Medication beliefs and use of medication lists - is there a connection? Results from a before-and-after study in Germany.

BACKGROUND: Despite increasing digitalisation the paper-based medication list remains one of the most important instruments for the documentation and exchange of medication-related information. However, even elderly patients with polypharmacy who are at high risk for medication errors and adverse drug events, frequently do not receive or use a complete and comprehensible medication list. Increasing the use of medication lists would be a great contribution to medication safety and facilitate the work of health care providers. METHODS: This study is related to the project MeinPlan (MyPlan) which comprised an information campaign on safe drug administration in the Rhine-Neckar region in South Germany. The campaign was evaluated in a before-and-after study based on a survey among two independent, representative samples of citizens over 65 years. In total, 5034 questionnaires were analysed. While the effects of the primary outcome (the percentage of citizens using a medication list) have been reported elsewhere, this analysis focusses on the effects of the campaign on citizens' medication beliefs and assesses whether medication beliefs are associated with the use of medication lists, the use of over-the-counter drugs and the use of the tools offered by the campaign. Medication beliefs were assessed with the German version of the General Beliefs About Medicines Questionnaire (BMQ) which results in subscales for "General Overuse", "General Usefulness" and "General Harm". The use of medication lists and over-the-counter drugs was assessed with self-developed questionnaire items. RESULTS: No statistically significant change in citizens' medication beliefs before and after the campaign could be detected. Likewise, no association between medication beliefs and the use of medication lists, the use of over-the-counter drugs or the use of the tools offered by the campaign could be shown. CONCLUSIONS: A campaign focussing on the risks of drug administration did not change the medication beliefs of the targeted population. Moreover, citizens' general medication beliefs do not seem to be crucial for their decision to use a medication list or over-the-counter drugs. Strategies to improve the use of medication lists by patients should focus on other influential factors, such as individual benefits and barriers and socio-psychological factors.

Caregivers' role in using a personal electronic health record: a qualitative study of cancer patients and caregivers in Germany.

BACKGROUND: Particularly in the context of severe diseases like cancer, many patients wish to include caregivers in the planning of treatment and care. Many caregivers like to be involved but feel insufficiently enabled. This study aimed at providing insight into patients' and caregivers' perspectives on caregivers' roles in managing the patient portal of an electronic personal health record (PHR). METHODS: A descriptive qualitative study was conducted comprising two study phases: (1) Usability tests and interviews with patients with cancer and caregivers (2) additional patient interviews after a 3-month-pilot-testing of the PHR. For both study parts, a convenience sample was selected, focusing on current state of health and therapy process and basic willingness to participate and ending up with a mixed sample as well as saturation of data. All interviews were audio-recorded, pseudonymized, transcribed verbatim and qualitatively analyzed. RESULTS: Two main categories emerged from qualitative data: 'Caregivers' role' and 'Graduation of access rights' - consisting of four subcategories each. The interviewed patients (n = 22) and caregivers (n = 9) felt that the involvement of caregivers is central to foster the acceptance of a PHR for cancer patients. However, their role varied from providing technical support to representing patients, e.g. if the patient's state of health made this necessary. Heterogeneous opinions emerged regarding the question whether caregivers should receive full or graduated access on a patient's PHR. CONCLUSIONS: In order to support the patient and to participate in the care process, caregivers need up-to-date information on the patient's health and treatment. Nevertheless, some patients do not want to share all medical data with caregivers, which might strain the patient-caregiver relationship. This needs to be considered in development and implementation of personal health records. Generally, in the debate on patient portals of a personal health record, paying attention to the role of caregivers is essential. By appreciating the important relationship between patients and caregivers right from the beginning, implementation, of a PHR would be enhanced. TRIAL REGISTRATION: ISRCTN85224823 . Date of registration: 23/12/2015 (retrospectively registered).

Use of medication lists: A population-based approach to increase the prevalence of medication lists within a region in Germany. A pre-post study
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OBJECTIVES: Patient-centered medication lists are a useful documentation method to support safe drug treatment, but they are still inconsistently used and are of varying quality. The aim of this study was to evaluate the effects of an information campaign on the prevalence and use of medication lists. MATERIAL AND METHODS: We launched a population-based, low-threshold information campaign within a large region in Germany in order to sensitize the population to the use of medication lists. A survey was sent out at baseline and after 18 months to 5,340 citizens aged ≥ 65 years, covering ~ 4% of the region's population. RESULTS: The response rate was 49.4% (N = 2,640) at baseline and 45.4% (N = 2,427) at follow-up. Sociodemographic details of respondents were similar at both time-points as was the possession rate of a medication list among participants with regular medicine intake (51.6%, N = 1,181/2,288 vs. 51.4%, N = 1,082/2,107). Combining baseline and follow-up data, respondents indicated that their general practitioner was involved in issuing the list most often (N = 1,668/2,263, 73.7%), however, in 195 cases (8.6%), respondents indicated being solely responsible for the list. The majority (90.8%, N = 2,055/2,263) indicated having their list in use for longer than 1 year, but for only half of those, the list was updated within the last year. After the intervention, 6% of the respondents indicated being familiar with the campaign those being more likely to possess a list (69.7% N = 83/119 vs. 50.2% N = 999/1,988). CONCLUSION: The campaign did not change overall possession rate, but respondents who were familiar with the campaign were more likely to possess such a list.

[Benefits of a Medication List from a Citizen's Perspective -A Qualitative Survey]. / Nutzen eines Medikationsplans aus Sicht der Bürger ­ eine qualitative Befragung.

BACKGROUND: Since October 2016, German patients are entitled to get a medication list if using at least 3 drugs. The patient's individual attitude to a medication list is supposed to be relevant for its use und acceptance. STUDY AIM: Because there is little known about those attitudes, this study examined which potential benefits patients see in possessing a medication list, and why certain patients might not use it. METHOD: In a qualitative survey, 375 citizens of the Rhein-Neckar region were interviewed by using a semi-standardized guide. A content analysis of the interviews was done. RESULTS: Most citizens described medication lists as having private and economic benefits such as for health care or safe drug use. But often, they combine potential benefits with requirements such as age, number of prescribed drugs, or health status. Unsatisfied individual needs, excessive demands or an attitude of rejection are possible reasons for non-use. CONCLUSION: For successful implementation of the medication list, the individual attitude of patients should be assessed to be able to provide tailored information and assistance. The views of citizens about a medication list agree with the aims of the so-called German E-Health Act, but differ particularly with regard to named requirements and prioritisation.

An Electronic Medication Module to Improve Health Literacy in Patients With Type 2 Diabetes Mellitus: Pilot Randomized Controlled Trial.

BACKGROUND: In primary care, patients play a crucial role in managing care processes and handling drug treatment. A decisive factor for success is their health literacy, and several interventions have been introduced to support patients in fulfilling their responsibility. OBJECTIVE: The aim of this study is to assess the influence of such an intervention (ie, a medication module) within a patient-led electronic health record on patients' health literacy. METHODS: We conducted a randomized controlled study among community-dwelling patients with type 2 diabetes mellitus. Patients were recruited from primary care practices. After randomization, patients either had access to an internet-based medication module allowing them to store their medication information, look up drug information, and print a medication schedule (intervention group), or they received an information brochure on the importance of medication schedules (control group). After 4-8 weeks, all patients were invited to attend a structured medication review (ie, follow-up visit). Data were collected via questionnaires before the start of the intervention and during the follow-up visit. The main outcome measure was the mean difference in health literacy between baseline and follow-up assessments of patients in the control and intervention groups. RESULTS: Of 116 recruited patients, 107 (92.2%) completed the follow-up assessment and were eligible for intention-to-treat analyses. Only 73 patients, of which 29 were in the intervention group, followed the study protocol and were eligible for per-protocol analysis. No differences in overall health literacy were observed in either the intention-to-treat or in the per-protocol cohorts. Reasons for a null effect might be that the cohort was not particularly enriched with participants with low health literacy, thus precluding measurable improvement (ie, ceiling effect). Moreover, the success of implementation was considered poor because both the correct application of the study procedure (ie, randomization according to the protocol and dropout of 29 patients) and the actual interaction with the medication module was modest (ie, dropout of 9 patients). CONCLUSIONS: The conduct of this randomized controlled study was challenging, leaving it open whether inadequate implementation, too short of a duration, or insufficient efficacy of the intervention, as such, contributed to the null effect of this study. This clearly outlines the value of piloting complex interventions and the accompanying process evaluations.