The barriers and facilitators people with diabetes from a nonEnglish speaking background experience when managing their medications: a qualitative study.

AIMS AND OBJECTIVES: To explore the barriers to and facilitators of effective medication management from the perspectives of people with diabetes from a nonEnglish speaking background, carers and health professionals. BACKGROUND: The barriers that people with diabetes experience managing their medications can adversely impact on health outcomes. People from nonEnglish speaking backgrounds are at risk of medication-related problems, although there is a paucity of research in this area. DESIGN: A qualitative research design using a purposive sampling approach. METHODS: People with type 1 or type 2 diabetes from a nonEnglish speaking background, their carers, and health professionals who assisted these people and their carers to manage their medications were recruited from the diabetes outpatient clinic at an adult teaching public hospital in Melbourne, Australia. Participants were interviewed using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim and analysed using a thematic framework method. RESULTS: Eleven people with diabetes, 10 carers and 10 health professionals were interviewed, and four key issues were identified: diabetes knowledge, diabetes impact, medication knowledge and medication management. The cost of medications, language barriers that hinder communication, forgetfulness, and poor knowledge and understanding emerged as barriers to effective medication management. Facilitators included the use of dose administration aids to manage medications, but current medication lists were not used. CONCLUSIONS: Findings revealed people with diabetes experienced a multitude of barriers when managing their medications, and, despite the problems people experienced, there appeared to be poor use of support aids to assist people to effectively manage their medications. RELEVANCE TO CLINICAL PRACTICE: The findings can be used to develop strategies aiming at improving how people from nonEnglish speaking backgrounds manage their medicines.

Development and evaluation of a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence.

UNLABELLED: Abstract Aims: To develop and evaluate a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence. METHODS: A retrospective audit of attendances at a diabetes outpatient clinic at a public, teaching hospital over a 16-month period was conducted. Logistic regression was undertaken to examine risk factors associated with medication problems relating to hypoglycaemia and medication non-adherence and the most predictive set of factors comprise the Diabetes Medication Risk Screening Tool. Evaluating the tool involved assessing sensitivity and specificity, positive and negative predictive values, cut-off scores, inter-rater reliability, and content validity. RESULTS: The Diabetes Medication Risk Screening Tool comprises seven predictive factors: Age, living alone, English language, mental and behavioural problems, comorbidity index score, number of medications prescribed, and number of high-risk medications prescribed. The tool has 76.5% sensitivity, 59.5% specificity, and has a 65.1% positive predictive value, and a 71.8% negative predictive value. A score of 27 or more out of 62 was associated with high-risk of a medication problem. The inter-rater reliability of the tool was high (κ = 0.79, 95% CI 0.75-0.84) and the content validity index was 99.4%. CONCLUSION: The Diabetes Medication Risk Screening Tool has good psychometric properties and can proactively identify people with diabetes at greatest risk of medication problems relating to hypoglycaemia and medication non-adherence.

British Columbia's COVID-19 surveys on population experiences, action, and knowledge (SPEAK): methods and key findings from two large cross-sectional online surveys.

OBJECTIVES: To describe the methodology and key findings of British Columbia's (BC) COVID-19 SPEAK surveys, developed to understand the experiences, knowledge, and impact of the COVID-19 pandemic on British Columbians. METHODS: Two province-wide, cross-sectional, web-based population health surveys were conducted one year apart (May 2020 and April/May 2021). Questions were drawn from validated sources grounded within the social determinants of health to assess COVID-19 testing and prevention; mental and physical health; risk and protective factors; and healthcare, social, and economic impacts during the pandemic. Quota-based non-probability sampling by geography was applied to recruit a representative sample aged 18 years and older. Recruitment included strategic outreach and longitudinal follow-up of a subgroup of respondents from round one to round two. Post-collection weighting using Census data by age, sex, education, ethnicity, and geography was conducted. RESULTS: Participants included 394,382 and 188,561 British Columbians for the first and second surveys, respectively, including a longitudinal subgroup of 141,728. Key findings showed that societal impacts, both early in the pandemic and one year later, were inequitably distributed. Families with children, young adults, and people from lower socioeconomic backgrounds have been most impacted. Significant negative impacts on mental health and stress and a deterioration in protective resiliency factors were found. CONCLUSION: These population health surveys consisting of two large cross-sectional samples provided valuable insight into the impacts and experiences of British Columbians early in the pandemic and one year later. Timely, actionable data informed several high-priority public health areas during BC's response to the COVID-19 pandemic.

RéSUMé: OBJECTIFS: Décrire la méthode et les principaux constats des enquêtes SPEAK de la Colombie-Britannique sur la COVID-19, élaborées pour comprendre l'expérience des Britanno-Colombiens durant la pandémie, ainsi que leurs connaissances de la pandémie et les effets qu'elle a eus sur eux. MéTHODE: Deux enquêtes en ligne transversales sur la santé de la population ont été menées dans toute la province à un an d'intervalle (en mai 2020 et en avril-mai 2021). Les questions, qui provenaient de sources validées ancrées dans les déterminants sociaux de la santé, ont servi à évaluer le dépistage et la prévention de la COVID-19; la santé mentale et physique; les facteurs de risque et de protection; et les effets sociaux, économiques et sur les soins de santé ressentis durant la pandémie. Un échantillonnage contingentaire non probabiliste par lieu géographique a été appliqué pour recruter un échantillon représentatif de personnes de 18 ans et plus. Le recrutement a inclus une prise de contact stratégique et un suivi longitudinal auprès d'un sous-groupe de répondants entre les cycles un et deux. Après la collecte, les données ont été pondérées selon l'âge, le sexe, le niveau d'instruction, l'ethnicité et le lieu géographique à l'aide des données du Recensement. RéSULTATS: Les participants étaient 394 382 Britanno-Colombiens au cours du premier cycle de l'enquête et 188 561 au deuxième cycle, dont un sous-groupe longitudinal de 141 728 personnes. Selon les principaux constats, la répartition des effets sociétaux, tant au début de la pandémie qu'un an plus tard, a été inéquitable. Les familles avec enfants, les jeunes adultes et les personnes de statut socioéconomique plus faible ont été les plus touchés. D'importants effets nuisibles sur la santé mentale et le stress ont été constatés, ainsi qu'une détérioration des facteurs de résilience protecteurs. CONCLUSION: Ces enquêtes sur la santé de la population comprenant deux grands échantillons transversaux ont jeté un éclairage précieux sur les effets subis et les expériences vécues par les Britanno-Colombiens au début de la pandémie et un an plus tard. Ces données opportunes et exploitables ont éclairé plusieurs domaines hautement prioritaires de la santé publique durant la riposte de la Colombie-Britannique à la pandémie de COVID-19.

Managing complex medication regimens: perspectives of consumers with osteoarthritis and healthcare professionals.

BACKGROUND: Managing medications is complex, particularly for consumers with multiple coexisting conditions for whom benefits and adverse effects are unpredictable and health priorities may be variable. OBJECTIVE: To investigate perceptions of and experiences with managing drug regimens from the perspectives of consumers with osteoarthritis and coexisting chronic conditions and of healthcare professionals from diverse backgrounds. METHODS: Using an exploratory research design, focus groups were formed with 34 consumers and 19 healthcare professionals. Individual interviews were undertaken with 3 community medical practitioners. RESULTS: Consumers' management of medications was explored in terms of 3 themes: administration of medications, provision of information, and the perceived role of healthcare professionals. In general, consumers lacked understanding regarding the reason that they were prescribed certain medications. Since all consumer participants had at least 2 chronic conditions, they were taking many drugs to relieve undesirable symptoms. Some consumers were unable to achieve improved pain relief and were reluctant to take analgesics prescribed on an as-needed basis. Healthcare professionals discussed the importance of using non-pharmacologic measures to improve symptoms; however, consumers stated that physicians encourage them to continue using medications, often for prolonged periods, even when these agents are not helpful. CONCLUSIONS: Consumers were dissatisfied about the complexity of their medication regimens and also lacked understanding as to how to take their drugs effectively. Dedicated time should be devoted during medical consultations to facilitate verbal exchange of information about medications. Pharmacists must communicate regularly with physicians about consumers' medication needs to help preempt any problems that may arise. Instructions need to be revised through collaboration between physicians and pharmacists so that "as needed" directions provide more explicit advice about when and how to use such drugs. Future research, using large, generalizable samples, should examine trends related to consumers' experiences of symptomatic relief from chronic conditions and their understandings about medications.

Development and evaluation of a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence.

Abstract Aims: To develop and evaluate a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence. Methods: A retrospective audit of attendances at a diabetes outpatient clinic at a public, teaching hospital over a 16-month period was conducted. Logistic regression was undertaken to examine risk factors associated with medication problems relating to hypoglycaemia and medication non-adherence and the most predictive set of factors comprise the Diabetes Medication Risk Screening Tool. Evaluating the tool involved assessing sensitivity and specificity, positive and negative predictive values, cut-off scores, inter-rater reliability, and content validity. Results: The Diabetes Medication Risk Screening Tool comprises seven predictive factors: age, living alone, English language, mental and behavioural problems, comorbidity index score, number of medications prescribed, and number of high-risk medications prescribed. The tool has 76.5% sensitivity, 59.5% specificity, and has a 65.1% positive predictive value, and a 71.8% negative predictive value. A score of 27 or more out of 62 was associated with high-risk of a medication problem. The inter-rater reliability of the tool was high (κ = 0.79, 95% CI 0.75 - 0.84) and the content validity index was 99.4%. Conclusion: The Diabetes Medication Risk Screening Tool has good psychometric properties and can proactively identify people with diabetes at greatest risk of medication problems relating to hypoglycaemia and medication non-adherence.

Medication-related problems occurring in people with diabetes during an admission to an adult teaching hospital: a retrospective cohort study.

AIMS: To examine the characteristics of medication-related problems occurring in people with diabetes admitted to hospital and to identify risk factors for medication-related problems. METHODS: A retrospective cohort study of medication-related problems occurring in patients admitted to an adult, inner-city Australian teaching hospital was conducted over two-years. The risk factors associated with medication-related problems were identified using random effect logistic regression. RESULTS: There were 9530 admissions of people with diabetes involving 5205 individuals over a two-year period. Medication-related problems were associated with 686 (7.2%) admissions involving 571 individuals (11.0%). The most common medication-related problems were medication errors (64.1%) associated with hypoglycaemia and unintentional overdose. Five factors were significantly associated with medication-related problems: female gender [odds ratio (OR) 1.30, 95% confidence intervals (CI) 1.11-1.52], age of 18-50 years (OR 2.32, CI 1.85-2.91), single marital status (OR 1.46, CI 1.24-1.74), mental and behavioural problems (OR 1.74, 1.43-2.11), and a comorbidity index score of at least one (OR 1.35-1.67). CONCLUSIONS: Five significant risk factors were associated with medication-related problems in people with diabetes admitted to hospital. These risks need to be considered when developing care plans and interventions to prevent medication-related problems for individuals with diabetes.