Impact of health literacy-conscious medication educational videos on primary medication nonadherence rates.

BACKGROUND: Primary medication nonadherence (PMN) occurs when a new medication is prescribed, but the patient does not obtain the medication, or an appropriate alternative. Medication knowledge may be a factor contributing to high PMN rates. A variety of approaches and technologies have been developed to enhance patient medication knowledge, though the impact of these interventions on PMN rates has not been studied. OBJECTIVES: The objectives of this study were to: 1) compare community pharmacy PMN rates between pharmacies that offer patient medication educational video services and those that do not, and 2) assess the relationships between video service delivery and PMN status. METHODS: This cohort study utilized data from six pharmacies (three case, three control). Adult individuals with a new electronic prescription for medications were assessed for PMN using the Pharmacy Quality Alliance (PQA) measure specifications. A 6-month measurement period was used to assess if medications or an appropriate alternative were dispensed within 30 days. Descriptive statistics were used to evaluate differences in PMN rates between case and control pharmacies. The relationships between medication education video service use and PMN status were assessed using multivariable logistic regression models. RESULTS: A total of 4038 patients were included in the analyses, contributing 6311 prescriptions for PMN assessment. Case pharmacies had significantly lower (25.9% versus 29.1%) PMN rates than control pharmacies (p=0.0090). Prescriptions filled at pharmacies that utilized medication educational videos had lower odds of PMN status [OR = 0.58 (0.43, 0.78)] than controls. Video use was associated with lower odds of PMN status [OR = 0.83 (0.70, 0.98)] when compared to prescriptions where patients did not receive the service. CONCLUSIONS: The use of health literacy-conscious, patient educational videos were associated with improved (lower) PMN rates. Medication education technologies represent a scalable solution to improve PMN and medication access.

The Impact of Assisted Living Organizational Structure and Process Characteristics on Staff Absence During COVID-19.

Quality of care in assisted living communities (ALCs) is important to consumers. The coronavirus disease of 2019 (COVID-19) pandemic and associated emergency policies have posed major challenges on staff recruitment and retention. This study aimed to examine the relationship between organizational characteristics of ALCs in Florida and challenges with staff absence during COVID-19 (N = 129 ALCs). Results indicated that structures (provision of memory care services), processes of care (challenges hiring new staff, staff sent home to comply with precautions, and staff anxiety), and local COVID-19 positivity rate were significantly associated with staff absence due to fear of infection, sickness, or family responsibilities. ALC providers and state regulatory agencies should develop policies and procedures that take these issues into consideration to prepare for future emergencies and disasters. Infection control policies should reflect whether an ALC provides memory care services and inform ways to overcome potential challenges with protocols. Efforts to reduce staff anxiety and disaster-related concerns should also be considered to ensure quality of care during emergencies.

ALCs who provided memory care services had significantly greater challenges with staff absence due to fear of infection during the COVID-19 pandemic.The administrative action of sending staff home to comply with COVID-19 precautions, difficulty hiring new staff, and staff anxiety were process characteristics of ALCs associated with greater challenges with staff absence.Policymakers should consider whether an ALC provides memory care services, faces potential challenges with infection control protocols, and addresses the mental health of staff when creating and implementing infection control policies.

Student responses to advance directives assignments in undergraduate courses in the United States: A qualitative examination of stress appraisals, coping, and outcomes.

Guided by stress and coping theory, qualitative content analysis was used to examine student written assignment responses (N = 100) about the importance of and student preparedness for completing their own advance directive (AD). Codes represented primary and secondary appraisals, coping, and outcomes. Primary appraisals were 47% benign, 47% stressful, and 6% irrelevant. Benign primary appraisals were associated with reporting greater internal and external resources and intent to complete an AD. Exposing students to information about AD can be useful, but student completion of an AD should be reserved for classes that help students process emotions and information about their preferences for end-of-life care.

Self-rated health and mental health among older incarcerated males.

OBJECTIVES: Older incarcerated persons are a rapidly growing population with considerable mental health needs. We evaluated perceived worth and meaningfulness in life as mediators in the relationship between self-rated health (SRH) and depression and anxiety. METHOD: Mediation analyses were conducted among 222 older incarcerated males from eight correctional facilities in Connecticut.PHQ-9 and GAD-7 assessed depression and anxiety, respectively. Subscales of the Geriatric Suicidal Ideation Scale (GSIS) measured perceived worth and meaningfulness in life. RESULTS: Greater SRH was associated with lower depression and anxiety. More perceived worth and meaningfulness in life were associated with better SRH and lower depression and anxiety. There is evidence of perceived worth and meaningfulness in life mediating the SRH-depression (ß = -0.86; 95% CI = -1.32 to -0.48; ß= -0.46, 95% CI = -0.82 to -0.17, respectively) and SRH-anxiety (ß = -0.71; 95% CI = -1.08 to -0.39; ß = -0.34, 95% CI = -0.65 to -0.10) relationships. CONCLUSION: SRH has both direct and indirect effects on depression and anxiety, by working through perceived worth and meaningfulness in life, in older incarcerated males. Assessing SRH, and focusing on ways to maintain self-worth and meaning, may be instrumental in promoting and sustaining their good mental health.

Feasibility of the Palliative Care Education in Assisted Living Intervention for Dementia Care Providers: A Cluster Randomized Trial.

BACKGROUND AND OBJECTIVES: Alzheimer's disease and related dementia (ADRD) is a major cause of death in the United States. While effective interventions have been developed to deliver palliative care to nursing home residents with ADRD, little work has identified effective interventions to reach assisted living (AL) residents with dementia. RESEARCH DESIGN AND METHODS: One hundred and eighteen AL residents with dementia from 10 different ALs in Florida participated. A pilot study using a cluster randomized trial was conducted, with 6 sites randomized to receive a palliative care educational intervention for staff (N = 23) to deliver care to residents; 4 sites were usual care. The feasibility of the intervention was assessed by examining recruitment, retention, and treatment fidelity at 6 months. Cohen's d statistic was used to calculate facility-level treatment effect sizes on key outcomes (documentation of advance care planning [ACP] discussions, hospice admission, and documentation of pain screening). RESULTS: The intervention proved feasible with high ratings of treatment fidelity. The intervention also demonstrated preliminary evidence for efficacy of the intervention, with effect sizes for the treatment group over 0.80 for increases in documentation of ACP discussions compared to the control group. Hospice admissions had a smaller effect size (0.16) and documentation of pain screenings had no effect. DISCUSSION AND IMPLICATIONS: The pilot results suggest that the intervention shows promise as a resource for educating and empowering AL staff on implementing person-centered palliative care delivery to persons with dementia in AL. A larger, fully powered randomized trial is needed to test for its efficacy.

"We Did More Damage": How COVID-19 Collapsed the Care Convoys of Residents Living With Dementia.

COVID-19 regulations have posed challenges for long-term care (LTC). However, few studies have examined how such regulations influenced the care of residents living with dementia. Our objective was to gain an understanding of LTC administrative leaders' perceptions regarding the impact of the COVID-19 response on this population. Using the convoys of care framework, we conducted a qualitative descriptive study. Forty-three participants, representing 60 LTC facilities, completed one interview where they described how COVID-19 policies shaped care for residents living with dementia. Results from deductive thematic analysis revealed that participants believed the care convoys of residents living with dementia were strained. Participants emphasized how diminished family involvement, increased staff responsibilities, and the industry's heightened regulatory climate contributed to disrupted care. Further, they highlighted how pandemic-focused safety guidelines did not always consider the unique needs of those living with dementia. Consequently, this study may inform policy by outlining considerations for future emergencies.