Medication management of type 2 diabetes in residential aged care

Abstract This study aimed to compare conventional medication management of type 2 diabetes (T2D) to medication management in conjunction with a lifestyle intervention using continuous glucose monitoring to minimize glucose excursions. Thirty adults (63% female; mean age, 53.3 years) who were diagnosed with T2D for less than 11 years (mean, 5.6 years), had glycated A1c (HbA1c) ≥ 7.0% (51 mmol/mol) (mean 8.8%, [73 mmol/mol]), and were not using insulin, were randomly assigned in a 1:2 ratio to routine care (RC) or 4 group sessions of glycemic excursion minimization plus real-time CGM (GEMCGM). Assessments at baseline and 5 months included a physical exam, metabolic and lipid panels, a review of diabetes medications, and psychological questionnaires. For the week following assessments, participants wore a blinded activity monitor and completed 3 days of 24-hour dietary recall. A subgroup also wore a blinded CGM. GEMCGM participants significantly improved HbA1c (from 8.9% to 7.6% [74-60 mmol/mol] compared with 8.8% to 8.7% [73-72 mmol/mol] for RC (P = .03). Additionally, GEMCGM reduced the need for diabetes medication (P = .01), reduced carbohydrate consumption (P = .009), and improved diabetes knowledge (P = .001), quality of life (P = .01) and diabetes distress (P = .02), and trended to more empowerment (P = .05) without increasing dietary fat, lipids, or hypoglycemia. Confirming our prior research, GEMCGM appears to be a safe, effective lifestyle intervention option for adults with suboptimally controlled T2D who do not take insulin.

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Interprofessional Team-Based Approach to Medication Management of Patients with Type 2 Diabetes: Family Physician Perspective

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2014.07.092 ◽

2014 ◽

Vol 38 (5) ◽

pp. S34

Author(s):

Neil Bell ◽

Olga Szafran ◽

Sandra Robertson ◽

Beverly Williams ◽

Philip Jacobs ◽

...

Keyword(s):

Type 2 Diabetes ◽

Family Physician ◽

Medication Management ◽

Interprofessional Team ◽

Physician Perspective ◽

Diabetes Family

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Nurse practitioner provided home telemonitoring and medication management improves glycemic control in primary care patiemts with type 2 diabetes more than monthly care coordination telephone call

Evidence-Based Nursing ◽

10.1136/ebn1072 ◽

2010 ◽

Vol 13 (3) ◽

pp. 74-75

Author(s):

K. H. Bowles

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Glycemic Control ◽

Nurse Practitioner ◽

Care Coordination ◽

Medication Management ◽

Telephone Call ◽

Home Telemonitoring

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Evaluation of a hybrid paper–electronic medication management system at a residential aged care facility

Australian Health Review ◽

10.1071/ah14206 ◽

2016 ◽

Vol 40 (3) ◽

pp. 244 ◽

Cited By ~ 7

Author(s):

Rohan A. Elliott ◽

Cik Yin Lee ◽

Safeera Y. Hussainy

Keyword(s):

Medication Management ◽

Care Facility ◽

Medication Administration ◽

Aged Care ◽

Management Systems ◽

Residential Aged Care ◽

Dose Administration ◽

Medication Administration Errors ◽

Residential Aged Care Facility ◽

Electronic Medication Administration

Objectives The aims of the study were to investigate discrepancies between general practitioners’ paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper–electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5–12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18 min to 98 h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper–electronic medication management systems, in which prescribers’ orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care facilities. The accuracy and safety of these systems has not been studied. What does this paper add? The present study identified discrepancies between general practitioners’ orders and pharmacy-prepared electronic medication administration charts, back-up paper medication charts and dose-administration aids, as well as delays between ordering, charting and administering medicines. Discrepancies and delays sometimes led to medication administration errors. What are the implications for practitioners? Facilities that use hybrid systems need to implement robust systems for communicating medication changes to their pharmacy and reconciling prescribers’ orders against pharmacy-generated medication charts and dose-administration aids. Fully integrated, paperless medication management systems, in which prescribers’ electronic medication orders directly populate an electronic medication administration chart and are automatically communicated to the facility’s pharmacy, could improve patient safety.

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A qualitative study exploring issues related to medication management in residential aged care facilities

Patient Preference and Adherence ◽

10.2147/ppa.s144513 ◽

2017 ◽

Vol Volume 11 ◽

pp. 1869-1877 ◽

Cited By ~ 1

Author(s):

Mariani Ahmad Nizaruddin ◽

Marhanis-Salihah Omar ◽

Adliah Mhd-Ali ◽

Mohd Makmor Bakry

Keyword(s):

Qualitative Study ◽

Medication Management ◽

Aged Care ◽

Residential Aged Care ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

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Experiences of barriers to self-monitoring and medication-management among Indian patients with type 2 diabetes, their primary family-members and physicians

Chronic Illness ◽

10.1177/17423953211032251 ◽

2021 ◽

pp. 174239532110322

Author(s):

Mahati Chittem ◽

Subha Gomathy Sridharan ◽

Matsungshila Pongener ◽

Sravannthi Maya ◽

Tracy Epton

Keyword(s):

Type 2 Diabetes ◽

Medication Management ◽

Family Members ◽

Capital City ◽

Medication Regimen ◽

Self Monitoring ◽

Indian Patients ◽

South Indian ◽

Primary Family

Objectives This study explored the subjective accounts of the main barriers to self-monitoring of blood-glucose (SMBG) and medication-management among Indian patients with type 2 diabetes (T2DM), their primary family-members (PFMs) and physicians. Methods Using convenience sampling, patients with T2DM, their PFMs, and physicians, residing in a South Indian capital city, were recruited for semi-structured, audio-recorded interviews. Thematic analysis was used to analyze the data. Results Fifty patients (female = 14; mean age = 42.5 years) and their PFMs (female = 38; mean age = 39 years), and 25 physicians (female = 4; mean age = 49.8 years) were recruited. Three superordinate themes were identified: (i) complex medication-regimen: confusion, forgetting and reduced motivation, (ii) family recommendations of alternative therapies due to the social pressures of avoiding stigma, intrusiveness and being misrepresented for injecting insulin, and (iii) an expensive illness: choosing to spend money on only medication. Discussion Implications of the findings highlight the need to (i) train physicians in communication and empathy skills, (ii) empower patients to communicate their barriers to physicians through triadic communication models and question-prompt lists, (iii) educate communities on the benefits of insulin for managing T2DM to reduce stigma, and (iv) equip communities with information about health insurance to address the financial toll of T2DM management.

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Electronic prescribing and medication management at a residential aged care facility

Applied Clinical Informatics ◽

10.4338/aci-2015-08-ra-0098 ◽

2016 ◽

Vol 07 (01) ◽

pp. 116-127 ◽

Cited By ~ 5

Author(s):

Cik Lee ◽

Safeera Hussainy ◽

Rohan Elliott

Keyword(s):

Patient Safety ◽

Medication Management ◽

Care Facility ◽

Aged Care ◽

Electronic Prescribing ◽

Residential Aged Care ◽

Aged Care Facility ◽

Training Support ◽

Retrospective Audit ◽

Residential Aged Care Facility

SummaryA cloud-based mobile electronic prescribing and medication management system (ePMMS), in which prescribers’ orders directly populate residential aged care facility (RACF) medication administration records (MARs) and are communicated electronically to the RACF’s pharmacy, may create efficiencies and improve patient safety when compared to the paper-based and hybrid paper-electronic medication management systems used in most Australian RACFs. Little is known about general-practitioners’ (GPs’), nurses’ and pharmacists’ acceptance of, or experiences with, ePMMS.To explore the uptake of an ePMMS by GPs, and the experiences and perceptions of GPs, nurses and pharmacists, at a 90-bed RACF that tested a beta-version ePMMS.Retrospective audit to determine the proportion of medicines ordered by GPs via the ePMMS over a three-month period. Focus groups conducted three-to-four months after implementation: one with GPs (n=5), one with nurses (n=12); in-depth interview/survey of pharmacists (n=2). Qualitative data were analysed thematically.Three of seven GPs used the ePMMS to order medicines; 53/205(25.9%) medicines were ordered via the ePMMS by GPs.Two broad themes were identified: benefits of the ePMMS, and barriers/limitations. Benefits related to patient safety and workforce efficiency, and included GPs’ ability to access and modify residents’ MARs remotely, no need for nurses to fax orders to the pharmacy, and no need for pharmacy transcription of GPs’ handwritten orders to create electronic MARs. Barriers and limitations related to inefficiency, low GP uptake and training/support, and included slower prescribing compared to written orders, the need for GP-signed paper copies of the MAR, lack of integration with GP clinic software, and low GP motivation to use the system, especially GPs with few patients at the RACF.GPs, nurses and pharmacists felt the ePMMS improved medication-safety and workforce-efficiency, however a number of barriers were identified that contributed to low GP-uptake and limited the benefits.

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Integrating pharmacists into aged care facilities to improve the quality use of medicine (PiRACF Study): Protocol for a cluster randomised controlled trial

10.21203/rs.3.rs-38456/v1 ◽

2020 ◽

Author(s):

sam kosari ◽

Jane Koerner ◽

Mark Naunton ◽

Gregory M Peterson ◽

Ibrahim Haider ◽

...

Keyword(s):

Controlled Trial ◽

Medication Management ◽

Care Facility ◽

Cluster Randomised Controlled Trial ◽

Aged Care ◽

Residential Aged Care ◽

Aged Care Facility ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

Abstract BackgroundMedication management in residential aged care facilities is an ongoing concern. Numerous studies have reported high rates of inappropriate prescribing and medication use in aged care facilities, which contribute to residents’ adverse health outcomes. There is a need for new models of care that enhance inter-disciplinary collaboration between residential aged care facility staff and healthcare professionals, to improve medication management. Pilot research has demonstrated the feasibility and benefits of integrating a pharmacist into the aged care facility team to improve the quality use of medicines. This protocol describes the design and methods for a cluster randomised controlled trial to evaluate the outcomes and conduct economic evaluation of a service model where on-site pharmacists are integrated into residential aged care facility healthcare teams to improve medication management.MethodsIntervention aged care facilities will employ on-site pharmacists to work as part of their healthcare teams. Pharmacists will assume responsibility for medication management, and collaborate with facility nurses, prescribers, community pharmacists, residents and families to improve the quality use of medicines. The intervention will last for 12 months. Aged care facilities in the control group will continue usual care. The target sample size is 1,188 residents from a minimum of 13 aged care facilities. The primary outcome is the appropriateness of prescribing, measured by the proportion of residents who are prescribed at least one potentially inappropriate medicine according to the 2019 Beers Criteria. Secondary outcomes include hospital and Emergency Department presentations, fall rates, prevalence and dose of antipsychotics and benzodiazepines, Anticholinergic Cognitive Burden Score, staff influenza vaccination rate, time spent on medication rounds, appropriateness of dose form modification and completeness of resident’s allergy and adverse drug reaction documentation. A cost-consequence and cost-effectiveness analysis will be embedded in the trial.DiscussionThe results of this study will provide information on clinical and economic outcomes of a model that integrates on-site pharmacists into Australian residential aged care facilities. The results will provide policymakers with recommendations relevant to further implementation of this model.Trial registrationACTRN: ACTRN12620000430932, retrospectively registered with ANZCTR on 1 April 2020. Available from https://www.anzctr.org.au/TrialSearch.aspx#&&conditionCode=&dateOfRegistrationFrom=&interventionDescription=&interventionCodeOperator=OR&primarySponsorType=&gender=&distance=&postcode=&pageSize=20&ageGroup=&recruitmentCountryOperator=OR&recruitmentRegion=&ethicsReview=&countryOfRecruitment=&registry=&searchTxt=ACTRN12620000430932&studyType=&allocationToIntervention=&dateOfRegistrationTo=&recruitmentStatus=&interventionCode=&healthCondition=&healthyVolunteers=&page=1&conditionCategory=&fundingSource=&trialStartDateTo=&trialStartDateFrom=&phase=

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