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Effectiveness of patient-oriented education and medication management intervention in people with decompensated cirrhosis.

ABSTRACT: People with chronic disease often have poor comprehension of their disease and medications, which can negatively affect health outcomes. In a randomised-controlled trial, we found that patients with decompensated cirrhosis who received a pharmacist-led, patient-oriented education and medication management intervention (n = 57) had greater knowledge of cirrhosis and key self-care tasks compared with usual care (n = 59). Intervention patients also experienced improved quality of life. Dedicated resources are needed to support implementation of evidence-based measures at local centres to improve outcomes.

SUBMITTER: Hayward KL

PROVIDER: S-EPMC7540524 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Effectiveness of patient-oriented education and medication management intervention in people with decompensated cirrhosis.

Hayward Kelly L KL Valery Patricia C PC Patel Preya J PJ Horsfall Leigh U LU Wright Penny L PL Tallis Caroline J CJ Stuart Katherine A KA David Michael M Irvine Katharine M KM Cottrell W Neil WN Martin Jennifer H JH Powell Elizabeth E EE

Internal medicine journal 20200901 9

People with chronic disease often have poor comprehension of their disease and medications, which can negatively affect health outcomes. In a randomised-controlled trial, we found that patients with decompensated cirrhosis who received a pharmacist-led, patient-oriented education and medication management intervention (n = 57) had greater knowledge of cirrhosis and key self-care tasks compared with usual care (n = 59). Intervention patients also experienced improved quality of life. Dedicated re ...[more]

PMID: 32929822

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Project description:Background and aimsPatients with decompensated cirrhosis are prescribed numerous medications. Data are limited as to whether patients are receiving medications they need and avoiding those they do not. We examined a large national claims database (2010-2015) to characterize the complete medication profile as well as the factors associated with appropriate and potentially inappropriate medication use in 12,621 patients with decompensated cirrhosis.Approach and resultsClinical guidelines and existing literature were used to determine appropriate and potentially inappropriate medications in decompensated cirrhosis. The total medication days' supply was calculated from pharmacy data and divided by the follow-up period for each decompensation. Ascites was the most common (86.5%), followed by hepatic encephalopathy (HE; 37.8%), variceal bleeding (VB; 17.5%), hepatorenal syndrome (6.3%), and spontaneous bacterial peritonitis (SBP; 6.1%). For patients with ascites, 55.8% filled a diuretic. For patients with HE, 32.4% and 63.3% filled rifaximin and lactulose, respectively. After VB, 60.3% of patients filled a nonselective beta blocker, and after an episode of SBP, 48.0% of patients filled an antibiotic for prophylaxis. The minority (4.5%-17.3%) had enough medication to cover >50% follow-up days. Potentially inappropriate medication use was common: 53.2% filled an opiate, 46.0% proton pump inhibitors, 14.2% benzodiazepines, and 10.1% nonsteroidal anti-inflammatory drugs. Disease severity markers were associated with more appropriate mediation use but not consistently associated with less inappropriate medication use.ConclusionsPatients with decompensated cirrhosis are not filling indicated medications as often or as long as is recommended and are also filling medications that are potentially harmful. Future steps include integrating pharmacy records with medical records to obtain a complete medication list and counseling on medication use with patients at each visit.

Project description:Medication education is vital for positive patient outcomes. However, there is limited information about optimal medication education by nurses during hospitalization and care transitions.Examine nurses' attitudes and behaviors regarding the provision of patient medication education. The secondary objectives were to determine if nurses' medication education attitudes explain their behaviors, describe nurses' confidence in patient medication knowledge and abilities, and identify challenges to and improvements for medication education.A cross sectional survey was administered to nurses servicing internal medicine, cardiology, or medical-surgical patients.Twenty-four nurses completed the survey. Greater than 90% of nurses believed it is important to provide information on new medications and medical conditions, utilize resources, assess patient understanding and adherence, and use open ended question. Only 58% believed it is important to provide information on refill medications. Greater than 80% of nurses consistently provided information on new medications, assessed patient understanding, and utilized resources, but one-third or less used open-ended questions or provided information on refill medications. Most nurses spend 5-9 minutes per patient on medication education and their attitudes matched the following medication education behaviors: assessing adherence (0.57; p<0.01), providing information on new medications (0.52; p<0.05), using open-ended questions (0.51; p<0.01), and providing information on refill medications (0.39; p<0.05). Nurses had higher confidence that patients can understand and follow medication instructions, and identify names and purpose of their medications. Nurses had lower confidence that patients know what to expect from their medication or how to manage potential side effects. Communication, including language barriers and difficulty determining the patient's understanding of the information, was the most common challenge for nurses and they suggested utilization of translator services and patient-friendly drug information resources as a way to improve.Nurses have positive attitudes toward patient medication education. However, their attitudes do not fully explain their behaviors and many nurses are spending limited time with patients on medication education. Enhancements to medication education could include resources on communication and collaboration with pharmacists.

Dataset Information

Effectiveness of patient-oriented education and medication management intervention in people with decompensated cirrhosis.

Publications

Effectiveness of patient-oriented education and medication management intervention in people with decompensated cirrhosis.

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