Pharmacists’ and older adults’ perspectives on the benefits and barriers of Home Medicines Reviews – a qualitative study

2019 ◽  
Vol 25 (2) ◽  
pp. 77-85 ◽  
Author(s):  
Kristie Rebecca Weir ◽  
Vasi Naganathan ◽  
Carissa Bonner ◽  
Kirsten McCaffery ◽  
Debbie Rigby ◽  
...  
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Older Patients ◽  
Opportunity To Learn ◽  
Professional Communication ◽  
Limited Information ◽  
Framework Analysis ◽  
Telephone Interviews ◽  
Medicines Use ◽  
Audio Recordings

Objectives Conducting a medication review is one way to optimize medications and support older people to reduce the burden of polypharmacy. In Australia, a service called a Home Medicines Review (HMR) is conducted by pharmacists as part of a nationally funded program. HMRs aim to identify and resolve problems associated with polypharmacy and improve collaboration between patient, pharmacist and general practitioner. The aim of this study was to explore the benefits of and barriers to HMRs from the perspective of older patients and pharmacists. Methods This qualitative study involved observations of HMRs ( n = 12) and telephone interviews with 32 participants including 11 accredited pharmacists, 17 older adults aged 65 years and above, with 4 of their companions, in Australia. The researcher observing took notes during the HMR and added more detail and reflections afterwards. Transcribed audio-recordings and observational notes were thematically coded using framework analysis. Results Older patients and their companions found the HMR useful and they appreciated the opportunity to learn more about their medicines. However, many did not understand the purpose of the HMR, had limited understanding about their medicines and some did not want to know more. Pharmacists found HMRs useful for identifying medication errors and improving adherence. They also reported barriers to effective HMRs relating to patients (resistance to the evaluation of their medicines, misunderstanding about the aim of the HMR) and GPs (limited information upon referral, and limited follow-up afterwards). Conclusions Older patients and pharmacists reported a range of benefits for HMRs in terms of optimizing medicines use. Barriers to effective HMR use need to be addressed, including gaps in inter-professional communication and factors related to patient involvement, such as limited medicines understanding and health literacy.

scholarly journals Perceived barriers and facilitators to uptake of non-traditional roles by pharmacists in Saudi Arabia and implications for COVID-19 pandemic and beyond: a qualitative study using Theoretical Domain Framework

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Eeman Mohammed ◽  
Saval Khanal ◽  
Zahraa Jalal ◽  
Ejaz Cheema ◽  
Mohammed H. Abutaleb ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Qualitative Study ◽  
Positive Attitude ◽  
Pharmacy Practice ◽  
Theoretical Domains Framework ◽  
Framework Analysis ◽  
Face To Face ◽  
Telephone Interviews ◽  
Practical Experiences ◽  
Traditional Roles

Abstract Background The COVID-19 pandemic has further strengthened the need for pharmacists to uptake non-traditional roles. Pharmacy practice in Saudi Arabia is emerging in recent years with greater policy emphasis on pharmacists taking new clinical roles. This study aimed to explore the experiences, perceptions and barriers of Saudi pharmacists about their uptake of non-traditional roles using Theoretical Domains Framework (TDF). Methods A qualitative semi-structured study using face-to-face or telephone interviews were conducted. Eligible participants included qualified pharmacists from Saudi Arabia. Interviews focused on pharmacist’s perceptions, current opportunities and key challenges towards the uptake of non-traditional roles. Interviews were audiotaped and transcribed verbatim. Results were analysed through the framework analysis method and were later mapped with respective domains of TDF. Results A total of 14 pharmacists completed the interview (9 females and 5 males). Participants showed an overall positive attitude towards the uptake of non-traditional roles. Participants felt that there was wider support available for pharmacists at the policy level to uptake non-traditional roles. However, a need for greater recognition of roles by other healthcare professionals and patients were identified. Participants alluded to reluctance of some physicians to take on board the suggestions from a pharmacist. Key barriers to uptake of non-traditional roles were related to environmental context and resources domain of TDF. For example, participants discussed the need for even further practical experiences during their undergraduate degree to become ready to adopt non-traditional roles in clinical practice. Conclusions Participants of this theoretically informed qualitative study showed an overall positive attitude towards the way pharmacy practice is progressing in Saudi Arabia and their uptake of non-traditional roles. However, there is a need to improve interdisciplinary working, patient awareness of pharmacist competencies and their educational preparedness in furthering their uptake of non-traditional roles. Addressing such barriers and promoting uptake of novel roles by pharmacists is imperative in the context of emerging COVID-19 and future pandemics.

scholarly journals Challenges in the management of people with heart failure with preserved ejection fraction (HFpEF) in primary care: A qualitative study of general practitioner perspectives

2021 ◽  
pp. 174239532098387
Author(s):  
Muhammad Z Hossain ◽  
Carolyn A Chew-Graham ◽  
Emma Sowden ◽  
Tom Blakeman ◽  
Ian Wellwood ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Qualitative Study ◽  
Ejection Fraction ◽  
Minority Groups ◽  
Learning Needs ◽  
Preserved Ejection Fraction ◽  
Framework Analysis ◽  
Long Term Conditions ◽  
Telephone Interviews

Objectives To explore the perspectives of general practitioners (GPs) on the identification and management of people, including those from ethnic minority groups, with Heart Failure with Preserved Ejection Fraction (HFpEF). Methods Qualitative study. Semi-structured, face-to-face or telephone interviews and focus groups were conducted with 35 GPs in England, which were audio-recorded and transcribed verbatim. Framework analysis was used to manage and interpret data. Results Themes presented reflect four inter-related challenges: GPs’ 1) lack of understanding HFpEF, impacting on 2) difficulties in communicating the diagnosis, leading to 3) uncertainty in managing people with HFpEF, further hindered by (4) discontinuity across the primary/secondary interface. All were considered more challenging by GPs when managing people from different cultures and languages. Discussion HFpEF is not well understood by GPs, leading to diagnostic difficulty, management uncertainty and potential inequity in care offered. People with HFpEF are seen as complex, with multiple long-term conditions and requiring personalised care. Challenges in their management occur across the healthcare system. This study has identified learning needs for GPs around identification and on-going support for people with HFpEF in primary care. It will contribute to the development of more flexible and patient-centred pathways across the primary/secondary care interface.

scholarly journals The role of older patients’ goals in GP decision-making about medicines: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kristie Rebecca Weir ◽  
Vasi Naganathan ◽  
Stacy M. Carter ◽  
Chun Wah Michael Tam ◽  
Kirsten McCaffery ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Older People ◽  
Older Patients ◽  
Geographic Location ◽  
Future Research ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Medicines Management ◽  
Lower Priority

Abstract Background To optimise medication use in older people, it is recommended that clinicians evaluate evidence on potential benefits and harms of medicines in light of the patients’ overall health, values and goals. This suggests general practitioners (GPs) should attempt to facilitate patient involvement in decision-making. In practice this is often challenging. In this qualitative study, we explored GPs’ perspectives on the importance of discussing patients’ goals and preferences, and the role patient preferences play in medicines management and prioritisation. Methods Semi-structured interviews were conducted with GPs from Australia (n = 32). Participants were purposively sampled to recruit GPs with variation in experience level and geographic location. Transcribed audio-recordings of interviews were coded using Framework Analysis. Results The results showed that most GPs recognised some value in understanding older patients’ goals and preferences regarding their medicines. Most reported some discussions of goals and preferences with patients, but often this was initiated by the patient. Practical barriers were reported such as limited time during busy consultations to discuss issues beyond acute problems. GPs differed on the following main themes: 1) definition and perception of patients’ goals, 2) relationship with the patient, 3) approach to medicines management and prioritisation. We observed that GPs preferred one of three different practice patterns in their approach to patients’ goals in medicines decisions: 1) goals and preferences considered lower priority – ‘Directive’; 2) goals seen as central – ‘Goal-oriented’; 3) goals and preferences considered but not explicitly elicited – ‘Tacit’. Conclusions This study explores how GPs differ in their approach to eliciting patients’ goals and preferences, and how these differences are operationalised in the context of older adults taking multiple medicines. Although there are challenges in providing care that aligns with patients’ goals and preferences, this study shows how complex decisions are made between GPs and their older patients in clinical practice. This work may inform future research that investigates how GPs can best incorporate the priorities of older people in decision-making around medicines. Developing practical support strategies may assist clinicians to involve patients in discussions about their medicines.

Comparison of older adult symptom occurrence rates in a geriatric-oncology clinic with meta-analysis for adults receiving chemotherapy.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 102-102
Author(s):  
Marie Anne Flannery ◽  
Allison Magnuson ◽  
Joseph John Guido ◽  
Luke Joseph Peppone ◽  
William Dale ◽  
...  
Keyword(s):  
Older Adults ◽  
Older Patients ◽  
Meta Analysis ◽  
Geriatric Oncology ◽  
Psychological Status ◽  
Published Data ◽  
Limited Information ◽  
Symptom Experience ◽  
Chi Square ◽  
Significant Difference

102 Background: The majority of cancers occur in older adults, yet there is limited information on their symptom experience because they are under-represented in studies. To address this gap we examined registry data from two partnered geriatric oncology clinics, our aims are to: 1) identify older patients’ symptom occurrence rates and 2) compare symptom occurrence rates to published norms for adults with cancer. Methods: At presentation, patients completed the MD Anderson Symptom Inventory with symptoms coded as present or absent. Prevalence rates were compared to rates from a meta-analysis (Reilly et al., 2013) of adult cancer patients receiving chemotherapy which included pooled data from 21 studies (age M = 58 years, Range 118 = 97 years.) Differences were tested with Chi-Square. Results: As compared to published data, older patients (N = 291, M = 80.6 years, SD = 6.47, 52% > 80 yrs.) reported higher rates for the following symptoms: drowsiness (65% vs. 43%), trouble remembering (60% vs. 44%), distress (50% vs. 41%), sadness (49% vs.34%) (p’s < .01), and dry mouth (55% vs. 48%, p = .03). Lower rates were reported for nausea/vomiting (23% vs 40%/ 13 vs 27%, p’s < .001). There was no significant difference for the rates of fatigue (60%), difficulty sleeping (52%), pain (50%), decreased appetite (49%), dyspnea (48%), and numbness/tingling (38%). Conclusions: Older adults referred to specialized geriatric oncology clinic present with multiple symptoms. These patients had a mean age of eighty, may reflect the frail and vulnerable and were not often receiving active treatment. Results reinforce that it is especially important to assess and intervene on cognitive and psychological status in older patients. Nausea/Vomiting were less common in older adults perhaps due to lower chemotherapy rates. Limitations exist as we were not able to control for other factors affecting symptoms in the analysis. Nonetheless, results are consistent with older adults reporting many symptoms at a similar or higher rate than prior studies including all adults receiving chemotherapy. Increased study of the symptom experience in older oncology patients is critical to advance palliative care and symptom science.

scholarly journals “Call a Teenager… That’s What I Do!” - Grandchildren Help Older Adults Use New Technologies: Qualitative Study (Preprint)

2019 ◽  
Author(s):  
Jennifer Dickman Portz ◽  
Christine Fruhauf ◽  
Sheana Bull ◽  
Rebecca S Boxer ◽  
David B Bekelman ◽  
...  
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Family Support ◽  
Technology Use ◽  
Older Patients ◽  
New Technologies ◽  
Family Members ◽  
Multiple Chronic Conditions ◽  
Health Technologies ◽  
Open Coding

BACKGROUND Although family technical support seems intuitive, there is very little research exploring this topic. OBJECTIVE The objective of this study was to conduct a subanalysis of data collected from a large-scale qualitative project regarding older adults’ experiences in using health information technology. Specifically, the subanalysis explored older adults’ experiences with technology support from family members to inform strategies for promoting older adults’ engagement with new health technologies. Although the primary analysis of the original study was theoretically driven, this paper reports results from an inductive, open-coding analysis. METHODS This is a subanalysis of a major code identified unexpectedly from a qualitative study investigating older adults’ use experience of a widespread health technology, the patient portal. A total of 24 older patients (≥65 years) with multiple chronic conditions (Charlson Comorbidity Index >2) participated in focus groups conducted at the patients’ primary clinic. While conducting the primary theoretically driven analysis, coders utilized an open-coding approach to ensure important ideas not reflected in the theoretical code book were captured. Open coding resulted in 1 code: family support. This subanalysis further categorized family support by who provided tech support, how tech support was offered, and the opinions of older participants about receiving family tech support. RESULTS The participants were not specifically asked about family support, yet themes around family assistance and encouragement for technology emerged from every focus group. Participants repeatedly mentioned that they called their grandchildren and adult children if they needed help with technology. Participants also reported that family members experienced difficulty when teaching technology use. Family members struggled to explain simple technology tasks and were frustrated by the slow teaching process. CONCLUSIONS The results suggest that older adults ask their family members, particularly grandchildren, to support them in the use of new technologies. However, family may experience difficulties in providing this support. Older adults will be increasingly expected to use health technologies, and family members may help with tech support. Providers and health systems should consider potential family support and engagement strategies to foster adoption and use among older patients.

scholarly journals Caregivers’ Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting

2019 ◽  
Vol 7 (4) ◽  
pp. 561-569
Author(s):  
Jo-Ana D Chase ◽  
David Russell ◽  
Meridith Rice ◽  
Carmen Abbott ◽  
Kathryn H Bowles ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Family Caregivers ◽  
Learning Strategies ◽  
Home Health Care ◽  
Home Health ◽  
Barriers To Learning ◽  
Telephone Interviews ◽  
Qualitative Descriptive ◽  
Training And Support

Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.

scholarly journals Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sunny Singhal ◽  
Pramod Kumar ◽  
Sumitabh Singh ◽  
Srishti Saha ◽  
Aparajit Ballav Dey
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Critically Ill ◽  
Clinical Features ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Meta Analysis ◽  
Severe Infection ◽  
Factors Affecting ◽  
Pooled Prevalence

Abstract Background Few studies have focused on exploring the clinical characteristics and outcomes of COVID-19 in older patients. We conducted this systematic review and meta-analysis to have a better understanding of the clinical characteristics of older COVID-19 patients. Methods A systematic search of PubMed and Scopus was performed from December 2019 to May 3rd, 2020. Observational studies including older adults (age ≥ 60 years) with COVID-19 infection and reporting clinical characteristics or outcome were included. Primary outcome was assessing weighted pooled prevalence (WPP) of severity and outcomes. Secondary outcomes were clinical features including comorbidities and need of respiratory support. Result Forty-six studies with 13,624 older patients were included. Severe infection was seen in 51% (95% CI– 36-65%, I2–95%) patients while 22% (95% CI– 16-28%, I2–88%) were critically ill. Overall, 11% (95% CI– 5-21%, I2–98%) patients died. The common comorbidities were hypertension (48, 95% CI– 36-60% I2–92%), diabetes mellitus (22, 95% CI– 13-32%, I2–86%) and cardiovascular disease (19, 95% CI – 11-28%, I2–85%). Common symptoms were fever (83, 95% CI– 66-97%, I2–91%), cough (60, 95% CI– 50-70%, I2–71%) and dyspnoea (42, 95% CI– 19-67%, I2–94%). Overall, 84% (95% CI– 60-100%, I2–81%) required oxygen support and 21% (95% CI– 0-49%, I2–91%) required mechanical ventilation. Majority of studies had medium to high risk of bias and overall quality of evidence was low for all outcomes. Conclusion Approximately half of older patients with COVID-19 have severe infection, one in five are critically ill and one in ten die. More high-quality evidence is needed to study outcomes in this vulnerable patient population and factors affecting these outcomes.

scholarly journals Comparison of adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing potentially inappropriate medication use in Hong Kong older patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Huanyu ZHANG ◽  
Eliza L. Y. WONG ◽  
Samuel Y. S. WONG ◽  
Patsy Y. K. CHAU ◽  
Benjamin H. K. YIP ◽  
...  
Keyword(s):  
Older Adults ◽  
Hong Kong ◽  
Older Patients ◽  
Inappropriate Medication ◽  
Female Gender ◽  
Potentially Inappropriate Medication ◽  
Multivariable Logistic Regression Analysis ◽  
Beers Criteria ◽  
Medical Conditions ◽  
Cross Sectional

Abstract Background The Hong Kong-specific criteria have been established in 2019 to assess potentially inappropriate medication (PIM) use in older adults and improve the local prescribing quality. The aim of this study was to compare the adaptive versions of the Hong Kong-specific criteria and 2015 Beers criteria for assessing the prevalence and correlates of PIM use in Hong Kong older patients. Methods A cross-sectional study was performed from January 1, 2014 to December 31, 2014 using the Hospital Authority (HA) database. A total of 489,301 older patients aged 65 years and older visiting general outpatient clinics (GOPCs) during the study period were included in the study. Two categories of PIM use included in the Hong Kong-specific criteria and 2015 Beers criteria, i.e. PIMs independent of diagnoses and PIMs considering specific medical conditions, were adapted to assess the prevalence of PIM use among the study sample. Characteristics of PIM users and the most frequently prescribed PIMs were investigated for each set of the criteria. Factors associated with PIM use were identified using the stepwise multivariable logistic regression analysis. Results The adaptive Hong Kong-specific criteria could detect a higher prevalence of patients exposed to at least one PIM than that assessed by the adaptive Beers criteria (49.5% vs 47.5%). Meanwhile, the adaptive Hong Kong-specific criteria could identify a higher rate of patients exposed to PIMs independent of diagnoses (48.1% vs 46.8%) and PIMs considering specific medical conditions (7.3% vs 4.9%) compared with that of the adaptive Beers criteria. The most frequently prescribed PIMs detected by the adaptive Beers criteria were all included in the adaptive Hong Kong-specific criteria. The strongest factor associated with PIM use was number of different medications prescribed. Patients with female gender, aged 65 ~ 74 years, a larger number of GOPC visits, and more than six diagnoses were associated with greater risk of PIM use, whereas advancing age was associated with lower risk of PIM use. Conclusions The adaptive Hong Kong-specific criteria could detect a higher prevalence of PIM use than the adaptive Beers criteria in older adults visiting GOPCs in Hong Kong. It is necessary to update the prevalence and correlates of PIM use regularly in older adults to monitor the burden of PIM use and identify vulnerable patients who need further interventions.

scholarly journals Voices of Experience: What Do Low-Income Older Adults Tell Us About Mobility, Technology, and Social Participation?

2021 ◽  
pp. 073346482110125
Author(s):  
Haley B. Gallo ◽  
Lia W. Marshall ◽  
Lené Levy-Storms ◽  
Kathleen H. Wilber ◽  
Anastasia Loukaitou-Sideris
Keyword(s):  
Older Adults ◽  
Los Angeles ◽  
Qualitative Study ◽  
Thematic Analysis ◽  
Social Participation ◽  
Low Income ◽  
Technology Use ◽  
Diverse Group ◽  
Senior Center ◽  
Perceived Safety

Mobility and technology can facilitate in-person and virtual social participation to help reduce social isolation, but issues exist regarding older adults’ access, feasibility, and motivation to use various forms of mobility and technology. This qualitative study explores how a diverse group of low-income, urban-living older adults use mobility and technology for social participation. We conducted six focus groups ( N = 48), two each in English, Spanish, and Korean at a Los Angeles senior center. Three major themes emerged from thematic analysis: using technology for mobility; links between mobility and social participation; and technology-mediated social participation. Cost, perceived safety, (dis)ability, and support from family and friends were related to mobility and technology use. This study demonstrates the range of mobility and technology uses among older adults and associated barriers. The findings can help establish a pre-COVID-19 baseline on how to make mobility and technology more accessible for older adults at risk of isolation.

Sign in / Sign up

Export Citation Format

Share Document