Why do patients struggle with their medicines?-A phenomenological hermeneutical study of how patients experience medicines in their everyday lives.

Why do so many people struggle with their medicines despite decades of research on medicines taking? Research into how people experience medicines in their everyday life remains scarce with the majority of research in this area of focusing on whether or not people take their medicines as prescribed. Hence, this study used a phenomenological hermeneutical qualitative design to gain a deeper understanding of individuals' perspectives on the lived experience of medicine-taking. Findings from this study highlight five main themes where participants experience medicines as: 1) life-saving and indispensable, 2) normal and a daily routine, 3) confusing and concerning, 4) unsuitable without adjustment, and 5) intrusive and unwelcome. These results can be the basis for mutually agreed prescribing through a co-creative approach that aims at enhancing open and honest dialogues between patients and healthcare professionals in partnership about medicines.

Women's experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID-19) pandemic: a qualitative evaluation.

OBJECTIVE: To explore the experiences of women in Scotland who accessed medical abortion at home up to 12 weeks' gestation, delivered via a telemedicine abortion service implemented in response to the coronavirus (COVID-19) pandemic, to identify areas for improvement and inform service provision. DESIGN: Qualitative interview study. SETTING: Abortion service in one National Health Service health board in Scotland. POPULATION OR SAMPLE: Twenty women who accessed telemedicine abortion services and self-administered mifepristone and misoprostol at home up to 12 weeks' gestation. METHODS: Thematic analysis of semi-structured qualitative interviews, informed by the Framework analytic approach. MAIN OUTCOME MEASURES: Women's experiences of accessing telemedicine for medical abortion at home, specifically: acceptability of the telephone consultation and remote support; views on no pre-abortion ultrasound scan; and self-administration of abortion medications at home. RESULTS: Novel study findings were three-fold: (1) participants valued the option of accessing abortion care via telemedicine and emphasised the benefits of providing a choice of telephone and in-person consultation to suit those with different life circumstances; (2) the quality of abortion care was enhanced by the telemedicine service in relation to access, comfort and flexibility, and ongoing telephone support; (3) participants described being comfortable with, and in some cases a preference for, not having an ultrasound scan. CONCLUSIONS: This research demonstrates support for the continuation of telemedicine abortion services beyond the temporary arrangements in place during COVID-19, and lends weight to the argument that offering the option of telemedicine abortion care can enable women to access this essential health service. TWEETABLE ABSTRACT: #Telemedicine provision of medical #abortion at home up to 12 weeks' gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher.

Demand for fentanyl becomes inelastic following extended access to fentanyl vapor self-administration.

Opioid use disorder imposes great societal harm in the United States and in countries worldwide. Animal models that accurately capture motivational changes that occur in opioid dependence are critical to studying this disorder. The present study used a model of opioid vapor self-administration combined with a behavioral economics approach to determine whether rats would be more motivated to "work" to defend their baseline intake of fentanyl (i.e., more inelastic demand) following sufficiently frequent, intense, and chronic exposure to self-administered vaporized fentanyl. Male rats were allowed to respond for deliveries of 1.5-s of vaporized 10 mg/ml fentanyl solution. Following 15 sessions of short access (ShA; 1 h) vs. long access (LgA; 12 h) to self-administration, we conducted a between-sessions demand curve procedure, and observed significantly more inelastic demand for fentanyl (Essential Value; EV), and increased maximal response output (Omax) in LgA compared with ShA rats. In a subsequent phase, the unit-dose was doubled to 3 s of fentanyl vaporization. After seven ShA vs. LgA sessions, we assessed demand again and found that LgA rats, contrasted to ShA rats, demonstrated significantly higher baseline intake or "hedonic setpoint" (Q0), in addition to significantly increased EV and Omax. These results demonstrate that extended access to self-administration of a vaporized opioid causes changes in behavioral economic metrics consistent with development of an addiction-like state in rats. The combination of the vapor model with a translationally relevant behavioral economics framework opens new avenues to study dysregulated motivational processes in substance use disorders.

Development and psychometric evaluation of the assessment of self-injection questionnaire: an adaptation of the self-injection assessment questionnaire.

BACKGROUND: Patient-reported outcome (PRO) instruments provide robust and effective means of evaluating patients' treatment experience; however, none adequately cover experience using self-injection devices with enhanced features, such as an electromechanical autoinjector (e-Device). The aim of this study was to develop a PRO instrument that accurately assesses patient experience of using an e-Device and to evaluate its psychometric properties. METHODS: A mixed-methods approach was taken; two parallel, targeted literature reviews were conducted to identify relevant concepts and existing self-injection PRO instruments that could be adapted. Patient feedback obtained from two focus groups was used to inform initial instrument development. The pilot instrument was then administered in a multicenter, open-label, phase 3 clinical study in which patients self-injected certolizumab pegol using an e-Device, to gather evidence of its psychometric qualities. Exit interviews were conducted with a sub-sample of patients enrolled in the study to confirm the appropriateness and clarity of the items included and cognitively debrief the instrument. Confirmatory factor analysis (CFA) was conducted on all items, and each domain's internal consistency was measured using Cronbach's ɑ. RESULTS: The literature searches identified several e-Device-specific concepts related to device features, device function, side effects/reactions/pain, confidence, and interference/convenience in daily life. Seven existing PRO instruments were identified. The Self-Injection Assessment Questionnaire (SIAQ), containing pre- and post-injection questionnaire modules, was selected as most suitable and adapted using feedback from 19 patients in the two focus groups to form the pilot Assessment of Self-Injection (ASI) questionnaire. CFA resulted in some changes to the grouping of items in the post-injection module domains following psychometric evaluation of the ASI. Internal consistency was satisfactory for all pre- and post-injection domains (ɑ > 0.8). Cognitive debriefing results from 12 patient exit interviews confirmed the ASI's appropriateness and clarity. CONCLUSIONS: The ASI was developed iteratively with patient input and was evaluated in its intended clinical context of use. Psychometric analyses indicated promising cross-sectional results; the ASI was well understood and considered relevant by patients self-injecting using the e-Device, suggesting that it could be used in real-world settings to aid with clinical decision making. TRIAL REGISTRATION: NCT03357471.

Experiences of women living in Hungary seeking a medical abortion online.

OBJECTIVE: The aim of the study was to analyse the characteristics and experiences of women living in Hungary who accessed a medical abortion through the telemedical service Women on Web. METHODS: We examined the characteristics and experiences of 136 women who requested a medical abortion from Women on Web between June 2013 and February 2017. The main outcome measures were acceptability and satisfaction with the service. RESULTS: Of the 136 women who completed an online consultation, 118 requested a medical abortion package. Follow-up information was provided by 73 women (61.9%), of whom 49 completed the follow-up survey and 24 provided follow-up information via email. Of the 59 women who went ahead with a medical abortion, five (8.5%) had a surgical intervention afterwards. All women who completed the follow-up survey reported that they found a home medical abortion to be acceptable. CONCLUSION: The lack of availability of medical abortion in the public health sector in Hungary and compulsory biased counselling make medical abortion at home through telemedicine a good alternative for Hungarian women.

Engagement in a National Naloxone Programme among people who inject drugs.

BACKGROUND: Availability of the opioid antagonist naloxone for lay administration has grown substantially since first proposed in 1996. Gaps remain, though, in our understanding of how people who inject drugs (PWID) engage with naloxone programmes over time. AIMS: This paper aimed to address three specific evidence gaps: the extent of naloxone supply to PWID; supply-source (community or prisons); and the carriage of naloxone among PWID. MATERIALS AND METHODS: Analysis of Scotland's Needle Exchange Surveillance Initiative (NESI) responses in 2011-2012 and 2013-2014 was undertaken with a specific focus on the extent of Scotland's naloxone supply to PWID; including by source (community or prisons); and on the carriage of naloxone. Differences in responses between the two surveys were measured using Chi-square tests together with 95% confidence intervals for rate-differences over time. RESULTS: The proportion of NESI participants who reported that they had been prescribed naloxone within the last year increased significantly from 8% (175/2146; 95% CI: 7-9%) in 2011-2012 to 32% (745/2331; 95% CI: 30% to 34%) in 2013-2014. In contrast, the proportion of NESI participants who carried naloxone with them on the day they were interviewed decreased significantly from 16% (27/169; 95% CI: 10% to 22%) in 2011-2012 to 5% (39/741; 95% CI: 4% to 7%) in 2013-2014. CONCLUSIONS: The supply of naloxone to PWID has increased significantly since the introduction of a National Naloxone Programme in Scotland in January 2011. In contrast, naloxone carriage is low and decreased between the two NESI surveys; this area requires further investigation.

A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive African Americans.

BACKGROUND: Poor adherence explains poor blood pressure (BP) control; however African Americans suffer worse hypertension-related outcomes. METHODS: This randomized controlled trial evaluated whether a patient education intervention enhanced with positive-affect induction and self-affirmation (PA) was more effective than patient education (PE) alone in improving medication adherence and BP reduction among 256 hypertensive African Americans followed up in 2 primary care practices. Patients in both groups received a culturally tailored hypertension self-management workbook, a behavioral contract, and bimonthly telephone calls designed to help them overcome barriers to medication adherence. Also, patients in the PA group received small gifts and bimonthly telephone calls to help them incorporate positive thoughts into their daily routine and foster self-affirmation. The main outcome measures were medication adherence (assessed with electronic pill monitors) and within-patient change in BP from baseline to 12 months. RESULTS: The baseline characteristics were similar in both groups: the mean BP was 137/82 mm Hg; 36% of the patients had diabetes; 11% had stroke; and 3% had chronic kidney disease. Based on the intention-to-treat principle, medication adherence at 12 months was higher in the PA group than in the PE group (42% vs 36%, respectively; P =.049). The within-group reduction in systolic BP (2.14 mm Hg vs 2.18 mm Hg; P = .98) and diastolic BP (-1.59 mm Hg vs -0.78 mm Hg; P = .45) for the PA group and PE group, respectively, was not significant. CONCLUSIONS: A PE intervention enhanced with PA led to significantly higher medication adherence compared with PE alone in hypertensive African Americans. Future studies should assess the cost-effectiveness of integrating such interventions into primary care. Trial Registration clinicaltrials.gov Identifier: NCT00227175.

HEEADSSS assessment for adolescents requiring anticoagulation therapy.

The care of adolescents with complex chronic illness needs to be developmentally appropriate to encourage adherence, knowledge retention and self-management. There has been an increase in the number of adolescents requiring long-term or lifelong anticoagulation therapy, related to either an underlying illness or idiopathic deep vein thrombosis. The burden of anticoagulant therapy, the associated risks and the required lifestyle changes can significantly impact on psychosocial well-being in the adolescent patient. This review identifies issues pertinent to adolescent anticoagulation management and discusses strategies to support optimal management. The HEEADSSS (Home, Education and employment, Eating, Activities with peers, Drugs, Sexual activity, Suicide and depression, and Safety) framework was used to provide guidance in undertaking a psychosocial assessment of adolescents requiring anticoagulant therapy in conjunction with a structured education strategy. Adolescent anticoagulant management strategies employing developmentally appropriate assessment and education will likely result in improved therapeutic outcomes for the patient and potentially facilitate transition to adult-based care.

Public perception on the role of community pharmacists in self-medication and self-care in Hong Kong.

BACKGROUND: The choices for self-medication in Hong Kong are much diversified, including western and Chinese medicines and food supplements. This study was to examine Hong Kong public knowledge, attitudes and behaviours regarding self-medication, self-care and the role of pharmacists in self-care. METHODS: A cross-sectional phone survey was conducted, inviting people aged 18 or older to complete a 37-item questionnaire that was developed based on the Thematic Household surveys in Hong Kong, findings of the health prorfessional focus group discussions on pharmacist-led patient self management and literature. Telephone numbers were randomly selected from residential phone directories. Trained interviewers invited eligible persons to participate using the "last birthday method". Associations of demographic characteristics with knowledge, attitudes and beliefs on self-medication, self-care and role of pharmacists, and spending on over-the-counter (OTC) products were analysed statistically. RESULTS: A total of 1, 560 phone calls were successfully made and 1, 104 respondents completed the survey which indicated a response rate of 70.8%. 63.1% had adequate knowledge on using OTC products. Those who had no formal education/had attended primary education (OR = 3.19, 95%CI 1.78-5.72; p < 0.001), had attended secondary education (OR = 1.50, 95%CI 1.03-2.19; p = 0.035), and aged ≥ 60 years (OR = 1.82, 95% CI 1.02-3.26; p = 0.042) were more likely to have inadequate knowledge on self-medication. People with chronic disease also tended to spend more than HKD100 on western (OR = 3.58, 95%CI 1.58-8.09; p = 0.002) and Chinese OTC products (OR = 2.94, 95%CI 1.08-7.95; p = 0.034). 94.6% believed that patients with chronic illnesses should self-manage their diseases. 68% agreed that they would consult a pharmacist before using OTC product but only 45% agreed that pharmacists could play a leading role in self-care. Most common reasons against pharmacist consultation on self-medication and self-care were uncertainty over the role of pharmacists and low acceptance level of pharmacists. CONCLUSIONS: The majority of respondents supported patients with chronic illness to self-manage their diseases but less than half agreed to use a pharmacist-led approach in self-care. The government should consider developing doctors-pharmacists partnership programs in the community, enhancing the role of pharmacists in primary care and providing education to patients to improve their awareness on the role of pharmacists in self-medication and self-care.

Misuse of prescribed stimulant medication for ADHD and associated patterns of substance use: preliminary analysis among college students.

OBJECTIVES: To explore the prevalence and characteristics associated with college students who misuse their prescribed stimulants for attention-deficit hyperactivity disorder (ADHD) and examine diversion and substance use behaviors as a function of misuse. METHODS: Cohort of 55 past-year prescribed stimulant users was identified from a random sample (n = 1738) at a large Midwestern research university following the self-administration of a web-based survey. An index was created to assess misuse of prescribed stimulants (i.e., Misuse Index). RESULTS: Of 55 college students who reported past-year use of prescribed stimulants for ADHD, 22 (40%) endorsed at least one item on the misuse index. The most frequently endorsed misuse items were used too much (36%), self-reported misuse (19%), and intentionally used with alcohol or other drugs (19%). Misusers of prescribed stimulant medication were more likely to report cigarette smoking (p = 0.022), binge drinking (p = 0.022), illicit use of cocaine (p = 0.032), and screen positive on the Drug Abuse Screening test (DAST-10) criteria (p = 0.002). The bivariate odds ratio for the DAST-10 findings was 8.4 (95% CI: 2.0-34.6). Diversion of prescribed stimulants was common (36%) and occurred more frequently among stimulant misusers (57%; p = 0.008). CONCLUSION: There is a strong relationship between misuse of prescribed stimulants for ADHD and substance use behaviors, as well as other deleterious behaviors such as diversion. These findings suggest the need for close screening, assessment, and therapeutic monitoring of medication use in the college population.

Assessment of self-injection experience in patients with rheumatoid arthritis: psychometric validation of the Self-Injection Assessment Questionnaire (SIAQ).

BACKGROUND: Subcutaneous self-injection of medication has benefits for the patient and healthcare system, but there are barriers such as dexterity problems and injection anxiety that can prevent self-injection being used effectively. An accurate method of evaluating patients' experiences with self-injection would enable assessment of their success in giving self-injections and the likelihood of them adhering to a self-injection regimen. The aim of this study was to develop a questionnaire to measure overall patient experience with subcutaneous self-injection (the Self-Injection Assessment Questionnaire [SIAQ]), and to investigate its psychometric properties. METHODS: The construct validity and reliability of the SIAQ were tested in patients with rheumatoid arthritis who volunteered to inject certolizumab pegol using a standard syringe during an open-label multinational extension trial of the long-term safety and efficacy of this drug. The SIAQ PRE module was self-completed before the first self-injection, and the POST module was self-completed following each of three fortnightly self-injections. RESULTS: Ninety-seven patients completed the SIAQ. All items correlated well with their respective domains in confirmatory factor analysis. As predicted, compared with other participants, patients with very low scores (less than 3 out of 10) in PRE causal domains (Feelings about injections and Self-confidence) were significantly less satisfied with their first self-injection, as were patients with a very low score in any POST causal domain (Self-confidence, Feelings about injections, Injection-site reactions and Ease of use), demonstrating known-groups validity. Causal domain scores generally correlated most strongly with the Satisfaction with self-injection domain, supporting convergent validity. The SIAQ demonstrated internal consistency and reproducibility; Cronbach's α and the test-retest coefficient were > 0.70 for all domains. Sensitivity and responsiveness were also shown, where measurable. Each language version showed structural validity. CONCLUSION: The SIAQ was demonstrated to be a valid, reliable tool in patients with rheumatoid arthritis.

Antibiotic use and knowledge in the community in Kalamoon, Syrian Arab Republic: a cross-sectional study.

Antibiotic misuse contributes to the growing problem of microbial resistance. To understand the current knowledge and practices regarding antibiotic use among Syrians, we conducted a cross-sectional study of 430 randomly selected adult residents of Kalamoon in the Syrian Arab Republic using a questionnaire. A high proportion (85%) had taken antibiotics in the past 4 weeks and 34% were not aware of the dangers of antibiotics. Of 365 participants, only 43% were prescribed the antibiotic by a physician to treat the condition, while 57% used an old prescription or took someone else's advice. Males, younger individuals, and those with low and medium income and lower educational status showed poorer practice and lower knowledge towards antibiotics. Educational efforts are needed to reduce patient demand for antibiotics.

Interference of postoperative pain on women's daily life after early discharge from cardiac surgery.

Women report more postoperative pain and problems performing domestic activities than men in the first month of recovery after cardiac surgery. The purpose of this article is to describe how women rate and describe pain interference with daily life after early discharge from cardiac surgery. A qualitative study was conducted in 2004-2005 with ten women recruited from a large Norwegian university hospital before discharge from their first elective cardiac surgery. Various aspects of the women's postoperative experiences were collected with qualitative interviews in the women's homes 8-14 days after discharge: a self-developed pain diary measuring pain intensity, types and amount of pain medication taken every day after returning home from hospital; and the Brief Pain Inventory-Short Form immediately before the interview. Qualitative content analysis was used to identify recurring themes from the interviews. Data from the questionnaires provided more nuances to the experiences of pain, pain management, and interference of postoperative pain. Postoperative pain interfered most with sleep, general activity, and the ability to perform housework during the first 2 weeks after discharge. Despite being advised at the hospital to take pain medication regularly, few women consumed the maximum amount of analgesics. Early hospital discharge after open cardiac surgery implies increased patient participation in pain management. Women undergoing this surgery need more information in hospital on why postoperative pain management beyond simple pain relief is important.

HIV-infected patients' adherence to highly active antiretroviral therapy: a phenomenological study.

Adherence to the treatment regimen is essential to the success of highly active antiretroviral therapy for patients who are infected with HIV. The evidence suggests that poor adherence to antiretroviral drug therapy is a major problem that has the potential to diminish effective viral suppression, promote viral resistance, and place patients at risk for hospitalization, opportunistic infections, and an increased risk of HIV transmission. The primary aim of this study was to understand patients' experiences regarding their adherence to antiretroviral drug therapy. Thus, 19 participants were recruited for in-depth interviews regarding their adherence to drug regimens. All the interviews were transcribed verbatim and analyzed by using Benner's phenomenological analysis approach. Four main themes emerged from the data: (i) choosing to live and the decision to start taking medications; (ii) strategies for adhering to the regimen and managing the side-effects; (iii) relationships with healthcare providers; and (iv) advantages of the medications as a motivator to continue one's adherence to the regimen. Studying and understanding the experiences of patients can provide new insights and strategies in order to enhance patients' adherence to highly active antiretroviral therapy.

Non-adherence in the hypertensive patient: can nursing play a role in assessing and improving compliance?

According to the Canadian Hypertension Society (Canadian Hypertension Education Program, 2008), hypertension remains a significant health problem that is projected to become a greater global burden in the next 20 years. Internationally, the estimated total number of adults with hypertension in 2000 was 972 million; 333 million in economically developed countries. Current trends suggest that the number of adults with hypertension will increase by about 60% to a total of 1.56 billion by 2025. Despite the availability of effective treatment, more than half of patients treated for hypertension drop out of care entirely within a year of diagnosis. Fifty per cent of patients who remain under medical supervision take only 80% of their prescribed medications. As a result, 75% of patients with a diagnosis of hypertension do not achieve optimum blood pressure control due to poor adherence to anti-hypertensive treatment. Nurses represent a formidable force in improving adherence and care outcomes by understanding the dynamics of compliance, and employing techniques in assessing and monitoring the problems of nonadherence. Nurses are well positioned to effectively use sustained strategies to improve adherence, thereby decreasing the global burden of hypertension. Using a case study approach, this author explores the dynamics of adherence and reviews techniques for assessing, monitoring, and improving compliance in hypertension therapy.

Behavioral economic assessment of price and cocaine consumption following self-administration histories that produce escalation of either final ratios or intake.

Various self-administration procedures are being developed to model specific aspects of the addiction process. For example, 'increased cocaine intake over time' has been modeled by providing long access (LgA) to cocaine during daily self-administration sessions under a fixed-ratio (FR1) reinforcement schedule. In addition, 'increased time and energy devoted to acquire cocaine' has been modeled by providing access to cocaine during daily self-administration sessions under a progressive-ratio (PR) schedule. To investigate the distinctiveness of these models, the behavioral economics variables of consumption and price were applied to cocaine self-administration data. To assess changes in consumption and price, cocaine self-administration was tested across a descending series of doses (0.237-0.001 mg per injection) under an FR1 reinforcement schedule to measure drug intake in the high dose range and thresholds in the low range. Cocaine consumption remained relatively stable across doses until a threshold was reached, at which maximal responding was observed. It was found that a history of LgA training produced an increase in cocaine consumption; whereas a history of PR training produced an increase in the maximal price (P(max)) expended for cocaine. Importantly, the concepts of consumption and price were found to be dissociable. That is, LgA training produced an increase in consumption but a decrease in P(max), whereas PR training produced an increase in P(max) without increasing consumption. These results suggest that distinct aspects of the addiction process can be parsed using self-administration models, thereby facilitating the investigation of specific neurobiological adaptations that occur through the addiction process.

User perceptions of in-home medication dispensing devices.

The purpose of this study was to characterize patient and clinician perceptions of programmable medication devices (dispensers and timers) being marketed to consumers to improve medication adherence. Using principles of usability testing, 33 volunteer staff and clinic patients rated seven devices. Raters scored devices on cueing and alarms, storage and dispensing, machine characteristics, potential to improve adherence, and cost. Medication dispensers ranked highest overall. However, even if the Department of Veterans Affairs paid for them, patient participants would be unlikely to use them. No significant differences were found across the devices in the perceived likelihood that the device would improve medication adherence. In this article, we provide a set of criteria for patients who might choose such a device and clinicians who may recommend these kinds of devices. More work is needed in the design and deployment of these devices if they are to be part of a successful medication adherence plan.

Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review.

AIM: This paper is a report of a literature review to identify research involving interventions to improve medication adherence in people with multiple co-existing chronic conditions. Title. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. Background. The importance of managing co-existing, chronic conditions in people of all ages is critical to prevent adverse health outcomes. DATA SOURCES: Databases, including Cumulative Index of Nursing and Allied Health Literature, Medline, PubMed and Web of Science were searched for the period January 1997-2007 using the combined keywords adherence, compliance, drug therapy, medication, clinical trial, randomized controlled trial, intervention, chronic condition, chronic disease, multiple morbidity and comorbidity. References of retrieved papers were also considered. METHODS: The inclusion criteria were: English language, oral medication adherence, self-administered medications, multiple prescribed medications for three or more chronic conditions and randomized controlled trials lasting at least 3 months. RESULTS: Studies examining medication adherence in people with multiple chronic conditions targeted people over 70 years of age, and were primarily focused on the management of polypharmacy and reducing healthcare costs. Adherence was measured using different tools and estimates of adherence, and interventions were predominantly delivered by pharmacists. The evidence for effective interventions to enhance medication adherence in multiple chronic conditions was weak, and psychosocial interventions were absent. CONCLUSION: Interventions that improve medication adherence for people with multiple chronic conditions are essential, given the increased prevalence of these conditions in people of all ages. Outcomes of improved adherence, such as disease control and quality of life, require investigation. Psychosocial interventions engaging people in medication self-management offer potential for improved patient outcomes in complex diseases.