Evaluation of an intervention to improve the safety of medication therapy via HIT-supported interprofessional cooperation in long-term care - a mixed method study.

BACKGROUND: In order to ensure the provision of appropriate and safe medication therapy in long-term care, close interprofessional cooperation and high levels of expertise are required. Online digital documentation and communication technology facilitate this process. The aim of the present study (sub-study 2 of the SiMbA-Study) was to evaluate a three-part health information technology (HIT) driven intervention on medication therapy safety in Austrian nursing homes (NHs) regarding its usefulness, practicability and implementation in routine care. METHODS: A concurrent embedded mixed-methods design was conducted to evaluate the intervention. Data was collected via expert interviews, focus group discussions and quantitative survey of general practitioners, nurses, and pharmacists in 3 NHs. Usefulness and effectiveness of the intervention were investigated through summative evaluation. Formative evaluation was utilized to gain insights regarding features and factors of the implementation process necessary to a successful integration in routine care. RESULTS: The sample comprised general practitioners, pharmacists, and nurses. 23 participants were interviewed, of which 17 participated in the focus group discussions and completed the quantitative Survey. All components of the intervention were deemed to be useful and effective. Effort and benefit of using health information technology were well balanced. Implementation success was mainly attributed to socio-normative factors. CONCLUSIONS: The implementation of HIT-based measures can be effective but is prone to various pitfalls that are highlighted in the study. A critical challenge for successful implementation is the combination of both, ensuring its prerequisites, while anticipating new problems that arise from HIT-integration on the one hand and changes in interprofessional cooperation on the other. TRIAL REGISTRATION: DRKS Data Management, ID: DRKS00012246 . Registered 16.05.2017 - Retrospectively registered.

Piloting of the virtual telecare technology 'Addison Care' to promote self-management in persons with chronic diseases in a community setting: protocol for a mixed-methods user experience, user engagement and usability pilot study.

INTRODUCTION: Chronic diseases in older adults are one of the major epidemiological challenges of current times and leading cause of disability, poor quality of life, high healthcare costs and death. Self-management of chronic diseases is essential to improve health behaviours and health outcomes. Technology-assisted interventions have shown to improve self-management of chronic diseases. Virtual avatars can be a key factor for the acceptance of these technologies. Addison Care is a home-based telecare solution equipped with a virtual avatar named Addison, connecting older persons with their caregivers via an easy-to-use technology. A central advantage is that Addison Care provides access to self-management support for an up-to-now highly under-represented population-older persons with chronic disease(s), which enables them to profit from e-health in everyday life. METHODS AND ANALYSIS: A pragmatic, non-randomised, one-arm pilot study applying an embedded mixed-methods approach will be conducted to examine user experience, usability and user engagement of the virtual avatar Addison. Participants will be at least 65 years and will be recruited between September 2022 and November 2022 from hospitals during the discharge process to home care. Standardised instruments, such as the User Experience Questionnaire, System Usability Scale, Instrumental Activities of Daily Living scale, Short-Form-8-Questionnaire, UCLA Loneliness Scale, Geriatric Depression Scale, Stendal Adherence with Medication Score and Self-Efficacy for Managing Chronic Diseases Scale, as well as survey-based assessments, semistructured interviews and think-aloud protocols, will be used. The study seeks to enrol 20 patients that meet the criteria. ETHICS AND DISSEMINATION: The study protocol has been approved by the ethic committee of the German Society for Nursing Science (21-037). The results are intended to be published in peer-reviewed journals and disseminated through conference papers. TRIAL REGISTRATION NUMBER: DRKS00025992.

Improving medication appropriateness in nursing homes via structured interprofessional medication-review supported by health information technology: a non-randomized controlled study.

BACKGROUND: In nursing home residents (NHRs), polypharmacy is widespread, accompanied by elevated risks of medication related complications. Managing medication in NHRs is a priority, but prone to several challenges, including interprofessional cooperation. Against this background, we implemented and tested an interprofessional intervention aimed to improve medication appropriateness for NHRs. METHODS: A non-randomized controlled study (SiMbA; "Sicherheit der Medikamentherapie bei AltenheimbewohnerInnen", Safety of medication therapy in NHRs) was conducted in six nursing homes in Austria (2016-2018). Educational training, introduction of tailored health information technology (HIT) and a therapy check process were combined in an intervention aimed at healthcare professionals. Medication appropriateness was assessed using the Medication Appropriateness Index (MAI). Data was collected before (t0), during (t1, month 12) and after (t2, month 18) intervention via self-administered assessments and electronic health records. RESULTS: We included 6 NHs, 17 GPs (52.94% female) and 240 NHRs (68.75% female; mean age 85.0). Data of 159 NHRs could be included in the analysis. Mean MAI-change was - 3.35 (IG) vs. - 1.45 (CG). In the subgroup of NHRs with mean MAI ≥23, MAI-change was - 10.31 (IG) vs. -3.52 (CG). The intervention was a significant predictor of improvement in MAI when controlled for in a multivariable regression model. CONCLUSIONS: Improvement of medication appropriateness was clearest in residents with inappropriate baseline MAI-scores. This improvement was independent of variances in certain covariates between the intervention and the control group. We conclude that our intervention is a feasible approach to improve NHRs' medication appropriateness. TRIAL REGISTRATION: DRKS Data Management, ID: DRKS00012246 . Registered 16.05.2017 - Retrospectively registered.

Improving medication appropriateness in nursing home residents by enhancing interprofessional cooperation: A study protocol.

Polypharmacy in elderly people is an increasing challenge for health professionals. Drug-Drug interactions, dosing or administration errors can cause preventable incidents and hospitalizations. Due to chronic illness and multi-morbidity, older people are considered as a particularly vulnerable group of patients. Furthermore, it is well known that communication between health professionals is often insufficient. The aim of this study is to improve the appropriateness of medication of nursing home residents by establishing a long-term structured medication review process and to enhance the interprofessional communication between general practitioners (GPs), nurses and pharmacists. GPs review and adapt medication of residents, nurses perform structured monitoring of residents for drug-related symptoms. Pharmacists check the appropriateness of prescribed therapy by performing a medication analysis. For this purpose, a special electronic platform (SiM-Pl) is developed to extend the original health documentation system with additional tools. SiM-Pl enables participants to gain access to relevant information regardless of time and place and shall facilitate health documentation and exchange of information. All involved health professionals receive a topic-related, specific education. The study is designed as a non-randomized, controlled trial. Health-related benefits and improved quality of life are expected for the participating residents.

[HIV testing of the general population: international recommendations and actual risks for HIV infections in health occupations]. / HIV-Testung an der Allgemeinbevölkerung: Internationale Empfehlungen und reale Risken für HIV-Infektionen für Gesundheitsberufe.

Austria has the highest HIV-test rate per 1,000 inhabitants in the European Union. This may be related to beliefs held by the health care personnel that knowledge of the HIV-serostatus of a patient (e.g. via preoperative routine testing) serves as a protective measure against occupational HIV-infection for themselves. International guidelines recommend universal screening for HIV in health-care settings only when the undiagnosed prevalence of HIV is > 0.1 %, or the diagnosed prevalence is > 0.2 %. HIV poses a small, but real risk to health-care personnel. Worldwide, 106 cases of occupational HIV-infection have been documented (since the beginning of counting in the 1990s until 2002): in Austria there have been 4 cases of occupational HIV-infection in 15 years of documentation. There is no convincing evidence that knowledge of the serostatus of a patient leads to changes in the behaviour of health-care workers. For low-prevalence countries, such as Austria, a rather focused testing-strategy is recommended.