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Erickson SR. Short Report: Where do caregivers of persons with intellectual or developmental disabilities obtain information about medication? RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 138:104534. [PMID: 37224596 DOI: 10.1016/j.ridd.2023.104534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/20/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND/AIMS/METHODS Medication information is available from many sources. This short report provides a simple description of where caregivers of people with intellectual/developmental disability (IDD) obtain medication information, and compares these sources between family caregivers and direct support professionals (DSP). PROCEDURES/OUTCOMES Cross-sectional study design using an internet-based survey of caregivers, aged 18 years or older, who provided support to adults with IDD. The primary outcome is the source of medication information reported by caregivers. RESULTS/CONCLUSIONS Eighty-nine caregivers responded. Health care professionals were the primary source (87.6 %) of medication information, followed by the internet (77.5 %). There was no difference between caregiver groups for these two sources. The prescription label/information sheet was the next most common source (56.2 %), with significantly more family (76.2 %) versus DSP (38.3 %), p < 0.001. A medication reference was also common (43.8 %), with 28.6 % of family and 57.4 % of DSP, p = 0.006. House manager/nurse was next, with 16.9 %, and television/radio as a source (10.1 %), no difference between groups. Lastly, friends or coworkers were 7.9 %, with no DSP endorsing this option, p = 0.006. IMPLICATIONS Caregivers obtain medication information from a variety of sources, with health care professionals being the primary source. The internet was also very common, which may be worrisome, due to the wide range of level of quality of information available. Educational interventions should be developed to provide caregivers with tools to be able identify and use legitimate medication information.
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Affiliation(s)
- Steven R Erickson
- University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109-1065, USA.
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Orth LE, Feudtner C, Kempe A, Morris MA, Colborn KL, Gritz RM, Linnebur SA, Begum A, Feinstein JA. A coordinated approach for managing polypharmacy among children with medical complexity: rationale and design of the Pediatric Medication Therapy Management (pMTM) randomized controlled trial. BMC Health Serv Res 2023; 23:414. [PMID: 37120509 PMCID: PMC10148507 DOI: 10.1186/s12913-023-09439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Children with medical complexity (CMC) often rely upon the use of multiple medications to sustain quality of life and control substantial symptom burden. Pediatric polypharmacy (≥ 5 concurrent medications) is prevalent and increases the risk of medication-related problems (MRPs). Although MRPs are associated with pediatric morbidity and healthcare utilization, polypharmacy is infrequently assessed during routine clinical care for CMC. The aim of this randomized controlled trial is to determine if a structured pharmacist-led Pediatric Medication Therapy Management (pMTM) intervention reduces MRP counts, as well as the secondary outcomes of symptom burden and acute healthcare utilization. METHODS This is a hybrid type 2 randomized controlled trial assessing the effectiveness of pMTM compared to usual care in a large, patient-centered medical home for CMC. Eligible patients include all children ages 2-18 years old, with ≥ 1 complex chronic condition, and with ≥ 5 active medications, as well as their English-speaking primary caregivers. Child participants and their primary parental caregivers will be randomized to pMTM or usual care before a non-acute primary care visit and followed for 90 days. Using generalized linear models, the overall effectiveness of the intervention will be evaluated using total MRP counts at 90 days following pMTM intervention or usual care visit. Following attrition, a total of 296 CMC will contribute measurements at 90 days, which provides > 90% power to detect a clinically significant 1.0 reduction in total MRPs with an alpha level of 0.05. Secondary outcomes include Parent-Reported Outcomes of Symptoms (PRO-Sx) symptom burden scores and acute healthcare visit counts. Program replication costs will be assessed using time-driven activity-based scoring. DISCUSSION This pMTM trial aims to test hypotheses that a patient-centered medication optimization intervention delivered by pediatric pharmacists will result in lower MRP counts, stable or improved symptom burdens, and fewer cumulative acute healthcare encounters at 90 days following pMTM compared to usual care. The results of this trial will be used to quantify medication-related outcomes, safety, and value for a high-utilization group of CMC, and outcomes may elucidate the role of integrated pharmacist services as a key component of outpatient complex care programs for this priority pediatric population. TRIAL REGISTRATION This trial was prospectively registered at clinicaltrials.gov (NCT05761847) on Feb 25, 2023.
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Affiliation(s)
- Lucas E Orth
- Skaggs School of Pharmacy & Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmacy, Children's Hospital Colorado, Aurora, CO, USA
| | - Chris Feudtner
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Departments of Pediatrics and Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Allison Kempe
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Megan A Morris
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kathryn L Colborn
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - R Mark Gritz
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sunny A Linnebur
- Skaggs School of Pharmacy & Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anowara Begum
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
| | - James A Feinstein
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA.
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Salzberg D, Zhang W, Moran M, Hardin J, McDermott S, Okoro C, Hollis N. Helpers help people with intellectual and developmental disabilities and hypertension to understand their condition and the need to adhere to anti-hypertensive medication. Disabil Health J 2021; 15:101219. [PMID: 34625396 DOI: 10.1016/j.dhjo.2021.101219] [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: 02/12/2021] [Revised: 09/09/2021] [Accepted: 09/20/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Recent evidence suggests that many adults with intellectual and developmental disabilities (IDD) do not adequately manage hypertension (HTN) medication. Known risk factors for insufficient prescription filling include age, residential placement, and lack of caregiver support. This is a first report of a randomized intervention trial designed to analyze the relationship of a brief educational intervention with increased knowledge about HTN and improvement in prescription filling for anti-hypertensive medication. OBJECTIVE/HYPOTHESIS The objective was to test whether an educational flyer and regular messages about HTN and the importance of refilling medication would improve scores on knowledge surveys. Participants were Medicaid members with HTN and IDD (Member) or caregivers (Helpers) who chose to participate on behalf of a Member. METHODS Recruitment letters explained that either the Member or their Helper could participate (not both). Participants were randomly assigned to the Case or Comparison group, and both were comprised of Members and Helpers. Only Case participants received a flyer and monthly HTN education messages for one year, but all participants completed knowledge surveys at baseline, six, and 12 months. Linear regression and log-binomial models were used to compare responses between groups. RESULTS Case Helpers had statistically significant improvements on HTN knowledge from baseline through the first year, compared to Comparison Members and Comparison Helpers. Regardless of group assignment, Helpers scored better on surveys than did Members. CONCLUSIONS This study suggests that it is beneficial to explicitly include Helpers in health care instruction and in management of chronic disease for adults with IDD.
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Affiliation(s)
- Deborah Salzberg
- Department of Epidemiology & Biostatistics, Discovery 1 Building, University of South Carolina, Columbia, SC, USA.
| | - Wanfang Zhang
- Department of Epidemiology & Biostatistics, Discovery 1 Building, University of South Carolina, Columbia, SC, USA
| | - Madeline Moran
- Department of Epidemiology & Biostatistics, Discovery 1 Building, University of South Carolina, Columbia, SC, USA
| | - James Hardin
- Department of Epidemiology & Biostatistics, Discovery 1 Building, University of South Carolina, Columbia, SC, USA
| | - Suzanne McDermott
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Catherine Okoro
- National Center on Birth Defects and Developmental Disability, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - NaTasha Hollis
- National Center on Birth Defects and Developmental Disability, Centers for Disease Control and Prevention, Atlanta, GA, USA; Commissioned Corps, US Public Health Service, USA
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Bourne MJ, Smeltzer SC, Kelly MM. Healthcare inequities among adults with developmental disability: An integrative review with implications for nursing education. Nurse Educ Pract 2021; 57:103225. [PMID: 34649127 DOI: 10.1016/j.nepr.2021.103225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/23/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
AIM This integrative review synthesized research on the healthcare inequities experienced by adults with developmental disability in the United States and discussed implications for nursing education. BACKGROUND Individuals with developmental disability are living longer with chronic comorbidities and experience healthcare inequities. METHOD Application of inclusion criteria to database and ancestry searches resulted in 26 articles that were assessed for quality and analyzed thematically. RESULTS Three categories of inequity were identified: knowledge deficits, communication challenges and poor quality of care. Knowledge deficits and communication challenges can lead to frustration, errors and unmet needs. Poor quality of care encompasses the decreased availability and access to services, limited health promotion participation and higher rates of hospitalizations and complications for adults with developmental disability. CONCLUSION Healthcare inequities may be reduced by targeting patient and provider knowledge. Inclusion of developmental disability content and clinical experiences in nursing education may improve care and reduce inequities for this underserved population.
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Affiliation(s)
- Melissa J Bourne
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
| | - Suzanne C Smeltzer
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
| | - Michelle M Kelly
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
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Queiroz JPC, Machado ALG, Vieira NFC. Health literacy for caregivers of elders with alzheimer's disease. Rev Bras Enferm 2020; 73Suppl 3:e20190608. [PMID: 32965437 DOI: 10.1590/0034-7167-2019-0608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/27/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the level of health literacy in informal caregivers of elders with Alzheimer's disease. METHODS Descriptive study with a quantitative and qualitative approach, with health literacy as a theoretical framework. Research carried out with 42 informal caregivers of elders with Alzheimer's from a geriatrics outpatient clinic, using a questionnaire with sociodemographic data and the Health Literacy instrument. RESULTS The functional and conceptual levels were more prevalent, with regards to elders with Alzheimer's, than the empowering level. Caregivers searched, evaluated, and used health information and expressed abilities to use and judge the information received. FINAL CONSIDERATIONS The predominance of categories in the cognitive level of learning indicates the need to strengthen the empowering level of these caregivers. Health literacy made it possible to reveal the demands of informal caregivers of elders with Alzheimer's, evaluating their individual ability to offer this type of assistance. It is also a tool capable of reaching better health results.
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Li Y, Hu L, Mao X, Shen Y, Xue H, Hou P, Liu Y. Health literacy, social support, and care ability for caregivers of dementia patients: Structural equation modeling. Geriatr Nurs 2020; 41:600-607. [DOI: 10.1016/j.gerinurse.2020.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 11/26/2022]
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MacLeod J, MacLure K. People with intellectual disabilities and their experience of medication: A narrative literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:976-991. [PMID: 32100409 DOI: 10.1111/jar.12719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with intellectual disabilities are known to have increased medical needs and are prescribed more medication than the general population. Understanding the reality of incorporating medication into their lives would help healthcare professionals provide care in more meaningful and personalised ways. AIM A narrative review of the current literature relating to people with intellectual disabilities and their experience of medication/pharmaceutical care. METHOD Electronic databases were searched for articles relating to intellectual disabilities and medication administration or pharmaceutical care. Other relevant papers identified from included article reference lists were also identified. A narrative literature was undertaken due to the heterogeneity of the identified papers. RESULTS A total of 29 studies from the literature searches were included alongside other relevant papers. CONCLUSIONS The published literature noted some aspects of the medication-related experiences of people with intellectual disabilities. However, a greater understanding of medication-related experiences is still required.
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Affiliation(s)
- Joan MacLeod
- Aberdeen City Health and Social Care Partnership, NHS Grampian and Doctoral Graduate, Robert Gordon University, Aberdeen, UK
| | - Katie MacLure
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
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Bonaccorsi G, Pieralli F, Innocenti M, Milani C, Del Riccio M, Donzellini M, Baggiani L, Lorini C. Health Literacy among Non-Familial Caregivers of Older Adults: A Study Conducted in Tuscany (Italy). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193771. [PMID: 31597265 PMCID: PMC6801529 DOI: 10.3390/ijerph16193771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/16/2022]
Abstract
Many older adults who live at home depend on a caregiver. When familial support cannot provide the necessary care, paid caregivers are frequently hired. Health literacy (HL) is the knowledge and competence required of people to meet the complex demands of health in modern society. The aim of this study is to assess the HL level of paid non-familial caregivers who were enrolled through two different sources: from the homes of assisted people in two Tuscan health districts (first sample) and during job interviews in a home care agency operating in Florence (second sample). The two different recruitment contexts allow us to provide a broader view of the phenomenon, presenting a picture of the HL level of those who are already working and those who are looking for a new job in this field. One-on-one face-to-face interviews, which include the administration of the Newest Vital Sign (NVS) to measure HL, were conducted. Recruitment resulted in 84 caregivers in the first sample and 68 in the second sample. In the first sample, the mean age was 51.2 ± 9 years; 94% of the participants were women. A high likelihood or likelihood of inadequate HL (i.e., a low level of HL) was found in 73.8% of cases. In the second sample, the mean age was 43.7 ± 11.5 years; 83.8% of the participants were women, and 80.9% had a low level of HL. In both samples, HL was statistically associated with the level of understanding of the Italian language. In conclusion, inadequate HL is an under-recognized problem among non-familial caregivers. Educational programs that aim to increase HL skills could be an effective approach to improving the qualification of informal healthcare professionals.
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Affiliation(s)
- Guglielmo Bonaccorsi
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy.
| | - Francesca Pieralli
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy.
| | - Maddalena Innocenti
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy.
| | - Chiara Milani
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy.
| | - Marco Del Riccio
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy.
| | - Martina Donzellini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy.
| | - Lorenzo Baggiani
- AUSL Toscana Centro, Florence, Piazza Santa Maria Nuova 1, 50122 Florence, Italy.
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy.
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Tyler CV, Wells MD. Direct Support Professionals' Perspectives on Ambulatory Health Care Processes and Quality. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:188-197. [PMID: 31120404 DOI: 10.1352/1934-9556-57.3.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Direct support professionals (DSPs) frequently accompany persons with intellectual and other developmental disabilities (IDD) to their health care appointments and could offer valuable insights into potential target areas for health-care improvement. DSPs completed surveys assessing healthcare processes and quality immediately following 118 ambulatory health care encounters involving their patients with IDD. Although DSPs generally judged the quality of health care as good (44%) or excellent (52%), they also observed that physicians directed questions to the DSP that the patient could have answered in 22% of encounters, and noted that physicians failed to ask critical psychosocial information in 24% of encounters. Competency-based training of DSPs around health-care advocacy could significantly improve the quality of health care provided to persons with IDD.
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Affiliation(s)
- Carl V Tyler
- Carl V. Tyler, Developmental Disabilities-Practice-Based Research Network, Case Western Reserve University, Lakewood, OH; Michael D. Wells, Developmental Disabilities-Practice-Based Research Network, Lakewood, OH; Developmental Disabilities-Practice-Based Research Network, Case Western Reserve University, Cleveland, OH
| | - Michael D Wells
- Carl V. Tyler, Developmental Disabilities-Practice-Based Research Network, Case Western Reserve University, Lakewood, OH; Michael D. Wells, Developmental Disabilities-Practice-Based Research Network, Lakewood, OH; Developmental Disabilities-Practice-Based Research Network, Case Western Reserve University, Cleveland, OH
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Look KA, Stone JA. Contextual factors influencing medication management by rural informal caregivers of older adults. Res Social Adm Pharm 2018; 15:1223-1229. [PMID: 30355459 DOI: 10.1016/j.sapharm.2018.10.007] [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: 04/02/2018] [Revised: 10/03/2018] [Accepted: 10/13/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Managing medications is an important part of the rural informal caregiver's role in the community setting, and the context within which care is provided plays an important role in shaping the work they perform. However, little is known about the intra- and interpersonal factors that impact the rural caregiver's involvement in and performance of medication management. OBJECTIVES To identify contextual factors influencing medication management by rural informal caregivers of older adults. METHODS Four separate focus groups with rural caregivers of older adults were conducted with 5-9 caregivers per group. Participants were asked to describe the medication management activities performed and problems they encountered while providing assistance. Focus groups were recorded, transcribed verbatim, and analyzed for themes using an inductive approach. RESULTS Care recipient independence, or their ability and preference to perform medication-related activities without supervision, was a key factor driving the caregiver's involvement in medication management and how it was performed. Many caregivers used a team-based approach to medication management that supported the care recipient's independence. Care recipient health and function was a driver behind the need for caregiving, and declines in physical and mental health led to changes in how medication management was carried out over time. Caregiver location also impacted the ways in which medication management was performed by caregivers. CONCLUSIONS Interventions and pharmacy services to support medication management by rural informal caregivers should be designed in a way that preserves and promotes the care recipient's independence, and should be tailored to the context within which caregiving is performed.
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Affiliation(s)
- Kevin A Look
- (a)Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705-2222, USA.
| | - Jamie A Stone
- (a)Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI, 53705-2222, USA
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Medication administration by caregiving youth: An inside look at how adolescents manage medications for family members. J Adolesc 2018; 69:33-43. [PMID: 30223151 DOI: 10.1016/j.adolescence.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Children take on the role of family caregiver throughout the world. No prior published research exists surrounding the particular circumstances of the task of medication administration and management by these youth, which was explored in this study. METHODS A series of focus groups were conducted using semi-structured interviews of 28 previously identified caregiving youth ages 12-19 years old who live in the United States. Data analysis followed guidelines of conventional content analysis. RESULTS The following categories emerged about youth caregivers handling medications: 1) tasks involve organizational and administrative responsibilities; 2) youth have varying degrees of knowledge pertaining to these medications; 3) most share responsibility with other family members; 4) they lack formal education about their responsibilities; 5) multiple challenges exist relating to this task; 6) managing medications is associated with emotional responses; and 7) possible safety issues exist. CONCLUSIONS These responsibilities represent a unique hardship and merit support and research from the medical, healthcare, legislative, and public health communities, among others.
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Salgado TM, Fedrigon A, Riccio Omichinski D, Meade MA, Farris KB. Identifying Medication Management Smartphone App Features Suitable for Young Adults With Developmental Disabilities: Delphi Consensus Study. JMIR Mhealth Uhealth 2018; 6:e129. [PMID: 29792292 PMCID: PMC5990856 DOI: 10.2196/mhealth.9527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/01/2018] [Accepted: 04/09/2018] [Indexed: 01/08/2023] Open
Abstract
Background Smartphone apps can be a tool to facilitate independent medication management among persons with developmental disabilities. At present, multiple medication management apps exist in the market, but only 1 has been specifically designed for persons with developmental disabilities. Before initiating further app development targeting this population, input from stakeholders including persons with developmental disabilities, caregivers, and professionals regarding the most preferred features should be obtained. Objective The aim of this study was to identify medication management app features that are suitable to promote independence in the medication management process by young adults with developmental disabilities using a Delphi consensus method. Methods A compilation of medication management app features was performed by searching the iTunes App Store, United States, in February 2016, using the following terms: adherence, medication, medication management, medication list, and medication reminder. After identifying features within the retrieved apps, a final list of 42 features grouped into 4 modules (medication list, medication reminder, medication administration record, and additional features) was included in a questionnaire for expert consensus rating. A total of 52 experts in developmental disabilities, including persons with developmental disabilities, caregivers, and professionals, were invited to participate in a 3-round Delphi technique. The purpose was to obtain consensus on features that are preferred and suitable to promote independence in the medication management process among persons with developmental disabilities. Consensus for the first, second, and third rounds was defined as ≥90%, ≥80%, and ≥75% agreement, respectively. Results A total of 75 responses were received over the 3 Delphi rounds—30 in the first round, 24 in the second round, and 21 in the third round. At the end of the third round, cumulative consensus was achieved for 60% (12/20) items in the medication list module, 100% (3/3) in the medication reminder module, 67% (2/3) in the medication administration record module, and 63% (10/16) in the additional features module. In addition to the medication list, medication reminder, and medication administration record features, experts selected the following top 3 most important additional features: automatic refills through pharmacies; ability to share medication information from the app with providers; and ability to share medication information from the app with family, friends, and caregivers. The top 3 least important features included a link to an official drug information source, privacy settings and password protection, and prescription refill reminders. Conclusions Although several mobile apps for medication management exist, few are specifically designed to support persons with developmental disabilities in the complex medication management process. Of the 42 different features assessed, 64% (27/42) achieved consensus for inclusion in a future medication management app. This study provides information on the features of a medication management app that are most important to persons with developmental disabilities, caregivers, and professionals.
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Affiliation(s)
- Teresa M Salgado
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, United States
| | - Alexa Fedrigon
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Donna Riccio Omichinski
- Department of Physical Medicine & Rehabilitation, University of Michigan Rehabilitation Engineering Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Michelle A Meade
- Department of Physical Medicine & Rehabilitation, University of Michigan Rehabilitation Engineering Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Karen B Farris
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
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Sullivan WF, Diepstra H, Heng J, Ally S, Bradley E, Casson I, Hennen B, Kelly M, Korossy M, McNeil K, Abells D, Amaria K, Boyd K, Gemmill M, Grier E, Kennie-Kaulbach N, Ketchell M, Ladouceur J, Lepp A, Lunsky Y, McMillan S, Niel U, Sacks S, Shea S, Stringer K, Sue K, Witherbee S. Soins primaires aux adultes ayant des déficiences intellectuelles et développementales. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:e137-e166. [PMID: 29650617 PMCID: PMC5897083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objectif Mettre à jour les Lignes directrices consensuelles canadiennes 2011 en matière de soins primaires aux adultes ayant une déficience développementale. Méthodes Des médecins de famille et d’autres professionnels de la santé expérimentés dans les soins aux personnes ayant des DID ont examiné et synthétisé les récentes connaissances empiriques, d’écosystèmes, expertes et expérientielles. Un système a été conçu pour catégoriser la qualité des recommandations. Recommandations Les adultes ayant des DID sont un groupe hétérogène de patients qui présentent des affections médicales et des facteurs qui influent sur leur santé, qui diffèrent de ceux qui touchent les autres membres de la communauté de par leur nature, leurs manifestations, leur gravité ou leur complexité. Ces personnes nécessitent une approche de soins et des interventions adaptées à leurs besoins. Les présentes lignes directrices offrent des conseils en matière de normes de soins. Nous avons incorporé des références à des outils cliniques et à d’autres ressources pratiques. Les approches de soins décrites ici s’appliquent aussi à d’autres groupes de patients ayant un déficit cognitif ou de la communication, ou d’autres déficits des fonctions adaptatives. Conclusion À titre de fournisseurs de soins de première ligne, les médecins de famille jouent un rôle vital de promotion de la santé et de bien-être auprès des adultes ayant des DID. Ces lignes directrices peuvent les aider à prendre des décisions avec les patients et les aidants naturels.
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Affiliation(s)
- William F Sullivan
- Professeur agrégé au département de médecine familiale et communautaire à l'Université de Toronto, en Ontario, médecin membre du personnel de services médicaux au Surrey Place Centre et à l'unité de pratique familiale de l'Hôpital St Michael, et directeur du programme de soins de première ligne des patients qui présentent un retard développemental au Surrey Place Centre.
| | | | - John Heng
- Professeur adjoint au département de philosophie et au département d'études interdisciplinaires du Collège universitaire King à London, Ont
| | - Shara Ally
- Infirmière en pratique avancée au Surrey Place Centre, chargée de cours à la faculté de soins infirmiers Lawrence S. Bloomberg de l'Université de Toronto, et candidate au MBA
| | - Elspeth Bradley
- Professeure agrégée au département de psychiatrie de l'Université de Toronto et psychiatre consultante et psychothérapeute auprès de patients ayant des déficiences intellectuelles
| | - Ian Casson
- Professeur agrégé à la faculté de médecine familiale de l'Université Queen's, à Kingston, Ont
| | - Brian Hennen
- Professeur émérite à l'Université Western à London et à l'Université Dalhousie à Halifax, N.-É
| | | | - Marika Korossy
- Bibliothécaire à la retraite au Surrey Place Centre à Toronto
| | - Karen McNeil
- Professeure adjointe au département de médecine familiale de l'Université Dalhousie
| | - Dara Abells
- Médecin de famille au Forest Hill Family Health Centre et aux Integrated Services for Autism and Neurodevelopmental Disorders à Toronto, et chargée d'enseignement au Department of Family and Community Medicine à l'Université de Toronto, en Ontario
| | - Khush Amaria
- Psychologue clinique et de la santé et chef d'équipe du Good 2 Go Transition Program à l'Hôpital Sick Children de Toronto
| | - Kerry Boyd
- Professeure clinique agrégée au département de psychiatrie et de neurosciences comportementales à l'Université McMaster à Hamilton et directrice clinicienne au Bethesda Community Services à Thorold, Ontario
| | - Meg Gemmill
- Professeure adjointe au département de médecine familiale de l'Université Queen's
| | - Elizabeth Grier
- Professeure adjointe au département de médecine familiale de l'Université Queen's
| | - Natalie Kennie-Kaulbach
- Attachée d'enseignement universitaire et coordonnatrice au laboratoire de compétences du Collège de pharmacie de l'Université Dalhousie
| | - Mackenzie Ketchell
- Analyste du comportement et professeure à l'école de services sociaux et communautaires au Humber Institute of Technology and Advanced Learning à Toronto
| | - Jessica Ladouceur
- Professeure auxiliaire au Centre de médecine familiale de l'Université Queen's à Belleville
| | - Amanda Lepp
- Résidente dans la discipline de médecine familiale à l'Université McMaster
| | - Yona Lunsky
- Scientifique principale au Centre de toxicomanie et de santé mentale à Toronto, et professeure et chef du département de retards du développement à l'Université de Toronto
| | - Shirley McMillan
- Infirmière clinicienne spécialisée dans les programmes pour adultes au Surrey Place Centre
| | - Ullanda Niel
- Médecin de famille au Scarborough Centre for Healthy Communities, en Ontario
| | - Samantha Sacks
- Chargée d'enseignement clinique au département de médecine familiale de l'Université McGill à Montréal au Québec, et médecin de famille au Centre d'innovation pour l'autisme et les déficiences intellectuelles Voyez les choses à ma façon
| | - Sarah Shea
- Professeure au département de pédiatrie à l'Université Dalhousie
| | - Katherine Stringer
- Professeure agrégée et présidente de la discipline de médecine familiale à l'Université Memorial of Newfoundland à St.John
| | - Kyle Sue
- Professeur clinique adjoint de la discipline de médecine familiale à l'Université Memorial of Newfoundland à St.John
| | - Sandra Witherbee
- Infirmière en pratique familiale à la clinique Dalhousie Family Medicine Clinic
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Sullivan WF, Diepstra H, Heng J, Ally S, Bradley E, Casson I, Hennen B, Kelly M, Korossy M, McNeil K, Abells D, Amaria K, Boyd K, Gemmill M, Grier E, Kennie-Kaulbach N, Ketchell M, Ladouceur J, Lepp A, Lunsky Y, McMillan S, Niel U, Sacks S, Shea S, Stringer K, Sue K, Witherbee S. Primary care of adults with intellectual and developmental disabilities: 2018 Canadian consensus guidelines. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:254-279. [PMID: 29650602 PMCID: PMC5897068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To update the 2011 Canadian guidelines for primary care of adults with intellectual and developmental disabilities (IDD). METHODS Family physicians and other health professionals experienced in the care of people with IDD reviewed and synthesized recent empirical, ecosystem, expert, and experiential knowledge. A system was developed to grade the strength of recommendations. RECOMMENDATIONS Adults with IDD are a heterogeneous group of patients and have health conditions and factors affecting their health that can vary in kind, manifestation, severity, or complexity from those of others in the community. They require approaches to care and interventions that are adapted to their needs. These guidelines provide advice regarding standards of care. References to clinical tools and other practical resources are incorporated. The approaches to care that are outlined here can be applied to other groups of patients that have impairments in cognitive, communicative, or other adaptive functioning. CONCLUSION As primary care providers, family physicians play a vital role in promoting the health and well-being of adults with IDD. These guidelines can aid their decision making with patients and caregivers.
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Affiliation(s)
- William F Sullivan
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario, a staff physician in Medical Services at Surrey Place Centre and the Family Practice Unit at St Michael's Hospital, and Director of the Developmental Disabilities Primary Care Program at Surrey Place Centre.
| | | | - John Heng
- Assistant Professor in the Department of Philosophy and the Department of Interdisciplinary Studies at King's University College in London, Ont
| | - Shara Ally
- An advanced practice nurse at Surrey Place Centre, Adjunct Lecturer in the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto, and an MBA candidate
| | - Elspeth Bradley
- Associate Professor in the Department of Psychiatry at the University of Toronto and a consulting psychiatrist and psychotherapist in intellectual disabilities
| | - Ian Casson
- Associate Professor in the Department of Family Medicine at Queen's University in Kingston, Ont
| | - Brian Hennen
- Professor Emeritus at Western University in London and Dalhousie University in Halifax, NS
| | | | | | - Karen McNeil
- Assistant Professor in the Department of Family Medicine at Dalhousie University
| | - Dara Abells
- Family physician at Forest Hill Family Health Centre in Toronto and the Integrated Services for Autism and Neurodevelopmental Disorders, and Lecturer in the Department of Family and Community Medicine at the University of Toronto
| | - Khush Amaria
- Clinical and health psychologist and team lead for the Good 2 Go Transition Program at the Hospital for Sick Children in Toronto
| | - Kerry Boyd
- Associate Clinical Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University in Hamilton, Ont, and Chief Clinical Officer for Bethesda Community Services in Thorold, Ont
| | - Meg Gemmill
- Assistant Professor in the Department of Family Medicine at Queen's University
| | - Elizabeth Grier
- Assistant Professor in the Department of Family Medicine at Queen's University
| | - Natalie Kennie-Kaulbach
- University Teaching Fellow and a coordinator in the Skills Lab in the College of Pharmacy at Dalhousie University
| | - Mackenzie Ketchell
- Behaviour analyst and Professor in the School of Social and Community Services at Humber Institute of Technology and Advanced Learning in Toronto
| | - Jessica Ladouceur
- Adjunct Professor in the Belleville Queen's University Family Medicine Centre
| | - Amanda Lepp
- Resident in the Discipline of Family Medicine at McMaster University
| | - Yona Lunsky
- Senior Scientist at the Centre for Addiction and Mental Health in Toronto and Professor and Developmental Disability Lead at the University of Toronto
| | - Shirley McMillan
- Clinical nurse specialist in the adult program at Surrey Place Centre
| | - Ullanda Niel
- Family physician at the Scarborough Centre for Healthy Communities in Ontario
| | - Samantha Sacks
- Clinical Faculty Lecturer in the Department of Family Medicine at McGill University in Montreal, Que, and a family physician at See Things My Way Centre for Innovation in Autism and Intellectual Disabilities
| | - Sarah Shea
- Professor in the Department of Pediatrics at Dalhousie University
| | - Katherine Stringer
- Associate Professor and Chair of Family Medicine at Memorial University of Newfoundland in St John's
| | - Kyle Sue
- Clinical Assistant Professor in the Discipline of Family Medicine at Memorial University of Newfoundland
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Yuen EYN, Knight T, Ricciardelli LA, Burney S. Health literacy of caregivers of adult care recipients: A systematic scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e191-e206. [PMID: 27426731 DOI: 10.1111/hsc.12368] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
Caregivers play a vital role in providing support to adults with a chronic condition, or cognitive or physical impairment. Low health literacy in caregivers has the potential to impact adequate care provision, and consequently, care recipient health outcomes. The aim of the study was to systematically review literature related to health literacy of caregivers of adult care recipients, and examine its relationship with care recipient, and caregiver, health outcomes. Electronic databases were searched for relevant English-language publications that assessed health literacy in caregivers. Included studies were abstracted into evidence tables and assessed using an eight-item quality scale. The search identified 2717 new titles and abstracts, with 67 shortlisted for full review. Twelve papers from 2003 to 2015 met the inclusion criteria. The prevalence of limited health literacy in caregivers ranged from 0% to 52.5% depending on the measure and cut-off criteria used. Associations were found between low caregiver health literacy and (i) poorer care recipient self-management behaviours; (ii) increased care recipient use of health services; and (iii) increased caregiver burden. The quality of the studies ranged from fair to excellent. Low health literacy in caregivers differed depending on the measures and scoring criteria used. Evidence to support the relationship between caregiver health literacy and care recipient, and caregiver health outcomes was limited to single studies. Recommendations for further research include: the development of caregiver health literacy measures across different populations; examination of associations between caregiver health literacy and care recipient outcomes; and the development of interventions designed to improve caregiver health literacy.
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Affiliation(s)
- Eva Y N Yuen
- School of Psychology, Deakin University, Burwood, Victoria, Australia
- College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Tess Knight
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | | | - Susan Burney
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Szalmuk Family Psycho-oncology Unit, Cabrini Health, Malvern, Victoria, Australia
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Knowledge that people with intellectual disabilities have of their inhaled asthma medications: messages for pharmacists. Int J Clin Pharm 2015; 38:135-43. [PMID: 26560115 DOI: 10.1007/s11096-015-0217-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fifteen percent of Australians with intellectual disability (ID) are reported to have asthma. People with ID are at risk of poor health knowledge due to deficits in intellectual and adaptive functioning, but their medication knowledge has largely been ignored in research to date. OBJECTIVE To explore the level of understanding of asthma medication use of people with ID who self-administer their inhaled medications, in order to inform future educational support. Setting The research was conducted in NSW, Australia, at the participants' homes, the point of health care access, or the offices of relevant support organisations. METHOD In this qualitative study face-to-face interviews were conducted with people with ID using a semi-structured interview guide. The interviews were recorded, transcribed and thematically analysed. Main outcome Identification of barriers to asthma medication self-management by people with ID. RESULTS Seventeen people with ID who self-administer their asthma medications were interviewed. Factors influencing their asthma medication knowledge and use included understanding of their illness and the need for medication; aspects of self-management and autonomy versus dependence. This sample of people with ID had a good understanding of the importance of using their inhaled asthma medications, as well as asthma triggers, and the difference between use of preventer and reliever medications. Both enablers and barriers to asthma medication self-management were identified in the domains of managing attacks, adherence, knowledge of side effects and sources of information on correct use of inhalers. The level of autonomy for medication use varied, with motivation to self-manage asthma influenced by the level of support that was practically available to individual participants. CONCLUSION This research investigated aspects of asthma medication self-management of people with ID. Based on the barriers identified, pharmacists should promote use of spacers and written asthma action plans as well as counsel people with ID about how to recognise and minimise side effects of asthma medications. Specific strategies for pharmacists when educating people with ID and their caregivers include active listening to determine understanding of concepts, exercising care with language, and working with the person's known routines to maximise adherence with preventer medications.
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