Ethnic differences of medicines-taking in older adults: a cross cultural study in New Zealand

Objectives The literature identifies many barriers to medicines use, including bio‐psycho‐social issues, but less is known regarding ethno‐cultural barriers, which are important in culturally diverse nations. The aim of this study was to explore ethnic differences in attitudes to medicines and medicines‐taking, focusing on the main constituents of the New Zealand (NZ) population: NZ European, Māori (the indigenous people of NZ), Pacific and Asian peoples. Methods A qualitative study involving a series of focus groups was conducted. Participants (>50 years old) taking medicines were recruited from various community‐based groups. The focus group discussions were transcribed verbatim and analysed for key themes via manual inductive coding and constant comparison. Key findings Twenty focus groups (n = 100 participants) were conducted. Three key common themes emerged: (1) conception of a medicine; (2) self‐management of medication; and (3) seeking further medicines information. In general, NZ European participants had a very narrow view of what a medicine is, were motivated to source medicines information independently and were very proactive in medicines management. At the other end of the spectrum, Pacific peoples expressed a broad view of what constitutes a medicine, were not motivated to source medicines information independently and were not proactive in medicines management, tending to instead rely on healthcare professionals for answers. The findings from the various ethnic groups highlight differences in attitudes to medicines per se and medicines‐taking; these influences on medication‐taking behaviour need to be considered in the provision of pharmaceutical care. Conclusion Ethnic differences in attitudes to medicines and medicines‐taking are apparent, although there are some commonalities in terms of needs regarding support and advice around medicines' use. This will help inform the development of resources and communication tools to assist pharmacists in providing pharmaceutical care to diverse patient populations.     

Variation within the CLEC16A gene shows consistent disease association with both multiple sclerosis and type 1 diabetes in Sardinia

Variation within intron 19 of the CLEC16A (KIAA0350) gene region was recently found to be unequivocally associated with type 1 diabetes (T1D) in genome-wide association (GWA) studies in Northern European populations. A variant in intron 22 that is nearly independent of the intron 19 variant showed suggestive evidence of association with multiple sclerosis (MS). Here, we genotyped the rs725613 polymorphism, representative of the earlier reported associations with T1D within CLEC16A, in 1037 T1D cases, 1498 MS cases and 1706 matched controls, all from the founder, autoimmunity-prone Sardinian population. In these Sardinian samples, allele A of rs725613 is positively associated not only with T1D (odds ratio=1.15, P one-tail=5.1 x 10(-3)) but also, and with a comparable effect size, with MS (odds ratio=1.21, P one-tail 6.7 x 10(-5)). Taken together these data provide evidence of joint disease association in T1D and MS within CLEC16A and underline a shared disease pathway.     

Addressing Multimorbidity and Polypharmacy in Individuals With Atrial Fibrillation

Purpose of Review

The objectives of this review were to (1) discuss how multimorbidity and polypharmacy contributes to the complexity of management among individuals with AF and (2) identify any interventions to manage polypharmacy in relation to AF.

Recent Findings

Based on the four landmark clinical trials of novel anticoagulants, the most common comorbidities with AF are hypertension, heart failure, diabetes, stroke and myocardial infarction. Polypharmacy was also found prevalent in 76.5% of patients with AF, with a median of six drugs per patient. Despite the consequences of polypharmacy in AF, there is very little evidence-based intervention designed to manage it. Hence, there is a need for further research to examine interventions to manage polypharmacy in relation to AF.

Summary

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia requiring treatment in adults. Due to the structural and/or electrophysiological abnormalities that occur in AF, patients are managed through the use of prophylactic anticoagulant and rate and/or rhythm control medications. However, these medications are considered high risk and can increase the chances of medication misadventure. Additionally, AF rarely occurs in isolation and is known to coexist with multiple other medical comorbidities, i.e. multimorbidity. This also increases the number of medications, i.e. polypharmacy and pill burden which results in treatment non-compliance to prescribed therapy.

     

The impact of age on antithrombotic use in elderly patients with non‐valvular atrial fibrillation

Aim of study: To investigate the use of antithrombotic therapy in elderly patients with atrial fibrillation (AF). Methods: Data were collected retrospectively from the medical records of 262 AF patients >65 years, who were admitted to a Sydney teaching hospital over a 12‐month period. Results: Overall, 202 (79%) patients were discharged on some antithrombotic therapy. Patients <80 years were as likely to receive antithrombotic therapy as those <80 years (75.8% versus 81.9%, P=0.23), but a significantly lower proportion received warfarin than did those <80 years (25.5% versus 61.5%, P < 0.0001). Definite contraindications to anticoagulation were a significant influence on antithrombotic agent selection (P=0.04), but multivariate analysis indicated that ‘old age’ was the largest contributing factor: patients >80 years were 5.46 times more likely to receive aspirin in preference to warfarin than their younger counterparts (P<0.0001). Conclusion: Warfarin is being withheld in AF patients ≥80 years for reasons other than recognised contraindications and is, therefore, potentially underutilised in the target elderly population. Further studies are necessary to determine whether this is appropriate.     

Warfarin use in the elderly: the nurses' perspective.

OBJECTIVE: To explore the barriers to warfarin use from the perspective of nurses working in aged care. DESIGN: A qualitative study, involving a semi-structured group interview, during March-April 2001. SETTING AND SUBJECTS: Eleven nurses, employed within the catchment of the Northern Sydney Area Health Service, who were involved in the care of elderly warfarinised patients. MAIN OUTCOME MEASURE: Identification, via thematic analysis, of the main themes underpinning the nursing perspective on warfarin use in this setting, with regard to their perceived role/s, experiences with patients, and potential strategies for managing the therapy. RESULTS: Five main themes were identified: perceived patient attitude toward warfarin; barriers to the use of warfarin; expressed lack of confidence in the processes involved; nurses' role in warfarin use; and strategies to improve warfarin use. Nurses were concerned about warfarin use in the elderly, but felt they had a limited capacity to intervene. CONCLUSION: Nurses are potentially underutilised as a resource and support for both patients and prescribers, in the management of warfarin therapy.     

Assessing the quality,suitability and readability of internet-based health information about warfarin for patients

Background

Warfarin is a high-risk medication where patient information may be critical to help ensure safe and effective treatment. Considering the time constraints of healthcare providers, the internet can be an important supplementary information resource for patients prescribed warfarin. The usefulness of internet-based patient information is often limited by challenges associated with finding valid and reliable health information. Given patients'' increasing access of the internet for information, this study investigated the quality, suitability and readability of patient information about warfarin presented on the internet.

Method

Previously validated tools were used to evaluate the quality, suitability and readability of patient information about warfarin on selected websites.

Results

The initial search yielded 200 websites, of which 11 fit selection criteria, comprising seven non-commercial and four commercial websites. Regarding quality, most of the non-commercial sites (six out of seven) scored at least an ‘adequate’ score. With regard to suitability, 6 of the 11 websites (including two of the four commercial sites) attained an ‘adequate’ score. It was determined that information on 7 of the 11 sites (including two commercial sites) was written at reading grade levels beyond that considered representative of the adult patient population with poor literacy skills (e.g. school grade 8 or less).

Conclusion

Despite the overall ‘adequate’ quality and suitability of the internet derived patient information about warfarin, the actual usability of such websites may be limited due to their poor readability grades, particularly in patients with low literacy skills.