Nienke E Dijkstra1, Carolien G M Sino2, Marieke J Schuurmans3, Lisette Schoonhoven4, Eibert R Heerdink5. 1. Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands; Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands; Research Group Innovation in Pharmaceutical Care, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, PO Box 12011, 3501, AA, Utrecht, the Netherlands. Electronic address: nienke.dijkstra@hu.nl. 2. Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands. Electronic address: Carolien.sino@hu.nl. 3. Education Center, University Medical Center Utrecht, Utrecht University, Utrecht, Hijmans van Den Bergh Building, 3508, GA, Utrecht, the Netherlands. Electronic address: M.J.Schuurmans@umcutrecht.nl. 4. Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, United Kingdom. Electronic address: L.Schoonhoven@umcutrecht.nl. 5. Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Heidelberglaan 8, 3584, CS, Utrecht, the Netherlands; Research Group Innovation in Pharmaceutical Care, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, PO Box 12011, 3501, AA, Utrecht, the Netherlands. Electronic address: Rob.heerdink@hu.nl.
Abstract
BACKGROUND: Medication self-management is complicated for older people. Little is known about older persons' considerations and decisions concerning medication therapy at home. OBJECTIVE: (s): To explore how older people living at home self-manage their medication and what considerations and decisions underpin their medication self-management behavior. METHODS: Semi-structured interviews with consenting participants (living at home, aged ≥65, ≥5 different prescription medications daily) were recorded and transcribed with supporting photographs. Content was analyzed with a directed approach and presented according to three phases of medication self-management (initiation, execution, and discontinuation). RESULTS: Sixty people were interviewed. In the initiation phase, participants used different techniques to inform healthcare professionals and to fill and check prescriptions. Over-the-counter medication was seldom discussed, and potential interactions were unknown to the participants. Some participants decided to not start treatment after reading the patient information leaflets for fear of side effects. In the execution phase, participants had various methods for integrating the use of new and chronic medication in daily life. Usage problems were discussed with healthcare professionals, but side effects were not discussed, since the participants were not aware that the signs and symptoms of side effects could be medication-related. Furthermore, participants stored medication in various (sometimes incorrect) ways and devised their own systems for ordering and filling repeat prescriptions. In the discontinuation phase, some participants decided to stop or change doses by themselves (because of side effects, therapeutic effects, or a lack of effect). They also mentioned different considerations regarding medication disposal and disposed their medication (in)correctly, stored it for future use, or distributed it to others. CONCLUSIONS: Participants' considerations and decisions led to the following: problems in organizing medication intake, inadequate discussion of medication-related information with healthcare professionals, and incorrect and undesirable medication storage and disposal. There is a need for medication self-management observation, monitoring, and assistance by healthcare professionals.
BACKGROUND: Medication self-management is complicated for older people. Little is known about older persons' considerations and decisions concerning medication therapy at home. OBJECTIVE: (s): To explore how older people living at home self-manage their medication and what considerations and decisions underpin their medication self-management behavior. METHODS: Semi-structured interviews with consenting participants (living at home, aged ≥65, ≥5 different prescription medications daily) were recorded and transcribed with supporting photographs. Content was analyzed with a directed approach and presented according to three phases of medication self-management (initiation, execution, and discontinuation). RESULTS: Sixty people were interviewed. In the initiation phase, participants used different techniques to inform healthcare professionals and to fill and check prescriptions. Over-the-counter medication was seldom discussed, and potential interactions were unknown to the participants. Some participants decided to not start treatment after reading the patient information leaflets for fear of side effects. In the execution phase, participants had various methods for integrating the use of new and chronic medication in daily life. Usage problems were discussed with healthcare professionals, but side effects were not discussed, since the participants were not aware that the signs and symptoms of side effects could be medication-related. Furthermore, participants stored medication in various (sometimes incorrect) ways and devised their own systems for ordering and filling repeat prescriptions. In the discontinuation phase, some participants decided to stop or change doses by themselves (because of side effects, therapeutic effects, or a lack of effect). They also mentioned different considerations regarding medication disposal and disposed their medication (in)correctly, stored it for future use, or distributed it to others. CONCLUSIONS: Participants' considerations and decisions led to the following: problems in organizing medication intake, inadequate discussion of medication-related information with healthcare professionals, and incorrect and undesirable medication storage and disposal. There is a need for medication self-management observation, monitoring, and assistance by healthcare professionals.
Authors: Cathelijn J Beerlage-Davids; Godelieve H M Ponjee; Joost W Vanhommerig; Ingeborg M J A Kuper; Fatma Karapinar-Çarkit Journal: Int J Clin Pharm Date: 2022-10-15