健康教育对社区老年人安全服药的影响

目的通过健康教育强化社区老年人的用药知识,做到安全服药。方法采用问卷和访谈的方法对社区146位老年人服药情况及用药知识进行调查。结果老年人的用药知识严重缺乏,良好率仅为4.8%,一般者为30.8%,差者为64.4%。采取做好组织工作、有计划的健康教育、特殊情况特殊教育后老年人的用药知识普遍提高,良好率为38.4%,一般者为47.9%,差者为13.7%,与健康教育前比较差异具有统计学意义(P<0.01)。结论对社区老年人进行用药知识的健康教育极其重要,健康教育增强了老年人服药的安全性。     

老年冠心病患者用药知识、信念及行为的调查与分析

目的通过对干部门诊老年冠心病(coronary heart disease,CHD)患者用药知识、信念、行为及其影响因素的调查与分析,为患者进一步实施用药知识教育提供帮助。方法随机整群抽取4个干休所的124名老年冠心病患者,采用自行设计调查问卷对用药知识、信念与行为进行调查、评估与分析。结果74.2%的老年冠心病患者用药知识欠缺,既往因冠心病住院的次数、现患慢性病种类数、离(退)休前的工作性质是影响患者掌握用药知识的因素;50%以上的老年冠心病患者用药行为关键方面依从性差,既往1年内药物不良反应发生种类数可能影响患者的用药行为;老年冠心病患者用药知识、信念及行为未完全达到统一。结论门诊老年冠心病患者在疾病控制过程中,需要更多系统、持续、不断更新的用药知识,以促进其树立正确的用药观念,建立良好的用药行为。     

Potential adverse drug events in an indigent and homeless geriatric population.

OBJECTIVE: To identify potential adverse drug events (ADEs) in a geriatric ambulatory population using the modified Beers criteria. METHODS: This is a cross-sectional study of an indigent and homeless geriatric population served by a network of six primary healthcare clinics with clinical pharmacy services. Medical records of patients > or = 65 years old visiting the clinics between December 1999 and April 2000 were retrospectively reviewed by a clinical pharmacist. Medications meeting the modfied Beers criteria were evaluated for the most common drug classes involved, severity potential, and dose or disease state restrictions. Following the identification of medications meeting Beers criteria, the pharmacist left a written recommendation regarding use of alternative drugs or doses in the medical record. Physician acceptance of pharmacy recommendations was also evaluated. RESULTS: Medical records of 146 patients (71.9% women, average age 72.6 +/- 6.7 y) were reviewed. Overall, 52 patients (35.6%) had 70 medications with the potential for causing an ADE based on the modified Beers criteria The most commonly identified medication classes were narcotic analgesics (20.0%), antihypertensives (20.0%), and antihistamines (14.3%). Fifteen of these medications (21.4%) had a high severity potential. Identified medications met the following modified Beers criteria: 41.4% were inappropriate in a specific disease state, 38.6% were inappropriate for the elderly, 10.0% exceeded maximum dosage guidelines, and 10.0% were inappropriate for both the elerly and the patients disease state. Approximately 60% of pharmacy recommendations were accepted by physicians. CONCLUSIONS: The modified Beers criteria are a useful tool for reviewing medical records to identify potential ADEs in an ambulatory geriatric population.     

An evaluation of stroke education in AVAIL registry hospitals

The purpose of this study is to explore factors associated with recall of medication education and satisfaction with healthcare provider communication in patients with acute stroke or transient ischemic attack. This is an analysis of data from the AVAIL (Adherence Evaluation of Acute Ischemic Stroke Longitudinal) study. At 3 months after discharge, 2,219 stroke patients from 99 sites were interviewed and asked about their perceptions of education and communication with their healthcare providers as well as their current medication use and knowledge. Results show that less than 2% of the respondents reported not understanding how to take their medications, 4% did not know how to refill their medications, and 5% did not know the reason they were taking them. A vast majority (92%) of participants reported high levels of satisfaction in their communications with healthcare providers after discharge. Although overall understanding and satisfaction was high, older subjects were less likely to recall receiving medication information at discharge or to understand their medications. Similarly, African Americans and patients discharged from an academic hospital were less likely to report receiving a written medication list. This report highlights the success of education efforts and potential areas for additional improvement.     

The effects of medication education on adherence to medication regimens in an elderly population

The purpose of this intervention study was to evaluate educational protocols to see which would be more effective in increasing medication compliance rates within an elderly population Forty-two patients were randomized into four groups Group 1 received a standard education protocol, group 2 received the standard education and 30 minutes of verbal instruction, group 3 received the standard education and a medication schedule, and group 4 received the standard education, a medication schedule, and 30 minutes of verbal instruction The intervention was given on the day of hospital discharge Home visits were made 2 weeks, 1 and 2 months post-hospital discharge Results of the visits revealed that groups 1 and 2 had higher rates of errors with medications than groups 3 and 4 In conclusion, the groups with a medication schedule had higher compliance rates Considering the sample size of 42, this study can act as a pilot study to justify further research in the effects of a medication schedule on compliance     

Evaluation of a nursing intervention project to promote patient medication education

Aim and objective. The purpose of this study was to evaluate patients’ knowledge regarding their medication regime following a nursing interventional project in patient medication education. Design. Evaluation. Background. Educating patients during their hospital stay regarding their medical treatment is an issue which the medical staff deals with on a daily basis. The hospitalisation period is a known critical point in the provision of influential information to the patient and related family members, probably because the hospitalised patient and family members have unique learning needs that cannot be postponed. Methods. The study was conducted in three internal medicine wards in a large university tertiary hospital in Jerusalem, Israel. The intervention project used structured written materials and verbal patient education related to highly potent drugs. The study evaluated patients’ knowledge regarding their medication as the main interventional outcome. In addition, the rate of patients receiving verbal and written education, rate of patient intention to take the medication and adequacy of nursing interventions according to the patients’ educational needs were also assessed. Data collection was carried out by a short structured tool that examined patient knowledge. With this tool, the nurse interviewed the patients and recorded the patient’s response and her recommended intervention. Results. Two hundred and fifty‐one patients participated in the study. Most of the patients (71–93%) reported that they had received instructions from nurses. The majority of the patients demonstrated a high level of knowledge regarding their medications and planned on taking their medications on a regular basis. Lack of knowledge was observed mostly on issues related to dietary recommendations. In these cases, the nurses’ intervention was not always documented and did not necessarily match the problem identified. Conclusions. The findings show that patients, who received medication education, demonstrated satisfactory level of knowledge and intended to take their medication. Patients’ knowledge feedback enables the nurse to assess her intervention. Relevance to clinical practice. Patient medication education in the hospital is a challenging task. This article suggests an applicable tool to assure that patients receive appropriate medication education, while assessing the effectiveness of this education. This tool also enables the nurses to modify their intervention according to patient response.     

风湿性疾病患者激素和免疫抑制剂用药依从性及其影响因素

目的了解风湿性疾病患者应用激素和免疫抑制剂的用药依从性及其影响因素,并提出相应的改善建议。方法方便选择某三级甲等医院门诊或住院应用激素和免疫抑制剂的风湿性疾病患者94例,应用自行设计的调查问卷进行调查。结果风湿性疾病患者用药依从性好的占12．8％,依从性差的占87．2％,其中减少药物剂量用药占98．8％。影响患者用药依从性的因素中忘记服药55例（占58．5％）,药物不良反应41例（占43．6％）,用药效果不佳25例（占26．6％）,其中药物不良反应影响患者用药依从性的差异具有统计学意义（x2=6．162,P=0．05）。患者获取疾病及药物相关知识来源于医务人员者78例（占83．0％）。结论风湿性疾病患者用药依从性较差,因此护士应根据患者的具体情况早期向患者开展有针对性的健康宣教,并通过各种有效方法和途径帮助患者提高用药依从性。     

Documentation of medication management by graduate nurses in patient progress notes: a way forward for patient safety

Nursing documentation provides evidence of nurses' management, the patient response, and evaluation of care. The aim of the study was to examine how graduate nurses document their medication management in the progress notes. A prospective clinical audit of patient medication charts and the progress notes made by 12 graduate nurses was undertaken. Graduate nurses were also individually interviewed and asked clarifying questions about their medication management. Documentation was examined based on four areas: assessment, planning care, administration of medications, and evaluating outcomes of medications. Recorded information about assessment focused on cues of a biomedical rather than a psychosocial nature. Planning care involved non-specific documentation of discharge planning needs, and little information about communication with doctors, pharmacists, nurses, patients and next of kin. Administration of medications included details about the names of medications given to patients, but no information about medication education provided to patients during this time. Evaluation of outcomes of medication administration was poorly documented. Graduate nurses tended to focus on assessing medications before their administration without considering how the patient responded to treatment. Recommendations are proposed for improving the quality of graduate nurses' progress notes. These recommendations include implementing and evaluating protocols that link nurses' decision-making to documentation processes. Adopting a supportive multidisciplinary approach to quality improvement and providing education that emphasises written documentation of verbal communication are also recommended.     

Medication use in the elderly patient: Focus on the perioperative/perianesthesia setting

As the population ages, the use of multiple medications also increases. Polypharmacy (taking multiple drugs at a time) presents concerns to the perianesthesia nurse who is caring for the geriatric patient. The pharmacokinetics and pharmacodynamics of drugs are often altered in older adult patients. Adverse drug reactions and drug interactions occur more often in geriatric patients than in younger patients. For these reasons, the benefits and risks of multiple medications and the administration of certain types of drugs must be carefully considered in the elderly patient. The selection of any medication should be individually based on the benefits and risks. Adverse drug reactions play a significant role in hospitalization for the general population, and the elderly are more susceptible to these. These drug reactions often contribute to significant morbidity as well as mortality. Medications need to be considered carefully in the older adult patient, but perhaps more so in the perioperative/perianesthesia period. Drug interactions are diverse. The type of anesthesia may influence the patient's outcome, depending on the medications the patient is currently taking. The patient's response to the stress of surgery is also affected by individual medical conditions as well as medications the patient is currently receiving Polypharmacy, inappropriate medications, adverse drug reactions, drug-disease issues, and drug interactions in the geriatric population are concerns in the perioperative/perianesthesia setting.     

老年糖尿病患者用药依从性调查分析

目的：了解老年糖尿病患者用药依从性现状及其影响因素,以期提供更好的治疗及用药指导。方法：采用问卷调查方法,对114名住院老年糖尿病患者进行调查,分析其用药依从性及影响因素。结果：114名老年糖尿病患者中,有36例用药依从性佳,有78例用药依从性差。影响其依从性的因素有：缺乏糖尿病及用药知识,记忆力减退,药物的不良反应,讲解不具体等。结论：加强对老年糖尿病患者有关疾病及用药知识的宣教,采取相应的护理对策,以提高患者用药的依从性。     

Pharmacists' knowledge and attitudes toward herbal medicine

OBJECTIVE: The use and sales of herbal medications have increased dramatically over the past several years. Pharmacists are in an ideal position to educate patients about herbal medicines. This study was intended to determine the knowledge and attitudes of pharmacists regarding herbal medications. METHODS: A survey was distributed to pharmacists at several state and regional meetings in Virginia and North Carolina between August and October 1998. The survey evaluated demographic data, attitudinal scales, and a 15-item herbal medicine knowledge test. Pharmacists immediately returned the surveys to the distributor on completion. RESULTS: Of the 217 surveys distributed, 164 met the inclusion criteria for further evaluation. Of the pharmacists surveyed, 68.0% practiced in a community pharmacy, 45.1% had previous continuing education on herbal medications, and 73.6% sold herbal medications in their practice settings. The average score on the herbal knowledge test was 6.3 (maximum score of 15). Pharmacists with previous continuing education scored significantly higher than those without prior continuing education (p < 0.001). Of the 15 questions, the five that pharmacists were most likely to answer correctly assessed the uses of herbal medications. Additionally, pharmacists with prior continuing education or with access to herbal medication information at their practice site were more likely to agree that providing information about herbal medication is a pharmacist's professional responsibility (p = 0.02 and p = 0.01, respectively). CONCLUSIONS: The findings from this study demonstrate that pharmacists were more likely to answer correctly about the uses of herbal medications than about drug interactions, adverse drug effects, and precautions of herbal medications. Additionally, pharmacists with previous continuing education on herbal medications were more knowledgeable about these products. With the increasing use of herbal medications, there is a greater need for pharmacy training programs in this area.     

Educational interventions for mental health consumers receiving psychotropic medication: a review of the evidence

The objective of this systematic review is to investigate the efficacy of educational interventions, relating to psychotropic medications, for consumers with a mental health disorder. This review included only randomized controlled trials that compared the effects of various educational interventions on knowledge retention, compliance to medication and treatment, incidence of relapse, and insight into illness in patients aged 18 years and over with a mental disorder. Twenty-one trials met the quality criteria and were included in the final analysis. Patients who were provided with education demonstrated a significant increase in the level of knowledge and compliance compared with those who were not. However, there was no difference in the incidence of relapse and insight in those who were provided education. A structured education session using both written and verbal methods followed by discussion of the contents is demonstrated to be effective. The evidence suggests that consumers who were provided multiple education sessions had greater knowledge gains in the short term (up to 1 month); however, the effectiveness of multiple sessions in the long term (2 years) is inconclusive. The review provides evidence that multiple education sessions are better than single education sessions in improving knowledge relating to medications and insight into illness. Evidence from the trials demonstrates that structured educational interventions delivered at frequent intervals are useful as part of the treatment programme for people with a mental illness. More well designed and reported randomized studies investigating the efficacy of education are urgently needed.     

整体护理延伸服务对行PCI术老年冠心病患者用药依从性的影响

目的 探讨整体护理延伸服务对行经皮冠状动脉支架植入术(PCI)术后老年冠心病患者用药依从性的影响。 方法 将178例老年冠心病PCI术后患者随机分为对照组88例和观察组90例。2组住院期间均接受常规治疗,观察组在进行常规治疗的基础上,出院后实施整体护理延伸服务。比较2组患者出院1年后用药依从性、心血管不良事件发生率、冠状动脉再狭窄率和再住院率。 结果 观察组用药依从性评分高于对照组 ,心血管不良事件发生率、冠状动脉再狭窄率和再住院率均低于对照组。 结论 对行PCI术老年冠心病患者进行整体护理延伸服务,可提高其用药依从性。     

Optimizing pharmacologic therapy for the elderly

The authors analyze the most important aspects one should bear in mind regarding medication in elderly patients. The authors study the pharmaco-kinetic and pharmaco-dynamic changes which occur with aging and how these influence variations in therapeutic responses and their most frequent adverse reactions among the elderly. The authors conclude that it is necessary to draw up individualized therapeutic plans for these patients. The authors also analyze the general recommendations made for administering and prescribing medications for the elderly. Considering that the administration of medication and the evaluation of adverse reactions are some of the most important responsibilities nurses have, the authors recommend specific programs be drawn up to evaluate the efficiency-risk binomial and to keep a close watch on adverse reactions in these patients.     

Medication education program in an inpatient geriatric rehabilitation unit

All patients admitted during a 6-month period to an inpatient geriatric rehabilitation unit were started on a medication education program incorporated into the rehabilitation program and utilizing existing staff. Patients were evaluated at admission, discharge, 90-day, and 1 year follow-up, using an 8-point medication knowledge scale. Of the 62 patients included in this study, at discharge 35 (group I, mean age 75.9) knew their medications and went home, 10 (group II, mean age 76.8) did not know their medications and went home, and 17 (group III, mean age 79.3) did not go home, whether they knew their medications or not. Mean length of stay (days) was: group I-30.9; group II-38.9; group III-33.3. This study describes a program for teaching an inpatient geriatric age group population self-medication management.     

Do programmes of medicine self-administration enhance patient knowledge,compliance and satisfaction?

Self-administration of medicine (SAM) programmes for hospital in-patients have become increasingly popular Such programmes are considered to facilitate education and learning A quasi-experimental, longitudinal study was carried out to examine and compare knowledge acquisition, drug compliance, and satisfaction between patients who self-administered their medications and those who did not Improvements in knowledge and compliance with medication regimes could not be linked directly with a SAM programme All patients had a high level of knowledge of their medications and appeared to be compliant with prescribed drug regimes Study findings support the hypothesis that knowledge improves with time, regardless of how medications are administered, but do not support the hypothesis that patients who self-administrate are more knowledgeable about their medications than those who do not Therefore, SAM programmes may improve patient knowledge but opportunities to obtain knowledge may not be unique to such programmes The ward or unit philosophy may be such that other patients, who are less willing or able to participate directly in their own care, also have the opportunity to improve their knowledge