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Dissertations / Theses on the topic 'Medication'
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1
Given, BarbaraA, CharlesW Given, Alla Sikorskii, Eric Vachon, and Asish Banik. "Medication burden of treatment using oral cancer medications." MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2017. http://hdl.handle.net/10150/625510.
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Objective: With the changes in healthcare, patients with cancer now have to assume greater responsibility for their own care. Oral cancer medications with complex regimens are now a part of cancer treatment. Patients have to manage these along with the management of medications for their other chronic illnesses. This results in medication burden as patients assume the self-management. Methods: This paper describes the treatment burdens that patients endured in a randomized, clinical trial examining adherence for patients on oral cancer medications. There were four categories of oral agents reported. Most of the diagnoses of the patients were solid tumors with breast, colorectal, renal, and gastrointestinal. Results: Patients had 1u4 pills/day for oral cancer medications as well as a number for comorbidity conditions (3), for which they also took medications (10u11). In addition, patients had 3.7u5.9 symptoms and side effects. Patients on all categories except those on sex hormones had 49%u57% drug interruptions necessitating further medication burden. Conclusions: This study points out that patients taking oral agents have multiple medications for cancer and other comorbid conditions. The number of pills, times per day, and interruptions adds to the medication burden that patients' experience. Further study is needed to determine strategies to assist the patients on oral cancer medications to reduce their medication burden.
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Litell, Munjanja Yvonne. "Medication Reconciliation in the Elderly." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6236.
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Medication therapy is the most prevalent and critical intervention of health delivery and the source of most errors in healthcare. Medication errors and associated adverse drug events (ADE) have serious health and economic ramifications, and in elderly patients ADE are the leading cause of morbidity and mortality. Medication reconciliation is the process of evaluating current medication treatment to manage the risk and optimize the outcomes of medication treatment by detecting, solving, and preventing ADEs. This education project answered the question whether education provided to long term care staff would improve knowledge of medication reconciliation and be retained over time. The education program was developed through results of a literature search to identify evidence-based standards for medication reconciliation. The guiding theory for program was Kurt Lewin's theory of planned change. The test was developed on the medication reconciliation content and arrangements made for each of the 30 participants who were RNs, LPNs, and CMAs to take the test before and after the education program and again at 30 and 45 days. Results showed statistically significant improvement (p < 0.05) with knowledge of medication reconciliation retained at 30- and 45-days post intervention. Positive social change is possible as nurses and CMAs in the long-term care facility use the knowledge of medication reconciliation to improve patient medication safety for the long-term care residences in the facility. Through appropriate reconciliation, medication errors and ADEs can be reduced or prevented and patient outcomes improved.
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Mekonnen, Alemayehu B. "Medication Reconciliation as a Medication Safety Initiative." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/18050.
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Medication errors and their adverse outcomes are the most common cause of patient injuries in hospitals. Medication reconciliation is the safety strategy usually called for, to prevent medication errors that occur at care transitions. This strategy has been adopted as a standard practice in many developed countries. However, in Ethiopia, there were no published studies on medication reconciliation, nor evidence-based interventions aimed to tackle the burden of medication errors. This thesis was a medication safety initiative focusing on medication reconciliation intervention overall, and explored the journey to medication reconciliation service implementation as a medication safety strategy in Ethiopian public hospitals. Given the lack of consistent reports regarding the impact of this strategy, the journey to implementation was guided by synthesise of the evidence supporting the effectiveness of this intervention. The findings of our systematic reviews have shown that medication reconciliation interventions carried out through pharmacist assessment at hospital transitions were found to be an effective strategy for improving clinical outcomes (e.g. adverse drug event-related hospital visits, all-cause readmissions, and emergency department visits), as well as process outcomes, such as the occurrence of medication errors. Therefore, the overarching aim of this thesis was to implement a pharmacist-led medication reconciliation intervention in resource-limited settings. Implementation of medication reconciliation is not an ultimate end but sustainability is an issue, and this should be corroborated by corresponding changes in attitudes, teamwork, communication, culture and leadership. For this purpose, the thesis employed methods from both safety and implementation sciences for successful implementation of the medication reconciliation program. System approaches to patient safety, such as patient safety culture has been explored, and patients’ experiences of medication-related adverse events have been discussed followed by a theoretically robust evidence-based exploration of the barriers to implementation. Patient safety culture in Ethiopian public hospitals has been found lower than the benchmark studies. Importantly, understaffing followed by problems during handoffs and care transitions and punitive response to error were identified as major safety problems. Particularly, handoffs and care transitions were largely affected by the lack of teamwork across units, punitive response to error reporting and managerial inaction for promoting patient safety. In addition to system factors presumed to affect patient safety, other factors such as individual healthcare professionals, patient, and task factors have been identified as challenges to achieve an optimal patient safety in the Ethiopian public hospitals. Resource limitations (e.g. material deficiencies, poor infrastructure) have been indicated as the greatest barriers for patient safety. Patients expressed a range of perceived experiences related to their medication, and a number of strategies required to improve patient safety practices have been suggested. Changes in practice, processes, structure, and systems were believed to help improve patient safety in the Ethiopian health care system. The results of this thesis have demonstrated that hospital pharmacists were very much enthusiastic for their extended roles and were positive towards the future of the profession; however, there were many factors that likely influenced their behaviour in the clinical practice, and these behavioural determinants were predominantly related to ‘Knowledge’, ‘Skills’, ‘Environmental constraints’, ‘Motivation and goals’, ‘Social influences’, and ‘Social/professional role’. While medication errors were highly prevalent at the time of hospital admission, this thesis has also found that pharmacist-led medication reconciliation was able to minimize medication errors significantly. Thus, implementation of medication reconciliation as a medication safety strategy is feasible, and pharmacists may be regarded as key resource personnel for the safe use of medications at the time of hospital admission. However, the sustainability of this service utilization is highly dependent on other behavioural determinants, such as knowledge and skill, competing priorities, and reimbursement for clinical services.
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Walsh, Marie Helen. "Automated Medication Dispensing Cabinet and Medication Errors." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/305.
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The number of deaths due to medical errors in hospitals ranges from 44,000 to 98,000 yearly. More than 7,000 of these deaths have taken place due to medication errors. This project evaluated the implementation of an automated medication dispensing cabinet or PYXIS machine in a 25-bed upper Midwestern critical access hospital. Lewin's stage theory of organizational change and Roger's diffusion of innovations theory supported the project. Nursing staff members were asked to complete an anonymous, qualitative survey approximately 1 month after the implementation of the PYXIS and again 1 year later. Questions were focused on the device and its use in preventing medication errors in the hospital. In addition to the surveys that were completed, interviews were conducted with the pharmacist, the pharmacy techs, and the director of nursing 1 year after implementation to ascertain perceptions of the change from paper-based medication administration to use of the automated medication dispensing cabinet. Medication errors before, during, and after the PYXIS implementation were analyzed. The small sample and the small number of medication errors allowed simple counts and qualitative analysis of the data. The staff members were generally satisfied with the change, although they acknowledged workflow disruption and increased medication errors. The increase in medication errors may be due in part to better documentation of errors during the transition and after implementation. Social change in practice was supported through the patient safety mechanisms and ongoing process changes that were put in place to support the new technology. This project provides direction to other critical access hospitals regarding planning considerations and best practices in implementing a PYXIS machine.
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Samaranayake, Nithushi Rajitha. "Medication safety in hospitals : medication errors and interventions to improve the medication use process." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193507.
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Medication errors are an unnecessary threat to patient safety. The aim of this study was to assess the epidemiology of medication errors and to assess the effectiveness of interventions intended to avoid medication errors in a tertiary-care hospital in Hong Kong.
The epidemiology of medication errors included the study of the pattern of interception of medication errors and the study of technology-related medication errors using medication incidents reported during years 2006–2010. 34.1% of all medication errors that were reported in the study hospital were not intercepted and 92.4% of all drug administration errors reached the patient. 17.1% of all reported medication errors were technology-related and, most were due to human interaction with technology.
The effects of a bar-code assisted medication administration (BCMA) system when used without the support of computerised prescribing (stand-alone), on its users and the dispensing process was studied using direct observations, questionnaires (Likert scale) and interviews. It was found that this system increased the number of dispensing steps from 5 to 8 and dispensing time by 1.9 times. Potential dispensing errors also increased (P<0.001). The perceived usefulness of the technology decreased among pharmacy staff (P=0.008) after implementation and they (N=16) felt that the system offered less benefit to the dispensing process (8/16) without the support of computerised prescribing. Nurses (N=10) felt that the stand-alone BCMA system was useful in improving the accuracy of drug administration (8/10).
Avoiding the use of inappropriate abbreviations in prescriptions will help to reduce medication errors. Therefore the effectiveness of a ‘Do Not Use’ list (a list of error-prone abbreviations used in the study hospital) and attitudes of health care professionals on using abbreviations in prescriptions was studied using prescription review and questionnaires respectively. The use of abbreviations included in the ‘Do Not Use’ list decreased significantly (P<0.001) after its introduction but other unapproved abbreviations to denote drug names and instructions were commonly used. 96% of doctors, and all pharmacists and nurses, believed that avoiding inappropriate abbreviations will help to reduce medication errors.
The use of abbreviations in prescriptions and attitudes of pharmacists in the study hospital was compared with a different medical system to determine the appropriateness of developing a universal error-prone abbreviation list. It was found that the types and frequencies of using inappropriate abbreviations vary among different medical systems.
In conclusion, additional interventions such as technological interventions are needed to minimise drug administration errors, but proper planning and careful monitoring are needed to avoid unintended errors when using technologies. Implementing a stand-alone BCMA system aimed at reducing drug administration errors may affect the dispensing process. Therefore effects of a technology on all related processes need to be considered before implementation, and monitored after implementation. The introduction of a ‘Do Not Use’ list is effective in reducing inappropriate abbreviations in prescriptions and most health care professionals agree that avoiding inappropriate abbreviations may help to reduce medication errors. However, formulating in-house error-prone and standard abbreviation lists in hospitals, continuous updating of the lists and frequent reminders to prescribers are recommended.published_or_final_version
Medicine
Doctoral
Doctor of Philosophy
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Shumaker, Becki Debora. "MEDICATION BELIEFS AND MEDICATION ADHERENCE IN THE OLDER ADULT." Thesis, The University of Arizona, 2003. http://hdl.handle.net/10150/610591.
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Purpose: To explore the relationship between beliefs about medication and
medication adherence in the older adult.
Organizing Constructs: Medication adherence and beliefs within the framework
of Orem's Self -Care Theory.
Study Design: This exploratory study uses a correlational design to survey a
convenience sample of older adults.
Methods: A convenience sample of 30 older adults, living independently, at least
65 years of age, and taking at least 3 prescription medications per day, were surveyed to
identify factors that may influence medication non -adherence. Participants were asked to
complete a demographic questionnaire, the Beliefs about Medication Scale, and the
Morisky Medication Adherence Scale. Descriptive analyses and Pearson Product
Moment Correlation Coefficients were conducted.
Results: A relationship between beliefs and medication adherence was not
identified in this group of older adults.
Conclusion: Beliefs may be an important factor in medication adherence. Further
research is needed to explore the relationship between the two concepts in a less
homogeneous sample.
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Oudah, Alsafa. "Medication Reconciliation : Electronic medication list discrepancies – Cross sectional study." Thesis, Umeå universitet, Institutionen för integrativ medicinsk biologi (IMB), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-178901.
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Badie, Shahene, Elizabeth Jing, Carissa Fernandez, and Terri Warholak. "An Assessment of Medication Synchronization on Improving Medication Adherence." The University of Arizona, 2015. http://hdl.handle.net/10150/614100.
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Class of 2015 AbstractObjectives: Our specific aim is to assess the changes in patient adherence in response to medication synchronization. Our working hypothesis is that medication synchronization will have a positive impact on patient adherence. Methods: This retrospective pre-post cohort study assessed medication adherence 365 days before and 365 days after enrollment into a prescription synchronization program. There were 5,994 patients included in the study. Seven medication classes and three demographic groups were chosen to assess for adherence. Adherence was determined by calculating mean proportion of days covered. A paired t-test was used to determine statistical significance for each drug class and demographic group. Exploratory analyses were done at 90 days and 180 days before and after the sync date to determine differences in terms of time. An alpha a-priori was set at 0.05 before analysis was started. Results: Current Fry’s Pharmacy patients greater than 18 years old that met the Centers for Medicare and Medicaid Services (CMS) for STARs rating criteria were included in the study. Results at 365 days showed a statistically significant decrease in PDC (p<0.0001), and was not affected by demographics. Conclusions: One year after the implementation of medication synchronization program at Fry’s Pharmacy, a statistically significance decrease in PDC is seen across all categories of chronic medications: statins, ACE-I/ARBs, beta-blockers, CCBs, metformin, thiazides, loop-diuretics, and inhaled corticosteroids. As such, medication synchronization may decrease patient adherence to the maintenance medications evaluated.
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Diaz, Melissa, Yanina Ortega, and Kevin Boesen. "Medication Therapy Management: Methods to Increase Comprehensive Medication Review Participation." The University of Arizona, 2013. http://hdl.handle.net/10150/614243.
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Class of 2013 AbstractSpecific Aims: To compare the Comprehensive Medication Review (CMR) rate for Workflow Model #1 (used in 2010) to the CMR rate for Workflow Model #2 (used in 2011) at the Medication Management Center (MMC). Methods: A retrospective database analysis was completed in which Comprehensive Medication Review (CMR) completion rates for 2010 and 2011 were assessed. Comparison included only Center for Medicare and Medicaid Services (CMS) contracts that the Medication Management Center (MMC) provided Medication Therapy Management (MTM) services for both in 2010 and 2011. Data was used to determine the effect a process change had on CMR participation rate at the MMC and best practices for improving the rate of Medication Therapy Management Program (MTMP) beneficiaries participating in a CMR. Main Results: In 2010, patient participation and response to a CMR offer letter was low (0.2%). The changes in process yielded an increase in the CMR completion rate (6.93%); this in turn yielded higher performance measurements for prescription drug plans. Conclusion: Workflow modifications, including a pro-active secondary CMR offer, led to a marked increase in member participation and CMR rates. Patients are more apt to consent to a CMR if they are called for a specific medication related problem. It is recommended to continue to convert TMR calls to CMRs whenever possible, monitor CMR rates at least quarterly, and make cold calls where needed to increase CMR percentages.
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Lim, Rosemary Hwee Mei. "A systems approach to medication safety in care homes: Understanding the medication system, investigating medication errors and identifying the requirements of a safe medication system." Thesis, University of Surrey, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.493045.
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In the year 2000, the United Kingdom government produced a report called "Organisation With a Memory" in response to the problem of safety in the healthcare sector and committed to reduce the number of serious medication errors. Whilst patient safety research in other healthcare settings such as the primary and secondary care has been under way for the past two decades, patient safety research in care homes has largely been neglected. This thesis presents the findings of the first large-scale epidemiological study of the prevalence and types of medication errors in England that was conducted as part of a wider study.
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Schneider, Anna-Maria. "Personalized asthma medication." Thesis, Umeå universitet, Designhögskolan vid Umeå universitet, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-125892.
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The aim of my master degree project of Advanced Product Design was to develop a monitoring and medication device to empower people who are suffering from asthma. Asthma is a major non-communicable disease characterized by recurrent attacks of breathlessness and wheezing. It is not possible to cure asthma, but appropriate management can control the disease and enable people to enjoy a good quality of life. Asthma varies in severity and frequency from person to person and not every asthmatic will require the same level of treatment. Also asthma conditions can vary over time and the level of airways inflammation has to be reviewed and medication has to be adjusted. Asthma diagnostic takes place at a point-of-care environment and is usually based on the pattern of symptoms, response to therapy over time and by objective parameters like lung function tests. My degree project was focused on a home used diagnostic and medication system in order to adjust the dosage of asthma medication on a more frequently basis.
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Gonzales, Kelly. "Safe medication administration." Diss., University of Iowa, 2011. https://ir.uiowa.edu/etd/2877.
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The purpose of this body of work was to address medication errors and safe medication administration practices in relation to practicing nurses and nursing students via several different approaches. These different approaches will be presented as three separate papers but interrelated themes. The specific purpose for each paper and the corresponding research questions were addressed individually in each chapter. The approach used in the first paper was a systematic literature search of medication administration errors and the pediatric population; five themes emerged including the incidence rate of medication administration errors, specific medications involved in medication administration errors and classification of the errors, why medication administration errors occur, medication error reporting, and interventions to reduce medication errors. The approach used in the second paper included a systematic literature review and implementation of a survey, both focusing on the assessment strategies for safe medication administration with practicing nurses and nursing students. Results of both the review and the survey indicated a lack of a comprehensive assessment of safe medication administration. The approach used in the third paper was a research study to conduct a psychometric evaluation of the Safe Medication Administration (SAM) Scale with baccalaureate nursing students. Results provided evidence of the validity and reliability of the SAM Scale. This body of work exposed a gap in nursing and demonstrates the importance of having a standardized assessment of safe medication administration with evidence of validity and reliability to demonstrate competency in this area.
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White, Megan, Andrea Rasdale, Erin M. Fekete, Stacey L. Williams, Matthew D. Skinta, Nicole M. Taylor, Michael Chatterton, and Brittney Woods. "Stigma, Medication Concerns, and Medication Adherence in People Living With HIV." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/8086.
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We hypothesized that higher levels of felt or enacted stigma would be related to poorer medication adherence, and that this relationship would be mediated by indicators of HIVrelated quality of life (HIV-QOL) including medication concerns, disclosure concerns, and perceptions of health provider treatment. 98 people living with HIV (PLWH) who were all currently taking ART medications completed an online survey that included measures of demographics, HIV-related stigma, medication, and HIV-QOL. Results suggested that concerns about medication accounted for the relationship between enacted HIV-related stigma and medication adherence.
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Khunkhun, Sanjeev, Jeff Krase, and Derek Rowen. "Comparison of Hospital Admission Medication Histories with Actual Outpatient Medication Regimens." The University of Arizona, 2006. http://hdl.handle.net/10150/624507.
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Class of 2006 AbstractObjectives: To assess the accuracy of medication histories taken upon hospital admission. Methods: This study was a prospective chart review comparing the accuracy of hospital admission medication histories with outpatient pharmacy and physician records. Eleven hundred patients admitted to El Dorado Hospital were eligible for participation. Patients were excluded if they were: under 18 years old, non-English speaking, in a room with precautions, transferred from a hospital or skilled nursing facility, unable to give oral consent, or admitted to a geri-psychiatric unit. After verification of medication, dose, and schedule with outpatient pharmacy and physician records, the findings were documented as perfect agreement, error of omission, or error of commission. Results: One hundred and nineteen patient histories were analyzed. Forty three patients (36%) had at least one error in their medication history. Of the 582 medications verified for accuracy, 491 medications were accurate and 91 errors were identified. Of the errors identified, 64 were errors of commission and 27 were errors of omission. The average age of patients who had at least one error type was 74.9 years, and the average age of patients who did not have any errors was 68.3 years (p = 0.004). Medication histories with six or more medications were more commonly associated with errors (p = 0.001). There was no relationship between medication history errors and specific classes of medications such as cardiovascular, lipid-lowering, and antidiabetic agents. Conclusions: Medication histories for patients older than 75 years or those that contain six or more medications are more likely to contain an error. There appears to be no link between medication class and occurrence of error. While this study does not address methods to reduce error rates, verification of medication histories with outpatient pharmacies and physicians may help reduce hospital medication errors and promote positive health outcomes.
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Buhl, Allison, and Kevin Boesen. "Measurable Benefit of Targeted versus Comprehensive Medication Reviews in Medication Therapy Management." The University of Arizona, 2015. http://hdl.handle.net/10150/614008.
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Class of 2015 AbstractObjectives: To determine whether comprehensive medication reviews (CMRs) or non-CMR interventions following targeted medication reviews (TMRs) resulted in more positive medication changes. A CMR is a structured medication management session that includes a full review of an individual’s medical and medication records. Non-CMR interventions are more targeted problem-based interventions that include shorter medication management sessions, written patient outreach, and direct to provider interventions. Methods: This cross-sectional quality improvement project compared the number of individuals with positive medication changes who received a CMR to those with positive medication changes who did not receive a CMR (non-CMR). Individuals were included in this project if they qualified for the Medication Management Center’s (MMC) pharmacist-driven medication therapy management (MTM) program and received their medication review(s) in 2012 or 2013. The addition of an appropriate medication or the removal of an inappropriate medication was considered a positive medication change within 120 days of intervention. Odds ratios were calculated using Wilcoxon Rank Sum. Results: A total of 418,649 participants in 2012 and 370,107 in 2013 had their medications reviewed as part of the MTM program. The non-CMR group accounted for the majority of the interventions (375,159 for non-CMR versus 43,490 for CMR in 2012 and 332,006 versus 38,101 for 2013). Significantly more positive medication changes were achieved in the non-CMR group (n=88,467 for 2012 and n=54,971 for 2013) following the medication review compared to the CMR group (n=9,796 for 2012 and n=7,034 for 2013). CMR recipients were more likely to receive a recommendation (odds ratio 0.70, 95% confidence interval 0.69-0.72 for 2012 and odds ratio 0.62, 95% confidence interval 0.60-0.63 for 2013). Non-CMR recipients were more likely to have a recommendation result in a medication change (odds ratio 1.24, 95% confidence interval 1.21-1.28 for 2012 and 1.26, 95% confidence interval 1.22-1.30 for 2013). Conclusions: While the percentage of participants who received a recommendation in the non-CMR group was lower, a greater percentage of these participants received a medication change. This indicates that non-CMR interventions following TMRs may be more effective in producing a positive medication change compared to CMRs.
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Dolly, Avril. "Effectiveness of a Medication Administration Protocol on Medication Errors and Inpatient Falls." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4511.
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Effectiveness of a Medication Administration Protocol on Medication Errors and Inpatient Falls
By
Avril Dolly
MS, University of the West Indies, 2010
BS, University of the West Indies, 2009
Project Submitted in Partial Fulfillment of the Requirements for the Degree of
Doctor of Nursing Practice
Walden University
November 2017
Adverse events such as medication errors and inpatient falls have been reported as the leading cause of safety incidences at the acute care facility in Trinidad and Tobago where this project was conducted. These mishaps aroused concerns about patient safety and led to a quality improvement (QI) initiative at the hospital. The QI project included establishing an evidence-based medication administration protocol in one unit in the hospital and a plan to examine the medication errors and the patient fall rates at the site. While multiple factors were noted to affect the risk for patient falls, this project was recognized as a starting point for a health system QI initiative that was to continue beyond the student's project. The purpose of this project was to evaluate the effectiveness of the medication administration protocol and determine if a corresponding change in the hospital patient fall rates occurred. An outcome impact evaluation model was used to examine both the medication error rate and the patient fall rates 3 months prior to and 3 months after implementation of the QI initiative. Results of a 2-tailed paired t-test show significant reductions in medication errors (p = .039) and patient fall rates (p = .033). While the results are statistically significant, the findings must be interpreted cautiously in view of the variables that could not be considered in this QI initiative. The findings of this project offer a beginning to a much-needed surveillance of patient fall rates and an ongoing promotion of safety through medication administration protocol used. The project offers an opportunity to promote positive social change by raising awareness of the need for a culture of patient safety.
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Åkerblad, Ann-Charlotte. "Adherence to Antidepressant Medication." Doctoral thesis, Uppsala University, Department of Neuroscience, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7769.
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Non-adherence to medication is a major obstacle in the treatment of depression. The objectives of the present study were to explore the effect of two interventions aiming to increase antidepressant treatment adherence, and to examine long-term consequences and costs of depression in adherent and non-adherent primary care patients.
A randomised controlled design was used to assess the respective effects of a written educational adherence enhancing programme and therapeutic drug monitoring in patients with major depression treated with sertraline for 24 weeks. All patients were prospectively followed during two years.
Treatment adherence was found in 41% of the 1031 included patients. None of the interventions resulted in a significant increase in adherence rate. However, significantly more patients in the group receiving the written educational material had responded at week 24 as compared to patients in the control group.
The overall remission rate after two years was 68%. In total, 34% of the responders experienced at least one relapse. Response and remission rates at week 24, year 1 and year 2 were significantly higher in adherent as compared to non-adherent patients. No relationship between adherence and relapse rate was seen.
The mean total cost per patient during two years was KSEK 363 whereof indirect costs represented 87%. No significant differences in costs between intervention groups or between adherent and non-adherent patients could be demonstrated. However, the mean cost per patient was 39% lower for treatment responders as compared to non-responders.
Non-adherence was predicted by age below 35 or above 64 years, no concomitant medications, personality disorder, sensation seeking personality traits and substance abuse.
The results indicate a strong positive relationship between treatment adherence and clinical outcome. In addition, the study shows that depression is a costly disease and that certain patient characteristics predict non-adherence.
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Åkerblad, Ann-Charlotte. "Adherence to antidepressant medication /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7769.
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Alsulami, Zayed Nama F. "Medication errors in children." Thesis, University of Nottingham, 2013. http://eprints.nottingham.ac.uk/27843/.
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Medication errors are a significant global concern and can cause serious medical consequences in children. Double checking of medicines by two nurses is one strategy used by many children's hospitals to prevent errors from reaching paediatric patients. This thesis involves different studies that evaluated the effectiveness of the double checking process in reducing and preventing medication administration errors in a children's hospital. In addition, a systematic review was conducted of medication errors studies in the Middle East. A systematic review was also conducted of published studies of double checking. Six electronic databases were searched for articles that assessed the double checking process during the administration of medicines. Sixteen articles were identified. Only one of them was a randomised controlled clinical trial in a clinical setting. Only one study was conducted in a children's hospital. The review found that there is insufficient evidence to either support or refute the practice of double checking and more clinical trials are needed to evaluate the double checking process in children's hospitals. Based on the findings that were highlighted from the systematic review, a prospective observational study of paediatric nurses using the double checking process for medication administration was undertaken. The study aimed to evaluate how closely double checking policies are followed by nurses in different paediatric areas, and also to identify any. medication administration errors during the study period. 2,000 drug dose administration events were observed. There was variation between paediatric nurses adherence to double checking steps and different medication administration errors were identified. Based on the observational study, a semi-structured questionnaire study was developed. It was designed to explore the paediatric nurses' knowledge and opinions about the double checking process. The study showed that many nurses have insufficient knowledge on the double checking process and the hospital policy for medication administration. A simulation study was conducted to examine whether single or double checking is more effective in detecting and reducing medication errors in children. Each participant in this study was required to prepare and administer medicines in scenarios for two "dummy patients" either with another nurse (double checking) or alone (single checking). Different confounders were built into each scenario (prescribing and administration) for nurses to identify and address during the administration process. Errors in drug preparation, administration and failure to address confounders were observed and documented. The main findings from this study were that the double checking process is more likely to identify medication administration errors and contraindicated drugs than single checking. The time taken for drug administration was similar for both processes. Another systematic review was conducted to identify the published medication errors studies that have been undertaken in the Middle East. The review identified 45 studies from 10 Middle Eastern countries. Nine of the studies focused on medication errors in paediatric patients. Educational programmes on drug therapy for doctors and nurses are urgently needed in the Middle East. These studies have contributed to the field of medication safety by providing more information about double and single checking medication administration processes in paediatric hospitals. More educational and training programmes for nurses about the importance of double checking and improving their adherence rate to the double checking steps during medication administration are required to improve its effectiveness.
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Devnozashvili, Mikheili, and K. G. Selivanova. "Medication reminder device development." Thesis, ХНУРЕ, 2019. http://openarchive.nure.ua/handle/document/8372.
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In this work we propose complex system that consists of manual and stationary blocks and will help patients for medication reminder. Developed system is combination of automatic pill dispenser and manual application device which will help user to manage complex medication regimes.
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Calhoun, McKenzie L. "Weight Loss Medication Update." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6887.
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Doyle, Mary Davis. "Impact of the Bar Code Medication Administration (BCMA) System on Medication Administration Errors." Diss., Tucson, Arizona : University of Arizona, 2005. http://etd.library.arizona.edu/etd/GetFileServlet?file=file:///data1/pdf/etd/azu%5Fetd%5F1093%5F1%5Fm.pdf&type=application/pdf.
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Shaeffer, Joseph. "Increasing Awareness of Proper Disposal Practices of Unwanted Household Medications in Muskingum County, Ohio." Otterbein University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1596205993309345.
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Biron, Alain. "Medication administration complexity, work interruptions, and nurses' workload as predictors of medication administration errors." Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=66704.
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Background: The evidence to date in support of system related factors to account for medication administration errors (MAE) remains scant and inconclusive. Objective: To examine the predictive power of medication administration complexity (component and coordinative), work interruptions and nurses' workload as potential contributing factors to MAE. Design: A prospective correlational design. Setting: A medical patient care unit in a university teaching hospital Sample: A convenience sample of medication administration rounds performed by registered nurses with at least six months of professional experience. Method: Data were collected using direct observation (MAE and work interruptions), self-report measures (subjective workload, nurses' characteristics) and the Medication Administration Complexity (MAC) coding scale (component and coordinative medication complexity). Results: One hundred and two rounds were observed, during which 965 doses were administered and performed by 18 nurses. When wrong administration time errors were included, MAE rate was 28.4% whereas it decreased to 11.1% when wrong time errors were excluded. An interruption during the medication preparation phase (OR 1.596; 1.044 - 2.441) significantly increased the odds of MAE. Two significant interaction effects were found (patient demand for nursing care X overtime and patient demand for nursing care X professional experience). These interactions pointed to more negative effects of overtime and professional experience among nurses who rated the demand for nursing care as above average. Contrary to expectations, coordinative medication administration complexity significantly decreased the odds of MAE (OR 0.558; .322-.967). Including wrong administration time errors changed the cluster of predictors with component medication administration complexity (1.039; 1.016 - 1.062), and nurses' workload (1.221; 1.061 - 1.405) were significant preIntroduction: Les résultats probants relatifs aux facteurs prédictifs des erreurs d'administration des médicaments (EAM) sont peu nombreux et non-concluants.Objectif: Examiner la complexité de l'administration (composante et coordination), les interruptions dans le processus d'administration des médicaments et la charge de travail infirmière subjective comme facteurs prédictifs des EAM.Devis: Un devis corrélationnel prospectif. Milieu: Une unité de médecine dans un centre hospitalier universitaire.Échantillon: Un échantillon de convenance formé de 102 cycles d'administration des médicaments effectués par 18 infirmières avec un minimum de six mois d'expérience professionnelle.Méthode: Les données ont été colligées par observation directe (EAM et interruptions), mesures auto-rapportées (charge de travail subjective, caractéristiques sociodémographiques) ainsi qu'avec l'échelle de la complexité de l'administration médicamenteuse (MAC coding scale).Résultats: 102 observations ont été effectuées au cours desquelles 965 doses ont été administrées par 18 infirmières. En incluant les erreurs de temps d'administration, le taux d'EAM était de 28.4% et diminua à 11.1% lorsque les erreurs de temps d'administration étaient exclues. Une interruption lors de la préparation des médicaments (OR 1.596; 1.044 - 2.441) augmente significativement le risque d'EAM. Deux interactions significatives ont été trouvées (charge de travail X temps supplémentaire et charge de travail X expérience professionnelle). Ces interactions indiquent un effet plus négatif du temps supplémentaire et de l'expérience professionnelle parmi les infirmières ayant une charge de travail supérieure à la moyenne. La complexité de coordination de l'administration de médicament, contrairement aux attentes, diminue significativement les risques d'EAM (OR 0.558; .322-.967). L'inclusion des erreurs de temp
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Bloomfield, Peter S. "Neuroinflammation and psychosis : antipsychotic medication." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/39588.
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Neuroinflammation is an early feature of a number of nervous system disorders. Inflammation in the brain is primarily mediated via microglial cells, which are active components of circuit development in the central nervous system. Schizophrenia is a psychiatric illness with deficits in perceptual, cognitive and emotional function. Prior to the onset of psychosis, there is a period of attenuated psychotic symptoms, where individuals experience sub threshold features of psychosis. This 'ultra high risk' period can provide unique opportunities to investigate the development of psychosis. It has been demonstrated through translocator protein (TSPO) positron emission tomographic (PET) imaging that microglial activity is elevated in chronic schizophrenia, however it is unknown whether this elevation is present prior to the onset of psychosis. It is also uncertain what effect antipsychotic medication has on microglia in vivo. This thesis is divided between clinical and animal investigation, the results can be split into four findings; Firstly we demonstrate that there is a higher binding of [11C]PBR28 (a novel TSPO PET ligand) in ultra high risk subjects and patients with schizophrenia compared to healthy controls. Symptoms in the ultra high risk subjects also correlate with the level of ligand binding. Secondly, brain volumes are not correlated with [11C]PBR28 binding or inflammatory cytokine levels in peripheral blood samples. The third finding of this thesis is that antipsychotic drug administration does not appear to alter cortical microglial cells in naïve and systemically inflamed animals. The final finding is that brain volume is reduced by antipsychotic medication. Together these findings demonstrate that inflammation is present in subjects experiencing subthreshold psychotic symptoms. The animal experiments suggest medicated patients would not be expected to have higher levels of microglial activity than their un-medicated counterparts. Further investigation is needed to determine the mechanism of cortical volume changes after medication and how this relates to TSPO.
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Puyat, Joseph Hernandez. "Disparities in antipsychotic medication use." Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/35977.
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Objectives: To examine ethnic and income-related disparities in the use of
antipsychotic medication by conducting a systematic review of the related literature
and a secondary data analysis.
Methods: The review was conducted using a protocol developed to systematically
search, select and review peer-reviewed articles on ethnic disparities in antipsychotic
use. Study selection and data abstraction were performed by two independent
reviewers. The secondary data analysis was conducted to examine income-related
disparities in antipsychotic use in three cohorts. The first cohort was comprised of 19 to
64-year olds who had a recorded schizophrenia diagnosis. Income-related differences in
the essential use of antipsychotics were assessed in this cohort. The second cohort was
comprised of seniors (65 years and older) who had a recorded dementia but not
schizophrenia or bipolar disorder diagnosis. The third cohort was of children and youth
(18 years and younger) who had no recorded schizophrenia or bipolar disorder
diagnosis. Income-related differences in the potentially inappropriate use of
antipsychotics were studied in these last two cohorts. Disparities in antipsychotic use
were assessed using logistic regression, adjusting for factors that influence medicine use
(i.e., age, sex, health status, relevant diagnoses and residence in urban areas).
Results: The systematic review found no consistent evidence of ethnic disparities in the
receipt of antipsychotic treatment. However, among those who were treated, ethnic
minorities were found to be consistently less likely than non minorities to receive the
newer type of antipsychotics. Results of the secondary data analyses indicate that the
odds of essential antipsychotic use were lower in low-income individuals than those
with higher incomes. Odds of exposure to potentially inappropriate antipsychotic use,
on the other hand, were higher among low-income individuals and seniors in long-term
care.
Conclusion: There is evidence of persistent disparities in the use of antipsychotic
medication. Periodic examination and studies that identify causal factors and effective
interventions are needed to reduce disparities.
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Star, Kristina. "Safety of Medication in Paediatrics." Doctoral thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-197323.
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Background: In paediatrics, the limited documentation to guide medication, the lack of suitable dosage forms, and the continuous development in childhood present a scenario where safety of medication is a particular challenge. Aim: To explore reported adverse drug reactions (ADRs) and the challenges in prescribing and administering medicines in paediatrics, in order to identify and suggest areas needing international surveillance within medication safety and improvement in the clinical setting. Methods: Four exploratory studies were conducted. Worldwide reporting of suspected ADRs (individual case safety reports, ICSR) with ages 0-17 years were examined overall. Twenty published case reports and ICSRs for adolescents, who developed a rare and incompletely documented ADR (rhabdomyolysis) during antipsychotic medicine use, were analysed in-depth. Prescribed doses of anti-inflammatory medicines were studied in a UK electronic health record database. Transcribed focus group interviews with 20 registered nurses from four paediatric wards in Sweden were analysed for factors that may promote or hinder safe medication practices. Descriptive statistics, multiple regression, and content analyses were used. Results: Although, skin reactions and anti-infective medicines were most frequently reported, and more reported in paediatric patients than in adults, medication errors and adverse reactions related to psychostimulant medicines were reported with increased frequency during 2005 to February 2010. The in-depth case analysis emphasised the need for increased vigilance following changes in patients’ medicine regimens, and indicated that ICSRs could contribute with clinically valuable information. Prescribed dose variations were associated with type of dosage form. Tablets and capsules were prescribed with a higher dose than liquid dosage forms. Six themes emerged from the interviews: preparation and administration was complex; medication errors caused considerable psychological burden; support from nurse colleagues was highly valued; unfamiliar medication was challenging; clear dose instructions were important; nurses handling medications needed to be accorded higher priority. Conclusions: Age-specific screening of ICSRs and the use of ICSRs to enhance knowledge of ADRs and medication errors need to be developed. Access to age-appropriate dosage forms is important when prescribing medicines to children. To improve medication safety practices in paediatric care, interdisciplinary collaborations across hospitals on national or even global levels are needed.
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Peng, Siwei, and 彭思玮. "Medication nonadherence among hypertension patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48425230.
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Optimal effect of medical treatment requires patients' adherence to those treatments, which plays a even greater role than the medical decision made by physicians. With the epidemiological dynamic evolving, chronic disease becomes the major burden of healthcare, such as AIDS, hypertension, COPD, tuberculosis, asthma, epilepsy, schizophrenia, depression and diabetes, which make the adherence especially medication adherence a sightworthy issue because the risk of poor adherence with the complexity and duration of treatment with both of them are inherent to chronic diseases. Among patients with hypertension, medication nonadherence contributes to poorly controlled blood pressure as an significant yet unrecognized role. With the mediator of negative outcomes of further development of vascular disorders, including stroke, heart failure, renal insufficiency and coronary diseases, medication nonadherence to antihypertensives become the root of all devil in terms of healthcare.
In terms of healthcare utilization, it costs approximately 396 to 792 million dollars per year and creates a significant burden. Effect factors for medication nonadherence among hypertension patients include knowledge about hypertension, beliefs about hypertension, perceived beliefs about medication, inadequate self-management behaviors, physician-patient relationship, social support and healthcare policy. The achievements of current single level interventions are not satisfactory, therefore multiple level interventions are calling for attention.Everyone in the healthcare system are responsible to alter the situation. A comprehensive healthcare system that consummates all the effect factors is the effective and efficient solution.published_or_final_version
Public Health
Master
Master of Public Health
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Desborough, James. "Medicines management : optimising medication adherence." Thesis, University of East Anglia, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.446500.
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Merriman, Carolyn S. "Medication Administration for Resource Parents." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/8430.
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Smith, Olivia N. "Medication Adherence and Older Adults." Bowling Green State University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1435674662.
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Aung, Myint Vason Silpasuwan. "Self-medication among Myanmar villagers /." Abstract, 1999. http://mulinet3.li.mahidol.ac.th/thesis/2542/42E-AungMyint.pdf.
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Nassir, Atheer J. "Medication Management in Mental Health." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/15467.
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Despite advances in clinical and mechanistic understanding, pharmacotherapy used in the management of some people with psychosis remains suboptimal – the unjustified use of poly antipsychotic prescribing (PAP) is a salient example. The aim of this thesis was to investigate the current antipsychotics prescribing trends in the hospital and community settings and to capture data on polypharmacy (PAP), and how these overlap with medicines for more general somatic medical conditions. To achieve these objectives, 4 sub-studies were designed and conducted. Olanzapine was the most commonly used oral antipsychotic across hospital and community settings. For patients receiving long-acting (depot) injectable (LAI) antipsychotics, risperidone long-acting injectable (RLAI) was most commonly prescribed. PAP was found to be more prevalent in the hospital setting rather than in the community, 33.8% vs. 16.9%, respectively. However, when prescribers were asked to estimate the prevalence of PAP among the patients they cared for, their responses varied widely with the highest reported PAP being up to 80%. Generally, clinicians who reported treating 30% and more of their patients with PAP were found to be more likely to have less number of years of experience in the mental health sector, treat more adult inpatients, and reported perceiving PAP as a practice that is supported to some extent by evidence from the literature. However, it was also found in this thesis that PAP was significantly associated to cardiometabolic unwanted effects, which may explain to some extent the minimal support that PAP receives in literature. In conclusion, the incidence of poly antipsychotic prescribing was found to be relatively high in both hospital and community settings with common sets of co-prescribed agents. Similar trends are evident in literature with a general sense that most poly antipsychotic prescribing is not supported by guidelines or evidence of efficacy and safety.
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Laba, Tracey-Lea. "Medication Adherence in Chronic Disease." Thesis, The University of Sydney, 2013. http://hdl.handle.net/2123/9546.
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Background: Chronic disease places a substantial health and economic burden on individuals and health systems globally. Effective chronic disease management relies on patient adherence to proven medications. Medication adherence rates in chronic disease are sub-optimal, yet adherence-enhancing intervention results are underwhelming. Potentially, current strategies are not matching patient adherence preferences, nor addressing heterogeneity in adherence behaviour between social groups. To inform effective intervention design, this thesis aimed to explore adherence preferences for chronic disease medications and to investigate the effectiveness of adherence-enhancing strategies in socioeconomically disadvantaged groups. Methods: Two discrete choice experiments (DCEs) and a qualitative study were conducted to explore adherence preferences within Australia. A systematic review exploring the effect of strategies aimed at improving adherence to cardiovascular disease medications in socioeconomically disadvantaged populations was conducted. Results and conclusions: Intentional medication decisions were a product of trading between treatment-related factors, particularly cost, treatment scheduling, medication harms and long-term benefits. A patient’s attitudes towards medications, expectations of prescribers and their social context shaped adherence preferences and behaviour. The findings do not support a one-size-fits-all approach to adherence-enhancing interventions. By accounting for heterogeneity in behaviour and critically addressing patient-perceived safety of medications, significant improvements in adherence within the Australian healthcare setting may be achieved.
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Ramasamy, Abhilasha. "Patient Adherence to Chronic Disease Medications in a Medication Therapy Management Program in Lucas County, Ohio." Connect to full text in OhioLINK ETD Center, 2009. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=toledo1249416012.
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Thesis (M.S.)--University of Toledo, 2009.Typescript. "Submitted as partial fulfillment of the requirements for The Master of Science Degree in Pharmaceutical Sciences, Administrative Pharmacy Option." "A thesis entitled"--at head of title. Bibliography: leaves 71-84.
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Fusco, Lori A. "Medication Safety Competence of Undergraduate Nursing Students." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=casednp158558798038964.
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Engelbrecht, Cecilia Justina. "The Impact of an electronic medication monitoring system on the adherence of patients to antiretroviral medication at the Tshepang Clinic, Dr George Mukhari Hospital." Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/775.
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Thesis (MSc(Med)(Pharmacy)) -- University of Limpopo, 2010.SUMMARY Introduction: The Human Immunodeficiency Virus (HIV) pandemic has become a global "monster" and much effort and funds have been channelled by various stake holders to change the deadly course of this threatening disease. Adherence has been identified as a critical element in optimal treatment of the disease with antiretroviral (ARV) medicines. A literature review was conducted on relevant facets of the HI virus, Acquired Immune Deficiency Syndrome (AIDS), disease prevention and treatment with ARVs, treatment obstacles, the importance of a sustained adherence level of at least 95% and the treatment interventions to promote medication adherence. Objectives: The objectives of this study were to evaluate the e-MuM electronic monitoring system (electronic microprocessor, reminder unit [a specialised wristwatch] and software program) for practicality, impact and effectiveness on ARV adherence, to test the ease of use for the patient and pharmacist, to get feedback from patients and clinic staff and finally to make recommendations concerning possible adaptations and the ideal use of the e¬MuM system. Method: The design was a four phase, prospective, randomised experimental, longitudinal study, conducted at the Tshepang Clinic of the Dr George Mukhari Hospital in Garankuwa using 210 volunteer patients.. After signing a consent form, patients were randomized into test and control groups, balanced according to gender and time on treatment. At the end of the baseline phase (only written adherence data collection), both groups were given their stavudine tablets in an electronic monitoring (e-MuM) container (from the end of the second month). The test group received interventions in the form of a alarm watch reminder unit (end of Phase 1), followed by visual (based on e-MuM generated graphs) and verbal feedback (end of Phases 2, 3 and 4). Other adherence tools used to evaluate and compare adherence in this study included a self-assessment questionnaire for gathering quantitative and qualitative data, visual analogue scale (VAS), 2-day and 7-day recall, tablet counts and the biological markers of the patients at the start and end of the study Results: There was no statistically significant difference between demographic data of the two groups at any point during the study. The mean time on treatment of the test group patients increased relative to baseline by the end of the study, which follows a reported trend that patients who have been on treatment for longer, tend to remain in studies. The e-MuM system revealed a large scattering of adherence results in both groups. Medication taken within an hour of the correct time was regarded as "strict" adherence and that taken at any time on the correct day as "lenient" adherence. The most significant increase in mean strict adherence was from Phase 2 to Phase 4 (after two verbal and visual feedback sessions). The adherence increase for the test group was 18.8% and 14.3% for the control group. The mean strict adherence level was 36.1 % for the test group and 29.8% for the control group for the full period. The mean lenient adherence for the full period was 45.5% for the test group and for the control group it was 36.6%. The difference between the two groups in adherence increase over time, did not reach the statistically significant level of P<0.05. One of the difficulties in the study data interpretation of the self-reported adherence was due to patieilts' decanting habits. Patients were asked to state whether and how often they removed their tablets from the original container into another container (decanting). Decanting habit options included daily, weekly, no decanting and unspecified decanting habits. Patients' decanting habits varied greatly. From decanting data available for a total of 209 patients, a majority (145) reported at least two different types of decanting habits for the study period, while five patients reported every decanting habit. Patients statements on their decanting habits were compared with the data recorded by the e-MuM system, but did not correlate at an individual level and were found not reliable enough to permit adjustment of the adherence levels that were calculated by the e-MuM system. Although self-assessment adherence measures exhibited a high degree of correlation, this was in stark contrast with the data obtained from the e-MuM. The mean adherence according to the Visual Analogue Scale (VAS) for the test group and control group was 87.7% and 88.4% respectively. Some of the study participants (11%) marked their adherence out of bounds on the 10cm solid line used for VAS. Despite frequent explanations from staff, some patients were not able to understand the abstract nature of the VAS. This observation may be related to patient educational level, as the majority of study participants (82%) had an incomplete secondary education or lower. In addition, clinic staff and data collectors commented that patients did not want to admit to being non¬ adherent. The mean stated adherence with the 7-day recall was 93.6% for the test group and 92.8% for the control group patients. The 2-day recall was omitted at the end of Phase 2. Adherence measured with tablet counts could not be used as it was only available in 60% of visits by test group patients and 64% of control group patients, as a result of patients not returning their remaining tablets at follow-up visits. Although positive tendencies in biological markers (CD4 and viral load [VL]) were evident towards the end of the study, differences between the groups did not reach statistical significance. The mean increase in CD4 count in the test group over the full period was 76.2 cells/mm3 and the number of patients in the test group with VL < 400 copies/ml increased from 72% to 89%. The mean increase in CD4 count in the control group was 72.2 cells/mm3 and the number of patients with VL < 400 copies/ml increased from 65% to 75%. Conclusion: The results of the study illustrated that the e-MuM system could be integrated in a normal clinic routine but additional staff and facilities (hardware) would be needed. The e-MuM system could be particularly helpful with new or suspected non¬ adherent patients. The disadvantage of the electronic monitoring system is its ability to monitor only one drug per container. It could be used with a fixed combination single tablet regimen. Patients were positive about the reminder unit as a tool to improve adherence. Doctors had mixed opinions of the usefulness of feedback graphs in monitoring adherence. Some patients disagreed with feedback results and this may reflect the anomalies caused by the range of decanting habits. The test group reached higher average rates of adherence than the control group, as jUdged bye-MuM recorded events, but differences were not statistically significant. The e¬ MuM data do not reflect adherence as such, merely container opening patterns, which makes it difficult to interpret results. In focus groups, patients and staff expressed their views about the use of the e-MuM system. No difficulty in the ease of use was reported by patients or staff. Notwithstanding this, a large portion of patients did decant tablets for various reasons, which made calculation of true adherence rates very difficult. A group of patients suggested routine use of the e-MuM system, to keep them conscious of their medication regimen while staff suggested limited use for new patients and non-adherent patients. The size of the container was the biggest obstacle according to patients and clinic staff and a small, more portable container was suggested. The sturdiness of the e-MuM lid with the microprocessor used for the study was questionable. Recommendations: Based on the results of this study, suggestions to increase adherence and utilise the e-MuM system are offered. The ideal medication dosage interval for patients, whose adherence patterns are being monitored electronically, would be once daily. For the e-MuM system to be practical, the device (container with embedded micro chip) has to be small, portable and sturdy. Patients will have to be educated to take every dose directly from the e-MuM container. For optimal e-MuM data interpretation, patient medication taking behaviour, including decanting of tablets must be accurately identified. A trained, dedicated, sensitive person has to interpret data and give feedback to patients.
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Thorneloe, Rachael Jane. "Investigating medication adherence in psoriasis : exploring the role of illness perceptions, medication beliefs, and emotional distress." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/investigating-medication-adherence-in-psoriasis-exploring-the-role-of-illness-perceptions-medication-beliefs-and-emotional-distress(758e5322-438d-4806-bd2c-84e39c6477dd).html.
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Objectives: Psoriasis is a long-term inflammatory condition associated with considerable psychological and social morbidity. There are multiple psoriasis treatment modalities and regimens making medication adherence particularly demanding. The Self-Regulatory Framework has not been widely applied to investigate adherence by people with psoriasis. This thesis reports research into psychological factors associated with medication adherence in psoriasis. Methods: A systematic review of adherence to treatments (Phase 1) was followed by a qualitative investigation of measures of adherence and treatment beliefs (Phase 2). A large-scale multisite quantitative survey of levels and determinants of adherence to systemic psoriasis treatments was carried out by linking new psychological measures with data from a national treatment registry (Phase 3). Finally a mixed-methods investigation into self- regulatory approaches to the understanding of adherence was undertaken (Phase 4). Findings: i) Adherence difficulties are prevalent in psoriasis, however poor methodology quality of previous studies limited conclusions of the systematic review ii) Patients using topical preparations described significant day-to-day variations in medication use as well as complex treatment decision-making processes; however, key behaviours and cognitions were not accurately reflected by corresponding scores of the standardised scales iii) Patients using systemic treatments reported high levels of adherence which were associated with: biologic rather than a traditional systemic; fewer concerns about systemic treatments; and lower PASI and DLQI scores. Unhealthy lifestyle behaviours were also prevalent iv) Effective treatment usage in psoriasis conflicted with the management of the physical and psychological demands of living with psoriasis. For patients using topical preparations, non-adherence was a strategic decision to reduce distress and gain control. Patients using systemic treatments expressed strong beliefs in the necessity of their treatment, yet reported high levels of anxiety and depression. Systemic treatment usage conflicted with the management of illness controllability and psychological adjustment. A more negative illness belief profile and greater appearance concerns accounted for the most variance in both anxiety and depression, even after controlling for disease severity. These findings have major implications for the measurement of adherence and treatment beliefs, as well as researchers’ ability to determine clinical outcomes and treatment response. Conclusions: Psoriasis treatment adherence can be practically challenging as well as emotionally charged. The construct of self-regulatory failure proved to be illuminating and improves understanding of the psychological processes that underpin medicines adherence and other aspects of self- management in people with psoriasis.
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Davidson, Lesley Gail. "The pharmacist as the medication manager : application of a comprehensive pharmaceutical care and medication management system." Thesis, University of Sunderland, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.437632.
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Murphy, Kate. "Clozapine, concomitant medications and consumers: Assessing the accuracy of medication records and the lived experience of people prescribed clozapine under shared care arrangements." Thesis, Griffith University, 2018. http://hdl.handle.net/10072/381000.
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Schizophrenia is a serious long-term mental illness associated with significant morbidity and mortality. Clozapine is the most effective antipsychotic medication for the treatment of schizophrenia, however, due to potentially life-threatening haematological adverse effects, its use is restricted to people who have not responded to an adequate trial of at least two other antipsychotic medications. The high risk of adverse effects, associated mandatory monitoring and prescribing restrictions all mean that clozapine consumers often continue to be managed in a secondary care public mental health (MH) service.
In people stabilised on maintenance treatment living in the community, a shared care model, involving collaboration between a psychiatrist in secondary care, a general practitioner (GP) and community pharmacy in primary care is a management option. The aim of shared care is to lessen the burden on the consumer and on the secondary care service by allowing the GP to undertake the majority of monitoring and reduce the frequency of secondary care appointments.
While this may appear to be an ideal arrangement, discrepancies in medication information at transitions of care from one health service to another are common and contribute to prescribing errors. Where clinicians do not have full medication information there is potential for inappropriate clinical decision-making and the consumer can be exposed to adverse drug events (ADEs), which are defined as any harm occurring during drug therapy.
The overall aim of the study was to generate information and form recommendations to optimise communication pathways and access to accurate medication information between and for stakeholders (secondary care, general practice and community pharmacy) and consumers of a clozapine shared care service. The study was designed to assess the completeness and accuracy of consumer medication records held by shared care stakeholders and to describe the experiences of the consumers.
This was an exploratory mixed methods study undertaken in two parts. Firstly, a quantitative approach was used to examine secondary and primary care medication records in a public MH service setting. Fifty-five consumers (aged 18–65 years) prescribed clozapine under shared care were eligible to participate. Information from medication and dispensing records was used by a pharmacist to compile a best possible medication history for each consumer. Discrepancies were identified through reconciliation of stakeholder records with the medication history. Discrepancies were defined as an omission, addition, or administration discrepancy (difference in dose, frequency, or clozapine brand).
Thirty-five consumers who had previously consented to review of their medication records were then eligible to participate in Part Two of the study. Participants completed a semi-structured interview that included a number of questionnaires. The questionnaires focused on beliefs about illness and medicines, adverse effects, medication adherence and treatment burden, while the interview focused on advantages and disadvantages of clozapine, shared care, and communication pathways. Analysis was descriptive and thematic.
In Part One, 35 (63.5%) consumers consented to review of their records. Overall, 32 of the 35 consumers had at least one discrepancy in their records, with a mean of 4.9 discrepancies per consumer. Of 172 discrepancies, 127 (73.8%) were omissions. Primarily, concomitant medicines were omitted in 19/35 (54%) of secondary care records, while clozapine was omitted in 13/32 (40.6%) of community pharmacy records. In Part Two, 10/35 (28.6%) consumers agreed to participate in an interview. Findings included a low level of treatment burden with minimal adverse effects and medium-to-good adherence. Four inter-related themes surrounding treatment in the clozapine shared care program were identified: (i) understanding of illness and recovery; (ii) positive outcomes of treatment; (iii) treatment burden and acceptance and (iv) communication pathways. All participants described a positive experience with treatment in the clozapine shared care program, citing the efficacy of clozapine and the GP relationship as major benefits. Other findings included the fact that consumers were mostly unaware of any communication that took place between their shared care clinicians and assumed that clinicians had access to accurate medication information.
In summary, discrepancies were highly prevalent in the shared care medication records of clozapine consumers in this service, however participants reported positive treatment outcomes. Improved documentation and timely access to accurate and complete medication records for shared care stakeholders is needed to reduce the risk for suboptimal clinical decision-making and ADEs. Expanding the pharmacist's role in this setting could improve timeliness and accuracy in medication-related documentation and communication and make shared care an option for a wider group of clozapine consumers.Thesis (Masters)
Master of Philosophy (MPhil)
School of Human Serv & Soc Wrk
Griffith Health
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Panozzo, Stacey Joy. "Nurses' perceptions of medication administration errors /." Title page, abstract and contents only, 2001. http://web4.library.adelaide.edu.au/theses/09S.PS/09s.psp195.pdf.
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Myhre, Teri Ann, and University of Lethbridge Faculty of Arts and Science. "Medication safety practices : a patient's perspective." Thesis, Lethbridge, Alta. : University of Lethbridge, School of Health Sciences, 2007, 2007. http://hdl.handle.net/10133/626.
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Medication administration constitutes a key element of acute care delivery, while errors in the process threaten patient safety. The purpose of the study is to explore patients’ perceptions, attitudes and beliefs about the safety practices utilized by nurses when administering medications. Specifically, the study addresses patients’ perceptions of nurse behaviours regarding safe medicine administration, patient behaviours, patients’ perceptions and nurse behaviours regarding pain medicine, patients’ perceptions of nursing care, and patients’ perceptions of their participation/accountability in care. The results identify key safety issues from a patients’ perspective to focus change strategies that will improve patient care.x, 125 leaves ; 29 cm
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Wixson, Sarah E. "Medication misadventures: the case of benzodiazepines." UKnowledge, 2015. http://uknowledge.uky.edu/pharmacy_etds/49.
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For patients afflicted with symptoms of anxiety and insomnia, benzodiazepines are generally a safe and effective short-term pharmacological treatment option. Although considered safer than other sedative-hypnotic medications, substantial concern exists regarding the addictive nature and abuse potential of benzodiazepines along with potentially inappropriate prescribing and utilization in clinically vulnerable populations. These medication misadventures can have a significant impact on public health. Examples of medication misadventures as they pertain to benzodiazepines include the prescribing and use in clinically vulnerable populations for whom they are contraindicated or their efficacy has not been evaluated, the development of tolerance or addiction, abuse of the medication, and the manifestation of negative health outcomes including cognitive impairment, withdrawal symptoms upon discontinuation, or the reoccurrence of a preexisting substance use disorder.
In order to better understand medication misadventures associated with benzodiazepines retrospective analyses using populations extracted from large health claims databases are employed. To understand how benzodiazepine use may lead to adverse events causing patient harm, the risk of exacerbations in benzodiazepine users diagnosed with chronic obstructive pulmonary disease was estimated. The inherent risk of benzodiazepine addiction and abuse was estimated in an HIV-infected population, a population with a high prevalence of substance use disorders. This risk was estimated by first determining whether HIV-infected individuals are more likely to have any benzodiazepine use compared to their uninfected counterparts, and secondly, by examining the association between HIV-infection and potentially problematic benzodiazepine use. Finally, in an effort to mitigate unexpected and undesirable consequences to public health associated with the prescription drug abuse epidemic in the US, states have implemented prescription drug monitoring programs (PDMPs) to track the prescribing and dispensing of controlled substance medications. The effect of these programs on benzodiazepine dispensing is evaluated on a state and national level.
Findings will provide healthcare professionals a better understanding regarding the risk of medication misadventures involving benzodiazepines when evaluating their appropriateness in patients with anxiety, depression, and insomnia. Additionally, policymakers will understand the implications of PDMPs on the dispensing of benzodiazepines as they become a more widely used tool to combat prescription drug abuse and diversion.
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Al-Omran, Ola A. "Factors affecting medication adherence in children." Thesis, University of Brighton, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.392875.
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Day, Jennifer Carol. "Schizophrenic patients' experiences of neuroleptic medication." Thesis, University of Liverpool, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.262388.
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Harpur, Ruth Ann. "ADHD medication related attitudes and behaviours." Thesis, University of Southampton, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.439375.
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Ashmore, Jamile Abraham. "Predicting medication compliance in asthma sufferers." Scholarly Commons, 1998. https://scholarlycommons.pacific.edu/uop_etds/2712.
Full textAbstract:
Asthma is a prevalent, costly, and potentially deadly disease. Despite advances in the pharmacological treatment of asthma, many asthma sufferers do not benefit from their medication the way they should because they fail to take it as prescribed. The noncompliance rate for asthma is about 30% to 40%. In this study, I describe the theoretical and practical rationale for, as well as the development of, a brief self-report measure (called the Multidimensional Asthma Questionnaire $\{$MAQ$\}$) for assessing medication compliance in asthma sufferers. Results of the study showed that the MAQ had adequate internal validity and a four factor structure that was designated belief, threat, use, and knowledge respectively. Although it was hypothesized that scores on the MAQ would correlate positively with an independent measure of compliance that was based on pharmacists' medication refill records, this hypothesis was not supported. Neither the MAQ, nor two other measures for assessing the attitudes and beliefs of asthma patients, had any relationship to medication compliance as estimated by pharmacists' refill records. In fact, when scores on the three questionnaires were entered into a multiple regression analysis, the results showed that minimal patient identifying information (gender, marital status, and SES) did a better job of predicting compliance. These results underscore the complexities of accurately assessing and measuring compliance in asthma sufferers. Suggestions for future research are described.
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Nugraheni, Gesnita. "Managing Medication Regimen: Arthritis Patients' Perception." University of Toledo Health Science Campus / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=mco1372863682.
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Judice, Martha Arambel. "Medication assistance programs for Montana elders." Montana State University, 2004. http://etd.lib.montana.edu/etd/2004/judice/JudiceM0805.pdf.
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Rogers, Philip John. "Patient medication records by community pharmacy." Thesis, University of Bath, 1993. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.357290.
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