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Eickhoff C, Müller U, Thomas S, Schmidt C, Hartling LS, Michael S, Schulz M, Bertsche T. Patients' Use of a Standardized Medication List - A Mixed Methods Study. Patient Prefer Adherence 2023; 17:2655-2666. [PMID: 37927342 PMCID: PMC10624198 DOI: 10.2147/ppa.s427192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose A medication list (ML) is a document listing the patient's entire medication, instructions for use, and indications. In Germany, a national standard was established in 2016 by law. However, data on patients' use of this standardized ML are scarce. We investigated (i) patients' practical use of the ML, (ii) patients' understanding of the ML, (iii) completeness and correctness of the current ML version, and (iv) reasons why patients did not adhere to their ML. Patients and Methods Community pharmacists recruited patients possessing a standardized ML with ≥5 medications. Information sources to evaluate the ML were: (a) brown bag analysis, (b) practical demonstration, (c) patient interview, and (d) patient file. Data were analyzed using qualitative and quantitative methods. Results Two hundred and eighty-eight patients (median age: 76 years, range: 27-95) were enrolled. (i) 38.5% of the patients used their ML regularly to prepare their medication and 73.3% to inform their physician. (ii) Overall, patients' understanding of the ML was good, with >80% of the patients being able to identify all relevant information. (iii) While n = 2779 medications were actually taken, n = 2539 were documented on the ML. No ML was fully correct and complete. Regarding particularly relevant items, ie, active ingredient, strength, dosage, medication missing or listed but not taken, 79.2% of ML were incorrect or incomplete. Handwritten modifications on the ML were frequent. (iv) Almost 60% of all patients did not follow their ML with "fear of adverse drug reactions" being the most frequently (n = 50) mentioned reason. Conclusion Completeness and correctness of the current ML version was poor with handwritten modifications being frequent. Additionally, most of the patients did not adhere to their ML. This indicates that measures that lead to correct and up-to-date ML and improvements in patient counseling about their medication should be developed and implemented into routine practice.
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Affiliation(s)
- Christiane Eickhoff
- Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Uta Müller
- Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Berlin, Germany
| | - Sophie Thomas
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Christian Schmidt
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | - Sebastian Michael
- Löwen-Apotheke Waldheim e.K, Waldheim, Germany
- Saxon Pharmacists Association, Leipzig, Germany
| | - Martin Schulz
- Department of Medicine, ABDA – Federal Union of German Associations of Pharmacists, Berlin, Germany
- Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Thilo Bertsche
- Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, Leipzig, Germany
- Drug Safety Center, Medical Faculty, Leipzig University and Leipzig University Hospital, Leipzig, Germany
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Karampatakis GD, Wood HE, Griffiths CJ, Lea NC, Ashcroft RE, Day B, Walker N, Coulson NS, De Simoni A. Ethical and Information Governance Considerations for Promoting Digital Social Interventions in Primary Care. J Med Internet Res 2023; 25:e44886. [PMID: 37756051 PMCID: PMC10568391 DOI: 10.2196/44886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/28/2023] [Accepted: 07/31/2023] [Indexed: 09/28/2023] Open
Abstract
Promoting online peer support beyond the informal sector to statutory health services requires ethical considerations and evidence-based knowledge about its impact on patients, health care professionals, and the wider health care system. Evidence on the effectiveness of digital interventions in primary care is sparse, and definitive guidance is lacking on the ethical concerns arising from the use of social media as a means for health-related interventions and research. Existing literature examining ethical issues with digital interventions in health care mainly focuses on apps, electronic health records, wearables, and telephone or video consultations, without necessarily covering digital social interventions, and does not always account for primary care settings specifically. Here we address the ethical and information governance aspects of undertaking research on the promotion of online peer support to patients by primary care clinicians, related to medical and public health ethics.
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Affiliation(s)
- Georgios Dimitrios Karampatakis
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Helen E Wood
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Chris J Griffiths
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Nathan C Lea
- Department of Medical Informatics & Statistics, The European Institute for Innovation through Health Data, Ghent University Hospital, Ghent, Belgium
| | | | - Bill Day
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Neil Walker
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
| | - Neil S Coulson
- Medical School, Nottingham City Hospital, Nottingham, United Kingdom
| | - Anna De Simoni
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Asthma UK Centre for Applied Research, Queen Mary University of London, London, United Kingdom
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Alefan Q, Yao S, Taylor JG, Lix LM, Eurich D, Choudhry N, Blackburn DF. Factors associated with early nonpersistence among patients experiencing side effects from a new medication. J Am Pharm Assoc (2003) 2021; 62:717-726.e5. [PMID: 34980560 DOI: 10.1016/j.japh.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Drug discontinuation (i.e., nonpersistence) is often attributed to the emergence of adverse effects. However, it is not known whether other factors increase the risk of nonpersistence when adverse effects occur. OBJECTIVES To identify factors associated with early nonpersistence among patients experiencing adverse effects from newly prescribed medications. METHODS A questionnaire was mailed to new users of antihypertensive, antihyperglycemic, and lipid-lowering medications in Saskatchewan, Canada, between 2019 and 2020. Only respondents experiencing adverse effects were included. Responses were compared between the nonpersistent group (i.e., people who had discontinued their medication) and the persistent group (i.e., those who were taking their medication at the time of the survey). Statistically significant factors were tested in multivariable logistic regression models. Odds ratios (ORs) and 95% CIs were reported. RESULTS Of the 3973 returned questionnaires, 813 respondents experienced adverse -effects from their new medication and were included in the study. Of these, 143 respondents (17.5%) had stopped their medication at the time of survey completion; most discontinuations (72.1%) occurred within 1 month of the first dose. Nonpersistent patients were older, had lower income, and were less likely to be taking an antihyperglycemic medication. After covariate adjustment, 6 factors were independently associated with nonpersistence: age less than 65 years (OR 1.56 [95% CI 1.01-2.41]), female sex (1.67 [1.08-2.59]), health condition not considered dangerous (2.09 [1.25-3.51]), medication not considered important for health (6.90 [4.40-10.84]), failure to expect adverse effects before starting medication (2.67 [1.74-4.10]), and taking 2 or more medications (0.45 [0.27-0.73]). CONCLUSION Despite the strong link between the emergence of adverse effects and early nonpersistence, our findings confirm that this association is highly influenced by several factors external to the physical experiences caused by the new medication.
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De Simoni A, Shah AT, Fulton O, Parkinson J, Sheikh A, Panzarasa P, Pagliari C, Coulson NS, Griffiths CJ. Superusers' Engagement in Asthma Online Communities: Asynchronous Web-Based Interview Study. J Med Internet Res 2020; 22:e18185. [PMID: 32573463 PMCID: PMC7381072 DOI: 10.2196/18185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/23/2020] [Accepted: 05/13/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Superusers, defined as the 1% of users who write a large number of posts, play critical roles in online health communities (OHCs), catalyzing engagement and influencing other users' self-care. Their unique online behavior is key to sustaining activity in OHCs and making them flourish. Our previous work showed the presence of 20 to 30 superusers active on a weekly basis among 3345 users in the nationwide Asthma UK OHC and that the community would disintegrate if superusers were removed. Recruiting these highly skilled individuals for research purposes can be challenging, and little is known about superusers. OBJECTIVE This study aimed to explore superusers' motivation to actively engage in OHCs, the difficulties they may face, and their interactions with health care professionals (HCPs). METHODS An asynchronous web-based structured interview study was conducted. Superusers of the Asthma UK OHC and Facebook groups were recruited through Asthma UK staff to pilot and subsequently complete the questionnaire. Open-ended questions were analyzed using content analysis. RESULTS There were 17 superusers recruited for the study (14 patients with asthma and 3 carers); the majority were female (15/17). The age range of participants was 18 to 75 years. They were active in OHCs for 1 to 6 years and spent between 1 and 20 hours per week reading and 1 and 3 hours per week writing posts. Superusers' participation in OHCs was prompted by curiosity about asthma and its medical treatment and by the availability of spare time when they were off work due to asthma exacerbations or retired. Their engagement increased over time as participants furthered their familiarity with the OHCs and their knowledge of asthma and its self-management. Financial or social recognition of the superuser role was not important; their reward came from helping and interacting with others. According to the replies provided, they showed careful judgment to distinguish what can be dealt with through peer advice and what needs input from HCPs. Difficulties were encountered when dealing with misunderstandings about asthma and its treatment, patients not seeking advice from HCPs when needed, and miracle cures or dangerous ideas. Out of 17 participants, only 3 stated that their HCPs were aware of their engagement with OHCs. All superusers thought that HCPs should direct patients to OHCs, provided they are trusted and moderated. In addition, 9 users felt that HCPs themselves should take part in OHCs. CONCLUSIONS Superusers from a UK-wide online community are highly motivated, altruistic, and mostly female individuals who exhibit judgment about the complexity of coping with asthma and the limits of their advice. Engagement with OHCs satisfies their psychosocial needs. Future research should explore how to address their unmet needs, their interactions with HCPs, and the potential integration of OHCs in traditional healthcare.
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Affiliation(s)
- Anna De Simoni
- Asthma UK Centre for Applied Research, Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
| | | | - Olivia Fulton
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Pietro Panzarasa
- School of Business and Management, Queen Mary University of London, London, United Kingdom
| | - Claudia Pagliari
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Neil S Coulson
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Chris J Griffiths
- Asthma UK Centre for Applied Research, Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
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Gibson JME, Miller C, Coupe J, Jones SP. Medication-taking after stroke: a qualitative meta-synthesis of the perspectives of stroke survivors, informal carers and health professionals. Fam Pract 2020; 37:4-14. [PMID: 31324915 DOI: 10.1093/fampra/cmz030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lifelong secondary prevention medication is recommended after stroke or transient ischaemic attack. However, poor medication adherence and persistence, which lead to suboptimal health outcomes, are common, but the reasons for this are not well understood, mainly because there have been few studies reporting adherence barriers in stroke survivors. OBJECTIVE The aim of this review was to undertake a meta-synthesis of qualitative studies of medication-taking after stroke. Outcomes of interest were: lived experiences, views and beliefs, and strategies and solutions used by community-dwelling stroke and transient ischaemic attack survivors, informal carers and health care professionals in relation to medication-taking. METHOD The review protocol was registered on PROSPERO (CRD42018086792). A search of online bibliographic databases was performed using key search terms of stroke, persistence, adherence and medication for years 1980-2018. Citation tracking was also carried out. Studies using qualitative or mixed methods were included. Systematic data extraction and synthesis were conducted using a meta-ethnographic approach. RESULTS Twelve studies were eligible for inclusion, with a total of 412 participants, two-thirds of whom were stroke survivors, ranging from 1 month to over 20 years post-stroke. Third-order themes identified were 'Medicines Work'-Information Work; Health Care Work; Carer Work; Emotional Work; Practical Work and an underpinning theme of Trust. However, many studies had significant methodological weaknesses. CONCLUSIONS This synthesis suggests that the burden of 'medicines work' after stroke is substantial and multifaceted. Its successful undertaking depends on mutual trust between stroke survivors, carers and health care professionals and trust in the benefits of medicines themselves.
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Affiliation(s)
| | - Colette Miller
- School of Nursing, University of Central Lancashire, Preston, UK
| | - Jacqueline Coupe
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
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Smith FE, Jones C, Gracey F, Mullis R, Coulson NS, De Simoni A. Emotional adjustment post-stroke: A qualitative study of an online stroke community. Neuropsychol Rehabil 2019; 31:414-431. [PMID: 31855105 DOI: 10.1080/09602011.2019.1702561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Understanding of emotional adjustment after stroke is limited. Under one-third of stroke survivors reporting emotional problems receive support. The aim of this study was to explore the process of emotional adjustment post-stroke and investigate the role played by participation in an online stroke community. We applied thematic analysis to 124 relevant posts within 114 discussion threads, written by 39 survivors and 29 carers. The contribution of online community engagement to emotional adjustment was explored using the Social Support Behaviour Code. Stroke survivors share common experiences of emotional adjustment and may not necessarily reach complete acceptance. Positive and negative trajectories of emotional adjustment were identified. Survivors progressed along, or moved between, positive and negative pathways not in a time-dependent manner but in response to "trigger events," such as physical setbacks or anti-depressant treatment, which may occur at any chronological time. An adapted version of Suhr's 1990 Social Support Behaviour Code showed that support provided through the online community took many forms, including advice, teaching, empathy and normalization of concerns. Participation in the stroke community was itself deemed to be a positive "trigger event." There is need to improve awareness of emotional adjustment and their "triggers" amongst stroke survivors, carers and clinicians.
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Affiliation(s)
- F E Smith
- The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - C Jones
- The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - F Gracey
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - R Mullis
- The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - N S Coulson
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
| | - A De Simoni
- The Primary Care Unit, University of Cambridge, Cambridge, UK.,Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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Yang Z, Edwards D, Massou E, Saunders CL, Brayne C, Mant J. Statin use and high-dose statin use after ischemic stroke in the UK: a retrospective cohort study. Clin Epidemiol 2019; 11:495-508. [PMID: 31388316 PMCID: PMC6607979 DOI: 10.2147/clep.s201983] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/29/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Trial evidence supports statin use after ischemic stroke and recent American, European and British guidelines recommend high-intensity statins for this indication. Limited data are available describing current statin use among these patients in unselected settings. We conducted a cohort study to examine secular trends and factors associated with statin use and dose following ischemic stroke. Methods: A retrospective cohort study of patients with first ischemic stroke between 2000 and 2014 was conducted using the Clinical Practice Research Datalink (CPRD). Proportions of statin users and high-intensity statin users within 2 years after stroke were estimated for each calendar year. We used Cox regression models to explore potential factors associated with statin use and Poisson regression models to calculate risk ratios for the use of a high-intensity statin. Results: A total of 80,442 patients with first stroke were analyzed. The proportion using statins within 2 years after stroke increased from 25% in 2000 to 70% in 2006 and remained at about 75% through 2014. Among post-stroke statin users, high-intensity use accounted for approximately 15% between 2004 and 2011 and then increased to almost 35% in 2014. Older patients (aged ≥75 years), younger patients (<45 years), patients with no prior statin treatment, dementia, underweight, or absence of cardiovascular factors (coronary heart disease, smoking, obesity, diabetes, hypertension, or transient ischemic attack) were less likely to use statins and less likely to receive a high-intensity statin. Conclusion: There has been an increase over time in both statin use and dose, but many patients with ischemic stroke continue to be under-treated. Clinical trials and policy interventions to improve appropriate post-stroke statin use should focus on younger and older patients, patients with no pre-stroke statin treatment, and patients without additional cardiovascular risk factors.
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Affiliation(s)
- Zhirong Yang
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Duncan Edwards
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Efthalia Massou
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Catherine L Saunders
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Harnessing social media data for pharmacovigilance: a review of current state of the art, challenges and future directions. INTERNATIONAL JOURNAL OF DATA SCIENCE AND ANALYTICS 2019. [DOI: 10.1007/s41060-019-00175-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Joglekar S, Sastry N, Coulson NS, Taylor SJ, Patel A, Duschinsky R, Anand A, Jameson Evans M, Griffiths CJ, Sheikh A, Panzarasa P, De Simoni A. How Online Communities of People With Long-Term Conditions Function and Evolve: Network Analysis of the Structure and Dynamics of the Asthma UK and British Lung Foundation Online Communities. J Med Internet Res 2018; 20:e238. [PMID: 29997105 PMCID: PMC6060304 DOI: 10.2196/jmir.9952] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/10/2018] [Accepted: 05/12/2018] [Indexed: 11/29/2022] Open
Abstract
Background Self-management support can improve health and reduce health care utilization by people with long-term conditions. Online communities for people with long-term conditions have the potential to influence health, usage of health care resources, and facilitate illness self-management. Only recently, however, has evidence been reported on how such communities function and evolve, and how they support self-management of long-term conditions in practice. Objective The aim of this study is to gain a better understanding of the mechanisms underlying online self-management support systems by analyzing the structure and dynamics of the networks connecting users who write posts over time. Methods We conducted a longitudinal network analysis of anonymized data from 2 patients’ online communities from the United Kingdom: the Asthma UK and the British Lung Foundation (BLF) communities in 2006-2016 and 2012-2016, respectively. Results The number of users and activity grew steadily over time, reaching 3345 users and 32,780 posts in the Asthma UK community, and 19,837 users and 875,151 posts in the BLF community. People who wrote posts in the Asthma UK forum tended to write at an interval of 1-20 days and six months, while those in the BLF community wrote at an interval of two days. In both communities, most pairs of users could reach one another either directly or indirectly through other users. Those who wrote a disproportionally large number of posts (the superusers) represented 1% of the overall population of both Asthma UK and BLF communities and accounted for 32% and 49% of the posts, respectively. Sensitivity analysis showed that the removal of superusers would cause the communities to collapse. Thus, interactions were held together by very few superusers, who posted frequently and regularly, 65% of them at least every 1.7 days in the BLF community and 70% every 3.1 days in the Asthma UK community. Their posting activity indirectly facilitated tie formation between other users. Superusers were a constantly available resource, with a mean of 80 and 20 superusers active at any one time in the BLF and Asthma UK communities, respectively. Over time, the more active users became, the more likely they were to reply to other users’ posts rather than to write new ones, shifting from a help-seeking to a help-giving role. This might suggest that superusers were more likely to provide than to seek advice. Conclusions In this study, we uncover key structural properties related to the way users interact and sustain online health communities. Superusers’ engagement plays a fundamental sustaining role and deserves research attention. Further studies are needed to explore network determinants of the effectiveness of online engagement concerning health-related outcomes. In resource-constrained health care systems, scaling up online communities may offer a potentially accessible, wide-reaching and cost-effective intervention facilitating greater levels of self-management.
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Affiliation(s)
- Sagar Joglekar
- Department of Informatics, King's College London, London, United Kingdom
| | - Nishanth Sastry
- Department of Informatics, King's College London, London, United Kingdom
| | - Neil S Coulson
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Stephanie Jc Taylor
- Asthma UK Centre for Applied Research, Barts Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
| | - Anita Patel
- Asthma UK Centre for Applied Research, Barts Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
| | - Robbie Duschinsky
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | | | - Chris J Griffiths
- Asthma UK Centre for Applied Research, Barts Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Pietro Panzarasa
- School of Business and Management, Queen Mary University of London, London, United Kingdom
| | - Anna De Simoni
- Asthma UK Centre for Applied Research, Barts Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
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Jamison J, Sutton S, Mant J, Simoni AD. Barriers and facilitators to adherence to secondary stroke prevention medications after stroke: analysis of survivors and caregivers views from an online stroke forum. BMJ Open 2017; 7:e016814. [PMID: 28713074 PMCID: PMC5541606 DOI: 10.1136/bmjopen-2017-016814] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To identify barriers and facilitators of medication adherence in patients with stroke along with their caregivers. DESIGN Qualitative thematic analysis of posts about secondary prevention medications, informed by Perceptions and Practicalities Approach. SETTING Posts written by the UK stroke survivors and their family members taking part in the online forum of the Stroke Association, between 2004 and 2011. PARTICIPANTS 84 participants: 49 stroke survivors, 33 caregivers, 2 not stated, identified using the keywords 'taking medication', 'pills', 'size', 'side-effects', 'routine', 'blister' as well as secondary prevention medication terms. RESULTS Perceptions reducing the motivation to adhere included dealing with medication side effects, questioning doctors' prescribing practices and negative publicity about medications, especially in regard to statins. Caregivers faced difficulties with ensuring medications were taken while respecting the patient's decisions not to take tablets. They struggled in their role as advocates of patient's needs with healthcare professionals. Not experiencing side effects, attributing importance to medications, positive personal experiences of taking tablets and obtaining modification of treatment to manage side effects were facilitators of adherence. Key practical barriers included difficulties with swallowing tablets, dealing with the burden of treatment and drug cost. Using medication storage devices, following routines and getting help with medications from caregivers were important facilitators of adherence. CONCLUSIONS An online stroke forum is a novel and valuable resource to investigate use of secondary prevention medications. Analysis of this forum highlighted significant barriers and facilitators of medication adherence faced by stroke survivors and their caregivers. Addressing perceptual and practical barriers highlighted here can inform the development of future interventions aimed at improving adherence to secondary prevention medication after stroke.
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Affiliation(s)
- James Jamison
- Primary Care Unit, Department of Public Health and Primary Care, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Stephen Sutton
- Primary Care Unit, Department of Public Health and Primary Care, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anna De Simoni
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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