Family caregivers’ perspectives on medication adherence challenges in older people with dementia: a qualitative study

Abstract

Objectives: To achieve a better understanding of medication non-adherence determinants in older people with dementia from caregivers’ perspectives and possible management solutions to improve medication adherence.

Method: Semi-structured telephone interviews were conducted with 20 caregivers of older people with dementia living in the community. Data was analyzed using an inductive thematic analysis based on Braun and Clarke’s method.

Findings: Four themes emerged: dementia symptoms influence medication adherence, medication increases caregiver burden, lack of self-efficacy, medication aids and technology to enhance medication adherence. Caregivers’ lack of knowledge reduces their self-efficacy in managing medications and increases their burden of care. The majority of caregivers used technology and welcomed its use to assist them with their role.

Conclusion: Caregivers require knowledge and support such as a multifaceted technology based intervention to assist with medication adherence.     

Consequences of non-medical switch among patients with type 2 diabetes

Objective: This study aimed to describe real-world experiences following a non-medical switch among adults with type 2 diabetes mellitus (T2DM) in the United States.

Methods: For this cross-sectional study, patients with T2DM (N?=?451) provided data on demographics, and how a non-medical switch of their anti-hyperglycemic agent (AHA) affected their general health, HbA1c levels and medication management, via an Internet-based survey. Patients self-reported their level of satisfaction with the original medication and emotional reactions to the non-medical switch. Patients who recently experienced a non-medical switch of their AHA(s) (n?=?379) were asked about the consequences of switching and their satisfaction with the switch (vs. the original) medication.

Results: Patients most frequently reported feeling very/extremely frustrated, surprised, upset and angry in reaction to a non-medical switch. Patients were somewhat satisfied with their original medication. Between 20% and 30% of patients reported the non-medical switch had a moderate/major effect on their general health, diabetes, mental well-being and control over their health. The blood glucose levels of recent switchers were somewhat/much worse (20.7%) and medication management was somewhat/much worse (12.9%) on the switch (vs. the original) medication. Some recent switchers reported old symptoms returning (7.7%) and experiencing new side-effects (14.2%).

Conclusions: Approximately one in five patients reported a moderate/major negative impact on their blood glucose level, diabetes, mental well-being, general health and control over their health following a non-medical switch. Findings suggest that a non-medical switch may have unintended negative health consequences and results in considerable burden across multiple domains for a sizeable minority of patients with T2DM.     

互联网远程管理对社区高血压患者治疗依从性影响的研究进展

高血压是严重危害人类健康的慢性病之一，全球范围内有较高的发病率和致死率，且控制率低，尤其在欠发达国家和地区。有效的高血压管理是提高患者治疗依从性和影响血压控制率的关键。随着互联网在全世界的发展，传统基于医生诊室管理高血压患者治疗依从性的模式在发生改变，本文综合探讨了国内外互联网远程管理对高血压患者治疗依从性的影响，分析得出互联网远程管理对高血压患者治疗依从性在健康教育、经济、医患沟通、随访等方面存在优势，但存在使用障碍、数据不准确、研究证据有限、安全性可靠性不能保证等挑战与不足，并提出展望，以期将互联网远程管理更好地应用于社区高血压患者的管理。     

Building longitudinal medication dose data using medication information extracted from clinical notes in electronic health records

ObjectiveTo develop an algorithm for building longitudinal medication dose datasets using information extracted from clinical notes in electronic health records (EHRs).Materials and MethodsWe developed an algorithm that converts medication information extracted using natural language processing (NLP) into a usable format and builds longitudinal medication dose datasets. We evaluated the algorithm on 2 medications extracted from clinical notes of Vanderbilt’s EHR and externally validated the algorithm using clinical notes from the MIMIC-III clinical care database.ResultsFor the evaluation using Vanderbilt’s EHR data, the performance of our algorithm was excellent; F1-measures were ≥0.98 for both dose intake and daily dose. For the external validation using MIMIC-III, the algorithm achieved F1-measures ≥0.85 for dose intake and ≥0.82 for daily dose.DiscussionOur algorithm addresses the challenge of building longitudinal medication dose data using information extracted from clinical notes. Overall performance was excellent, but the algorithm can perform poorly when incorrect information is extracted by NLP systems. Although it performed reasonably well when applied to the external data source, its performance was worse due to differences in the way the drug information was written. The algorithm is implemented in the R package, “EHR,” and the extracted data from Vanderbilt’s EHRs along with the gold standards are provided so that users can reproduce the results and help improve the algorithm.ConclusionOur algorithm for building longitudinal dose data provides a straightforward way to use EHR data for medication-based studies. The external validation results suggest its potential for applicability to other systems.     

Leadership qualities emerging in an online social support group intervention

Technology-delivered interventions addressing a broad range of problems for which clients present for therapy are proliferating. However, little is known of leadership dynamics that emerge in online group interventions. The purpose of this study was to assess the types of leadership qualities that would emerge in an online social support group intervention to improve medication adherence for men with HIV, and to characterize the demographic and psychosocial profiles of leaders. Written posts (n = 616) from 66 men were coded using an adapted version of the Full Range Model of leadership. Results showed that 10% (n = 64) of posts reflected one of five leadership types, the most common of which was mentoring/providing feedback (40% of leadership posts). The next most common leadership style was instances in which encouragement was offered (30% of leadership posts). Leaders appeared to have lived with HIV longer and have higher Internet knowledge scores than non-leaders. Results indicate that online group interventions potentially may be useful to supplement traditional face-to-face treatment by providing an additional venue for group members to mentor and provide emotional support to each other. However, additional research is needed to more fully understand leadership qualities and group dynamics in other online group intervention settings.     

联合干预治疗剖宫产产后出血的临床疗效分析

目的分析宫腔填纱配合米索前列醇局部给药治疗剖宫产产后出血临床疗效。方法选取我院收治的90例剖宫产产后出血患者的资料,其入院时间为2018年1月—2019年6月。按照其入院时间的先后来进行分组—对照组(n=45,常规治疗干预)和观察组(n=45,采取宫腔填纱配合米索前列醇局部给药治疗)。对两组患者不同时间点的出血状况进行统计,且观察其血红蛋白水平治疗前后的变化。结果在两组产后2 h、24 h、48 h出血量上比较,观察组低于对照组,差异具有统计学意义(P<0.05);在治疗前,两组患者的血红蛋白水平差异无统计学意义(P>0.05);在治疗后,观察组优于对照组(P<0.05)。结论宫腔填纱配合米索前列醇局部给药治疗剖宫产产后出血的疗效显著。