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An Evidence-Based Procedure for Self-Management of Medication in Hospital: Development and Validation of the SelfMED Procedure.

ABSTRACT: AIM:To develop and validate a procedure for self-management of medication by patients whilst in hospital. BACKGROUND:Self-management of medication allows patients to self-manage their medication in a controlled and supportive hospital environment. This practice is encouraged worldwide, yet an evidence-based procedure to evaluate the ability of patients to self-manage and to monitor and support self-management are absent. METHODS:The evidence-based procedure for self-management of medication (SelfMED) was developed based on previous conducted qualitative research, literature review, and the current regulation. It was validated by healthcare providers and a multidisciplinary expert meeting. Questions within the procedure that could be biased were tested for inter-rater reliability. RESULTS:First, the SelfMED procedure was developed. It consists of a stepped assessment of patient's competencies for self-management performed by healthcare providers and the patient. When self-management is allowed, the SelfMED monitoring tool monitors the patient's intake of self-managed medication. Secondly, the procedure was revised for clarity, appropriateness, and face validity by five healthcare providers and a multidisciplinary expert meeting, resulting in the final version. Thirdly, three questions from the final version were tested for interrater reliability. Cohen's Kappa showed moderate to strong levels of agreement. CONCLUSIONS:The developed SelfMED procedure provides an evidence based approach of facilitating self-management of medication. The content of the procedure was found valid to evaluate the patient's ability to self-manage and to monitor them while self-managing.

SUBMITTER: Vanwesemael T

PROVIDER: S-EPMC6164845 | biostudies-other | 2018 Jul

REPOSITORIES: biostudies-other

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An Evidence-Based Procedure for Self-Management of Medication in Hospital: Development and Validation of the SelfMED Procedure.

Vanwesemael Toke T Dilles Tinne T Van Rompaey Bart B Boussery Koen K

Pharmacy (Basel, Switzerland) 20180726 3

<h4>Aim</h4>To develop and validate a procedure for self-management of medication by patients whilst in hospital.<h4>Background</h4>Self-management of medication allows patients to self-manage their medication in a controlled and supportive hospital environment. This practice is encouraged worldwide, yet an evidence-based procedure to evaluate the ability of patients to self-manage and to monitor and support self-management are absent.<h4>Methods</h4>The evidence-based procedure for self-managem ...[more]

PMID: 30049965

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Project description:Background Providing evidence-based care is recognized as a key competence for all healthcare professionals. In order to support community pharmacists in evidence-based self-medication counseling, the umbrella organization of German pharmacists initiated the development of a nationwide concept. The key element of the concept was a professional newsletter that should help pharmacists incorporate research findings into their daily counseling practice. Objective To develop, implement and evaluate the professional newsletter concept. Setting German community pharmacies. Method Clinical pharmacists from a German university compiled and synthesized clinical trial data in a professional newsletter that would supply community pharmacists with evidence-based information on common over-the-counter medicines as well as instructions for searching and appraising scientific literature. The electronic newsletter was offered to interested community pharmacists free of charge, once or twice a month, after they signed up for a subscription. About one year after the publication of the first newsletter issue, the subscribers were invited to take part in an anonymous cross-sectional online survey. In all, 21 newsletter issues were published through the end of the survey period. Main outcome measure Perceived value of the professional newsletter with 10 predefined objectives. Results A total of 1975 persons subscribed to the professional newsletter. Of those, 150 persons working in community pharmacies completed the survey. Most of them perceived the synthesized information as 'useful' (81-95%). They attributed positive changes in knowledge (89%), skills (87-91%), awareness (85%), and motivation (67-77%) to the newsletter. However, almost half of them (43%) found it difficult to incorporate reading the newsletter in their everyday working life. Free-text feedback suggested that further modifications should be considered to facilitate a better integration of the newsletter into everyday pharmacy practice. Conclusion A nationwide provided professional newsletter can play a vital part in supporting pharmacists in evidence-based self-medication counseling. However, the practicability of such a newsletter needs to be further improved and the newsletter should be accompanied by additional measures.

Project description:Importance:Complex medication regimens pose self-management challenges, particularly among populations with low levels of health literacy. Objective:To test medication management tools delivered through a commercial electronic health record (EHR) with and without a nurse-led education intervention. Design, Setting, and Participants:This 3-group cluster randomized clinical trial was performed in community health centers in Chicago, Illinois. Participants included 794 patients with hypertension who self-reported using 3 or more medications concurrently (for any purpose). Data were collected from April 30, 2012, through February 29, 2016, and analyzed by intention to treat. Interventions:Clinics were randomly assigned to to groups: electronic health record-based medication management tools (medication review sheets at visit check-in, lay medication information sheets printed after visits; EHR-alone group), EHR-based tools plus nurse-led medication management support (EHR plus education group), or usual care. Main Outcomes and Measures:Outcomes at 12 months included systolic blood pressure (primary outcome), medication reconciliation, knowledge of drug indications, understanding of medication instructions and dosing, and self-reported medication adherence. Medication outcomes were assessed for all hypertension prescriptions, all prescriptions to treat chronic disease, and all medications. Results:Among the 794 participants (68.6% women; mean [SD] age, 52.7 [9.6] years), systolic blood pressure at 12 months was greater in the EHR-alone group compared with the usual care group by 3.6 mm Hg (95% CI, 0.3 to 6.9 mm Hg). Systolic blood pressure in the EHR plus education group was not significantly lower compared with the usual care group (difference, -2.0 mm Hg; 95% CI, -5.2 to 1.3 mm Hg) but was lower compared with the EHR-alone group (-5.6 mm Hg; 95% CI, -8.8 to -2.4 mm Hg). At 12 months, hypertension medication reconciliation was improved in the EHR-alone group (adjusted odds ratio [OR], 1.8; 95% CI, 1.1 to 2.9) and the EHR plus education group (adjusted odds ratio [OR], 2.0; 95% CI, 1.3 to 3.3) compared with usual care. Understanding of medication instructions and dosing was greater in the EHR plus education group than the usual care group for hypertension medications (OR, 2.3; 95% CI, 1.1 to 4.8) and all medications combined (OR, 1.7; 95% CI, 1.0 to 2.8). Compared with usual care, the EHR tools alone and EHR plus education interventions did not improve hypertension medication adherence (OR, 0.9; 95% CI, 0.6-1.4 for both) or knowledge of chronic drug indications (OR for EHR tools alone, 1.0 [95% CI, 0.6 to 1.5] and OR for EHR plus education, 1.1 [95% CI, 0.7-1.7]). Conclusions and Relevance:The study found that EHR tools in isolation improved medication reconciliation but worsened blood pressure. Combining these tools with nurse-led support suggested improved understanding of medication instructions and dosing but did not lower blood pressure compared with usual care. Trial Registration:ClinicalTrials.gov identifier: NCT01578577.

Dataset Information

An Evidence-Based Procedure for Self-Management of Medication in Hospital: Development and Validation of the SelfMED Procedure.

Publications

An Evidence-Based Procedure for Self-Management of Medication in Hospital: Development and Validation of the SelfMED Procedure.

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