RESUMO
BACKGROUND: Self-management of complex medication regimens for chronic illness is challenging for many older adults. OBJECTIVES: The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology. DESIGN: This study used a randomized controlled trial with three arms and longitudinal outcome measurement. SETTING: Older adults having difficulty in self-managing medications (n = 414) were recruited at discharge from three Medicare-certified home healthcare agencies in a Midwestern urban area. METHODS: All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (the Geriatric Depression Scale, Mini Mental Status Examination, Physical Performance Test, and SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline and at 3, 6, 9, and 12 months. RESULTS: After covariate and baseline health status adjustment, time × group interactions for the MD.2 and medplanner groups on health status outcomes were not significant. Time × group interactions were significant for the medplanner and control group comparisons. DISCUSSION: Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.
Assuntos
Idoso Fragilizado , Serviços de Saúde para Idosos/organização & administração , Nível de Saúde , Cuidados de Enfermagem/organização & administração , Autocuidado , Automedicação/enfermagem , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/tratamento farmacológico , Doença Crônica/enfermagem , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Avaliação de Programas e Projetos de SaúdeAssuntos
Estimulantes do Sistema Nervoso Central , Cognição/efeitos dos fármacos , Características Culturais , Nootrópicos , Uso Off-Label/ética , Automedicação/enfermagem , Valores Sociais , Transtornos Relacionados ao Uso de Substâncias/enfermagem , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/efeitos adversos , Comportamento de Escolha , Indústria Farmacêutica/ética , Ética Médica , Ética em Enfermagem , Humanos , Nootrópicos/administração & dosagem , Nootrópicos/efeitos adversos , Autoadministração/ética , Autoadministração/enfermagem , Automedicação/ética , Estados UnidosRESUMO
PURPOSE: To review the research on women's self-treatment of vaginal symptoms, describe factors influencing this phenomenon, identify evidence-based interventions, and suggest strategies for nurse practitioners (NPs) to promote safe and effective self-treatment decisions by women. DATA SOURCES: Research articles identified through Medline and CINAHL databases. CONCLUSIONS: The primary factors influencing women's decisions to self-treat vaginal symptoms were personal (attitudes, beliefs, values, knowledge and experience, and emotions) and environmental (culture, social networks and norms, media, and life context). IMPLICATIONS FOR PRACTICE: Women's self-diagnostic skills and decision making for self-treatment can be improved through education and support from NPs. The traditional office visit may not provide an opportunity to teach women appropriate self-care because many women do not access providers for advice or information. Different methods of providing information to large numbers of women through consumer publications need to be developed and evaluated.
Assuntos
Candidíase Vulvovaginal/prevenção & controle , Tomada de Decisões , Medicamentos sem Prescrição/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Automedicação/psicologia , Mulheres/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Comportamento de Ajuda , Humanos , Modelos Psicológicos , Profissionais de Enfermagem/organização & administração , Profissionais de Enfermagem/psicologia , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Avaliação em Enfermagem , Pesquisa Metodológica em Enfermagem , Atenção Primária à Saúde/organização & administração , Automedicação/métodos , Automedicação/enfermagem , Apoio Social , Inquéritos e Questionários , Mulheres/educaçãoRESUMO
This paper reviews some of the evidence in relation to herbal remedies, and considers both their efficacy and safety for pregnant and childbearing women. It concludes with some suggested guidelines for midwifery and obstetric practice.
Assuntos
Tocologia/normas , Educação de Pacientes como Assunto/métodos , Fitoterapia , Preparações de Plantas/uso terapêutico , Plantas Medicinais , Automedicação/enfermagem , Adulto , Feminino , Humanos , Papel do Profissional de Enfermagem , Preparações de Plantas/efeitos adversos , Gravidez , Cuidado Pré-Natal/métodosRESUMO
More than 100,000 over-the-counter (OTC) products are now sold in drugstores, convenience stores, gas stations, and supermarkets. In 1997, the OTC retail market was responsible for an estimated $20.6 billion in health care savings. This article discusses the methods by which drugs are approved for OTC use by the Food and Drug Administration. The article also reviews trends and issues related to self-care with OTC medications, including cost-effectiveness, managed care, advertising, and safety. The clinician should assume that OTC use is a common patient self-care behavior; therefore, information regarding the patient's OTC use should be collected during the history taking. Other implications of OTC use for primary care providers are proposed.