAC) pilot program. Methods A program evaluation was performed on MAC, consisting of a document review of program materials (e.g., MAC Policy and Procedure Manual, electronic patient records) along with stakeholder interviews. The document review consisted of the collection of existing MAC documents, followed by an analysis of the information contained within each document. Patients, physicians and MAC staff were interviewed using a semi-structured interview approach. Patient and physician interviews were conducted by phone and by an interviewer external to the study. Interviews were continued until saturation was reached. The MAC staff was interviewed in person by the investigator. All interviews were recorded and transcribed verbatim. Thematic analysis was used to identify common themes by having three individuals independently review each group of stakeholder interview transcripts. Results During the 17-month pilot, 53 patients were referred to MAC, mostly from family physicians (79.2%). Patients were elderly (mean 71 years) and mostly female (67.9%). On average, patients were taking 13.3 medications and had 9.2 medical conditions. For the 42 patients for whom an assessment was completed, an average of 5.1 drug therapy problems (DTPs) per patient was identified. The document review revealed that MAC did not achieve all of its internal program objectives (e.g., to generate a consistent flow of patient referrals; to promote the service to physicians and patients; and to improve medication-related short-term outcomes for patients). All three interview groups reported a high level of satisfaction and support for the program. Interviewees described various ways in which they felt that they benefitted from the program, including medication regimen optimization (patients), support in dealing with complex medication regimens (physicians), and a strong sense of personal and professional satisfaction and fulfilment (MAC staff). The evaluation of the MAC program resulted in the identification of several program strengths (e.g., a strong, well-defined patient care process; an accessible service location; MAC pharmacist mentorship and support program), along with opportunities for improvement (e.g., expanded promotional activities; administrative support for the program; implementation of a formal satisfaction survey to obtain regular feedback from key stakeholders). Conclusion The results of this study suggest the independent consultant pharmacist model for the provision of CMM services has potential to be utilized as a new service delivery model (in addition to community pharmacies and primary health care teams) to provide CMM services in the primary health care system (PHCS). The study findings have identified several strengths and opportunities for improvement, which may be useful for future attempts at implementing the CMM service model.

Understanding Medication Self-Management Capacity among Older Adults Living in Low-Income Housing Communities ABSTRACT Background: Medication self-management capacity (MMC) is an individual’s cognitive and functional ability to self-administer a medication regimen as prescribed. Poor MMC is an issue in older adults often resulting in negative health outcomes and loss of independence. Therefore, understanding low-income older adults’ capacity to manage their medications may help identify individuals who are at risk for developing medication mismanagement and guide future intervention strategies based on an individual need to promote safe medication use and healthy aging in place in the community. Objectives: 1) To determine the cognitive and physical functional deficiencies in MMC among low-income older adults, 2) To identify variables that predict deficiencies in MMC in this population, 3) To determine the impact of using pharmaceutical aids/services on MMC, and 4) To examine the association between MMC and emergency room (ER) visits. Methods: This was a cross-sectional study of older adult residents living in low-income housing buildings served by the RHWP. At a study interview, information on demographics, medical history, and medication use was collected. MMC was evaluated using the Medication Management Instrument for Deficiencies in the Elderly (MedMaIDE) tool. Cognitive and functional status, health literacy and depression symptoms were assessed. ER visits were determined retrospectively over the last six months Descriptive analyses were performed to identify cognitive and physical functional deficiencies in MMC. Linear regression analysis was conducted to identify variables that predict MMC and assess the relationship between MMC and using pharmaceutical aid/service. Logistic regression analysis was used to examine the association between ER visits and MMC. Results: A total of 107 participants were included, and 89% were African-American with an average age of 68.54 years (±7.23). They had an average of 4.92 (±2.85) comorbidities and used approximately 8 (±4.12) medications on a regular basis. The mean total deficiency in medication management was 3 (±2.00) as assessed by MedMaIDE. Lacking medication knowledge was common among the participants: 69.16% could not name and 46% state the indication of all of their medications, and 38.32% did not how and when all of their medications should be taken. When controlling for ADLs and falls, the mean total deficiency score in MedMaIDE increased among those with an educational level equal to high school or less compared with participants who had a higher educational level than high school [β=1.32, 1.24, p= 0.0195, 0.0415, respectively], and participants who reported difficulty reading prescription medication labels or opening medication bottles compared with those who did not report any difficulties [β=1.18, 1.43, p= 0.0036, 0.0047, respectively]. About 20.56% of participants were receiving assistance with medications from someone, and 79.44% used at least one pharmaceutical aid/service. However, receiving assistance with medications and using pharmaceutical aid/service were not significantly associated with MMC [p= 0.5334, 0.0853, respectively]. The participants reported a total of 23 (21.5%) ER visits within six months. The adjusted model for age, educational level, number of comorbidities, and ADLs suggested that for every one-unit increase in the total deficiency score, the odds of ER visits increased by 1.23 (p=0.1809) times. Conclusion: Many older adults who lived in low-income housing had impaired capacity to manage their medications independently. They appeared to have inadequate medication knowledge, which affects their cognitive ability to manage medications. Low educational level and health literacy and reporting trouble reading labels or opening medication bottles were predictors to deficient MMC. Future studies are needed to confirm whether or not MMC predicts those who may not able to remain living independently safely or who may need additional support with medications to remain independent.

No Brasil, o campo da saúde, em especial a saúde mental, adota o conceito de ‘autonomia’ e tem por ele muito apreço, conforme explicitado em grande parte das políticas públicas da área, sem, no entanto, descrevê-lo ou problematizá-lo. Em geral, as pesquisas de campo voltadas ao contexto da saúde mental pressupõem um entendimento a priori ou naturalizado de autonomia. O objetivo desta pesquisa de mestrado é abordar a autonomia em três ênfases: conceito, exercício e ato. Como conceito, traçamos um breve percurso histórico-filosófico a fim de clarear, problematizar e atualizar o termo ‘autonomia’. Como exercício, buscamos elucidar, a partir da pesquisa e estratégia da Gestão Autônoma da Medicação (GAM) em seus cinco anos de existência e atuação, exercícios do conceito, êxitos, tropeços e capturas. E, como ato/performance, apresentamos a experiência de um laboratório de imersão. Tratamos, como laboratório, uma viagem a Montreal-CA durante 15 dias em novembro de 2013, realizada por dez pessoas que participaram como pesquisadores no projeto GAM (usuários de saúde mental e discentes das universidades envolvidas). A GAM aposta numa metodologia participativa de se fazer pesquisa e saúde mental, considerando todos os envolvidos como pesquisadores e esfumaçando o lugar de sujeitos de pesquisa. Em afinidade com tal proposta, adotamos para esta dissertação a metodologia cartográfica, a dissolução do lugar do pesquisador, a valorização da experiência. O trabalho que segue é composto também de fotografias, links para vídeos e blog, uma narrativa, todos feitos coletivamente. Trata-se de uma produção que não passa somente pela escrita, tão pouco unicamente pelas mãos da mestranda. / In Brazil, the health field, and mental health, particularly, uses the concept of ‘autonomy’ and is very esteem about it, as explained on a greatest part of public policies area, without, however, describe or questioning the term. In general, the field researches regarding to the mental health context assume an understanding a priori or naturalized as autonomy. The purpose of this master's research is to address the autonomy in three emphasis: concept, exercise and act. As a concept, we draw a brief historical-philosophical route in order to lighten, discuss and update the term 'autonomy'. As an exercise, we seek to elucidate, from the research and strategy of the Autonomous Medication Management (GAM) in its five years of existence and operation, concept exercises, successes, trips and catches. As an act / performance, we present the experience of an immersion lab. We consider as a laboratory, a trip to Montreal-CA for 15 days in November 2013, performed by ten people who participated as researchers in the GAM project (mental health users and students of the universities involved). GAM bets on a participatory methodology of doing research and mental health, considering all its participants as researchers and smudging the place of research subjects. In affinity with this proposal, we have adopted for this thesis the cartographic methodology, the dissolution of the place of the researcher, the appreciation of the experience. The work that follows also consists of photographs, links to videos and to the blog, a narrative, all made collectively. This is a production that not only goes through writing, and also not only by the hands of the master's degree.

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.

No Brasil, o campo da saúde, em especial a saúde mental, adota o conceito de ‘autonomia’ e tem por ele muito apreço, conforme explicitado em grande parte das políticas públicas da área, sem, no entanto, descrevê-lo ou problematizá-lo. Em geral, as pesquisas de campo voltadas ao contexto da saúde mental pressupõem um entendimento a priori ou naturalizado de autonomia. O objetivo desta pesquisa de mestrado é abordar a autonomia em três ênfases: conceito, exercício e ato. Como conceito, traçamos um breve percurso histórico-filosófico a fim de clarear, problematizar e atualizar o termo ‘autonomia’. Como exercício, buscamos elucidar, a partir da pesquisa e estratégia da Gestão Autônoma da Medicação (GAM) em seus cinco anos de existência e atuação, exercícios do conceito, êxitos, tropeços e capturas. E, como ato/performance, apresentamos a experiência de um laboratório de imersão. Tratamos, como laboratório, uma viagem a Montreal-CA durante 15 dias em novembro de 2013, realizada por dez pessoas que participaram como pesquisadores no projeto GAM (usuários de saúde mental e discentes das universidades envolvidas). A GAM aposta numa metodologia participativa de se fazer pesquisa e saúde mental, considerando todos os envolvidos como pesquisadores e esfumaçando o lugar de sujeitos de pesquisa. Em afinidade com tal proposta, adotamos para esta dissertação a metodologia cartográfica, a dissolução do lugar do pesquisador, a valorização da experiência. O trabalho que segue é composto também de fotografias, links para vídeos e blog, uma narrativa, todos feitos coletivamente. Trata-se de uma produção que não passa somente pela escrita, tão pouco unicamente pelas mãos da mestranda. / In Brazil, the health field, and mental health, particularly, uses the concept of ‘autonomy’ and is very esteem about it, as explained on a greatest part of public policies area, without, however, describe or questioning the term. In general, the field researches regarding to the mental health context assume an understanding a priori or naturalized as autonomy. The purpose of this master's research is to address the autonomy in three emphasis: concept, exercise and act. As a concept, we draw a brief historical-philosophical route in order to lighten, discuss and update the term 'autonomy'. As an exercise, we seek to elucidate, from the research and strategy of the Autonomous Medication Management (GAM) in its five years of existence and operation, concept exercises, successes, trips and catches. As an act / performance, we present the experience of an immersion lab. We consider as a laboratory, a trip to Montreal-CA for 15 days in November 2013, performed by ten people who participated as researchers in the GAM project (mental health users and students of the universities involved). GAM bets on a participatory methodology of doing research and mental health, considering all its participants as researchers and smudging the place of research subjects. In affinity with this proposal, we have adopted for this thesis the cartographic methodology, the dissolution of the place of the researcher, the appreciation of the experience. The work that follows also consists of photographs, links to videos and to the blog, a narrative, all made collectively. This is a production that not only goes through writing, and also not only by the hands of the master's degree.

No Brasil, o campo da saúde, em especial a saúde mental, adota o conceito de ‘autonomia’ e tem por ele muito apreço, conforme explicitado em grande parte das políticas públicas da área, sem, no entanto, descrevê-lo ou problematizá-lo. Em geral, as pesquisas de campo voltadas ao contexto da saúde mental pressupõem um entendimento a priori ou naturalizado de autonomia. O objetivo desta pesquisa de mestrado é abordar a autonomia em três ênfases: conceito, exercício e ato. Como conceito, traçamos um breve percurso histórico-filosófico a fim de clarear, problematizar e atualizar o termo ‘autonomia’. Como exercício, buscamos elucidar, a partir da pesquisa e estratégia da Gestão Autônoma da Medicação (GAM) em seus cinco anos de existência e atuação, exercícios do conceito, êxitos, tropeços e capturas. E, como ato/performance, apresentamos a experiência de um laboratório de imersão. Tratamos, como laboratório, uma viagem a Montreal-CA durante 15 dias em novembro de 2013, realizada por dez pessoas que participaram como pesquisadores no projeto GAM (usuários de saúde mental e discentes das universidades envolvidas). A GAM aposta numa metodologia participativa de se fazer pesquisa e saúde mental, considerando todos os envolvidos como pesquisadores e esfumaçando o lugar de sujeitos de pesquisa. Em afinidade com tal proposta, adotamos para esta dissertação a metodologia cartográfica, a dissolução do lugar do pesquisador, a valorização da experiência. O trabalho que segue é composto também de fotografias, links para vídeos e blog, uma narrativa, todos feitos coletivamente. Trata-se de uma produção que não passa somente pela escrita, tão pouco unicamente pelas mãos da mestranda. / In Brazil, the health field, and mental health, particularly, uses the concept of ‘autonomy’ and is very esteem about it, as explained on a greatest part of public policies area, without, however, describe or questioning the term. In general, the field researches regarding to the mental health context assume an understanding a priori or naturalized as autonomy. The purpose of this master's research is to address the autonomy in three emphasis: concept, exercise and act. As a concept, we draw a brief historical-philosophical route in order to lighten, discuss and update the term 'autonomy'. As an exercise, we seek to elucidate, from the research and strategy of the Autonomous Medication Management (GAM) in its five years of existence and operation, concept exercises, successes, trips and catches. As an act / performance, we present the experience of an immersion lab. We consider as a laboratory, a trip to Montreal-CA for 15 days in November 2013, performed by ten people who participated as researchers in the GAM project (mental health users and students of the universities involved). GAM bets on a participatory methodology of doing research and mental health, considering all its participants as researchers and smudging the place of research subjects. In affinity with this proposal, we have adopted for this thesis the cartographic methodology, the dissolution of the place of the researcher, the appreciation of the experience. The work that follows also consists of photographs, links to videos and to the blog, a narrative, all made collectively. This is a production that not only goes through writing, and also not only by the hands of the master's degree.

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.

No description available.

Yes / Background: medication-related problems occur frequently when older patients are discharged from hospital. Interventions to support medication use have been developed; however, their effectiveness in older populations are unknown. This review evaluates interventions that support successful transitions of care through enhanced medication continuity. Methods: a database search for randomised controlled trials was conducted. Selection criteria included mean participant age of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible. Results: twenty-four studies (total participants=17,664) describing activities delivered at multiple time points were included. Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis, stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone followup (RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced hospital readmissions. Conclusion: our results suggest that interventions that best support older patients’ medication continuity are those that bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self management, telephone follow-up and medication reconciliation activities were most likely to be effective; however, further research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions. / National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant PB-PG-0317-20010).