Kristie Rebecca Weir1, Carissa Bonner1, Kirsten McCaffery1, Vasi Naganathan2, Stacy M Carter3, Debbie Rigby4, Lyndal Trevena5, Andrew McLachlan6, Jesse Jansen7. 1. Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia. 2. Centre for Education and Research on Ageing (CERA), Concord Clinical School, The University of Sydney, NSW, 2006, Australia; Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, NSW, 2139, Australia. 3. Research for Social Change, Faculty of Social Science, The University of Wollongong, NSW, 2522, Australia. 4. DR Pharmacy Consulting, Brisbane, QLD, Australia. 5. Ask Share Know Centre for Research Excellence, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia. 6. Centre for Education and Research on Ageing (CERA), Concord Clinical School, The University of Sydney, NSW, 2006, Australia; Faculty of Pharmacy, University of Sydney, NSW, 2006, Australia. 7. Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia. Electronic address: jesse.jansen@sydney.edu.au.
Abstract
BACKGROUND: In Australia, the Home Medicines Review (HMR) is a nationally-funded program, led by pharmacists to optimize medication use for older people. A Medicines Conversation Guide was developed for pharmacists to use in the context of a HMR. The Guide aims to increase patient involvement and support discussions about: general health understanding, decision-making and information preferences, health priorities related to medicines, patient goals and fears, views on important activities and trade-offs. OBJECTIVE: This study describes the development and feasibility testing of a Medicines Conversation Guide in HMRs with pharmacists and older patients. METHODS: The Guide was developed using a systematic and iterative process, followed by testing in clinical practice with 11 pharmacists, 17 patients (aged 65+) and their companions. A researcher observed HMRs, surveyed and qualitatively interviewed patients and pharmacists to discuss feasibility. Transcribed recordings of the interviews were thematically coded and a Framework Analysis method used. RESULTS: Pharmacists found the Guide to be an acceptable and useful component to the HMR, especially among patients with limited knowledge of their medicines. The Guide seemed most effective when integrated with the HMR and tailored to suit the individual patient. Some questions were difficult for patients to grasp (e.g. trade-offs) or sounded formal. Most patients found the Guide focused the HMR on their perspective and encouraged a more holistic approach to the HMR. From the quantitative survey, pharmacists found the Guide easy to implement, balanced and understandable. CONCLUSIONS: Pharmacists and patients reported the Guide fits with the HMR encounter relatively easily and promoted communication about goals and preferences in relation to medications. This study highlighted some key challenges for communication about medicines and how the Guide may help support the process of involving patients more in the HMR.
BACKGROUND: In Australia, the Home Medicines Review (HMR) is a nationally-funded program, led by pharmacists to optimize medication use for older people. A Medicines Conversation Guide was developed for pharmacists to use in the context of a HMR. The Guide aims to increase patient involvement and support discussions about: general health understanding, decision-making and information preferences, health priorities related to medicines, patient goals and fears, views on important activities and trade-offs. OBJECTIVE: This study describes the development and feasibility testing of a Medicines Conversation Guide in HMRs with pharmacists and older patients. METHODS: The Guide was developed using a systematic and iterative process, followed by testing in clinical practice with 11 pharmacists, 17 patients (aged 65+) and their companions. A researcher observed HMRs, surveyed and qualitatively interviewed patients and pharmacists to discuss feasibility. Transcribed recordings of the interviews were thematically coded and a Framework Analysis method used. RESULTS: Pharmacists found the Guide to be an acceptable and useful component to the HMR, especially among patients with limited knowledge of their medicines. The Guide seemed most effective when integrated with the HMR and tailored to suit the individual patient. Some questions were difficult for patients to grasp (e.g. trade-offs) or sounded formal. Most patients found the Guide focused the HMR on their perspective and encouraged a more holistic approach to the HMR. From the quantitative survey, pharmacists found the Guide easy to implement, balanced and understandable. CONCLUSIONS: Pharmacists and patients reported the Guide fits with the HMR encounter relatively easily and promoted communication about goals and preferences in relation to medications. This study highlighted some key challenges for communication about medicines and how the Guide may help support the process of involving patients more in the HMR.
Authors: Holly O Witteman; Ruth Ndjaboue; Gratianne Vaisson; Selma Chipenda Dansokho; Bob Arnold; John F P Bridges; Sandrine Comeau; Angela Fagerlin; Teresa Gavaruzzi; Melina Marcoux; Arwen Pieterse; Michael Pignone; Thierry Provencher; Charles Racine; Dean Regier; Charlotte Rochefort-Brihay; Praveen Thokala; Marieke Weernink; Douglas B White; Celia E Wills; Jesse Jansen Journal: Med Decis Making Date: 2021-10 Impact factor: 2.583