Lauren Cadel1, Amanda C Everall2, Tanya L Packer3, Sander L Hitzig4, Tejal Patel5, Aisha K Lofters6, Sara J T Guilcher7. 1. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. Electronic address: lauren.cadel@utoronto.ca. 2. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. Electronic address: amanda.day@utoronto.ca. 3. Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, NS, Canada. Electronic address: Tanya.Packer@dal.ca. 4. St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: sander.hitzig@sunnybrook.ca. 5. School of Pharmacy, University of Waterloo, Kitchener, ON, Canada; Centre for Family Medicine Family Health Team, Kitchener, ON, Canada; Department of Family Medicine, DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address: t5patel@uwaterloo.ca. 6. Women's College Hospital, Toronto, ON, Canada; Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. Electronic address: aisha.lofters@utoronto.ca. 7. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: sara.guilcher@utoronto.ca.
Abstract
RATIONALE: Spinal cord injury/dysfunction (SCI/D) is an exemplar condition with a high prevalence of secondary complications, chronic conditions and use of multiple medications (polypharmacy). Optimizing medication self-management is important for persons with SCI/D to improve outcomes; however, there is a lack of research on how healthcare/service providers and persons with SCI/D experience medication self-management. OBJECTIVE: To explore attitudes and experiences of medication self-management from the perspectives of persons with SCI/D and providers, and to explore the extent to which the Taxonomy of Everyday Self-management Strategies (TEDSS) framework captured participants' experiences with medication self-management. METHODS: In-depth, semi-structured interviews were conducted by telephone until data saturation was reached. Interviews were transcribed verbatim and analyzed using constant comparative approaches. The TEDSS framework was adapted and applied deductively. RESULTS: Fifty-one individuals participated in this study, 32 providers and 19 persons with SCI/D. Disease controlling strategies was the domain discussed in most detail by all participants. In this domain, participants discussed managing medications and treatments, monitoring/managing side effects, and controlling complications. Process strategies (problem-solving, decision-making) and resource strategies (seeking support) were the next most frequently discussed domains. Among all participant groups, there was a lack of detailed discussion of social interactions, health behaviour, and internal strategies. Medication self-management support was not extensively discussed by any group. CONCLUSION: This study highlighted the complex nature of medication self-management. While persons with SCI/D and providers discussed similar components of the TEDSS framework, providers had minimal reflections on the impact of medication self-management on everyday life. This study identified the need for explicit discussions between providers and persons with SCI/D, involving all components of self-management and self-management support in order to improve medication self-management.
RATIONALE: Spinal cord injury/dysfunction (SCI/D) is an exemplar condition with a high prevalence of secondary complications, chronic conditions and use of multiple medications (polypharmacy). Optimizing medication self-management is important for persons with SCI/D to improve outcomes; however, there is a lack of research on how healthcare/service providers and persons with SCI/D experience medication self-management. OBJECTIVE: To explore attitudes and experiences of medication self-management from the perspectives of persons with SCI/D and providers, and to explore the extent to which the Taxonomy of Everyday Self-management Strategies (TEDSS) framework captured participants' experiences with medication self-management. METHODS: In-depth, semi-structured interviews were conducted by telephone until data saturation was reached. Interviews were transcribed verbatim and analyzed using constant comparative approaches. The TEDSS framework was adapted and applied deductively. RESULTS: Fifty-one individuals participated in this study, 32 providers and 19 persons with SCI/D. Disease controlling strategies was the domain discussed in most detail by all participants. In this domain, participants discussed managing medications and treatments, monitoring/managing side effects, and controlling complications. Process strategies (problem-solving, decision-making) and resource strategies (seeking support) were the next most frequently discussed domains. Among all participant groups, there was a lack of detailed discussion of social interactions, health behaviour, and internal strategies. Medication self-management support was not extensively discussed by any group. CONCLUSION: This study highlighted the complex nature of medication self-management. While persons with SCI/D and providers discussed similar components of the TEDSS framework, providers had minimal reflections on the impact of medication self-management on everyday life. This study identified the need for explicit discussions between providers and persons with SCI/D, involving all components of self-management and self-management support in order to improve medication self-management.
Authors: Eleni M Patsakos; Mark T Bayley; Ailene Kua; Christiana Cheng; Janice Eng; Chester Ho; Vanessa K Noonan; Matthew Querée; B Catharine Craven Journal: J Spinal Cord Med Date: 2021 Impact factor: 1.985