Use of medication lists: A population-based approach to increase the prevalence of medication lists within a region in Germany. A pre-post study
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OBJECTIVES: Patient-centered medication lists are a useful documentation method to support safe drug treatment, but they are still inconsistently used and are of varying quality. The aim of this study was to evaluate the effects of an information campaign on the prevalence and use of medication lists. MATERIAL AND METHODS: We launched a population-based, low-threshold information campaign within a large region in Germany in order to sensitize the population to the use of medication lists. A survey was sent out at baseline and after 18 months to 5,340 citizens aged ≥ 65 years, covering ~ 4% of the region's population. RESULTS: The response rate was 49.4% (N = 2,640) at baseline and 45.4% (N = 2,427) at follow-up. Sociodemographic details of respondents were similar at both time-points as was the possession rate of a medication list among participants with regular medicine intake (51.6%, N = 1,181/2,288 vs. 51.4%, N = 1,082/2,107). Combining baseline and follow-up data, respondents indicated that their general practitioner was involved in issuing the list most often (N = 1,668/2,263, 73.7%), however, in 195 cases (8.6%), respondents indicated being solely responsible for the list. The majority (90.8%, N = 2,055/2,263) indicated having their list in use for longer than 1 year, but for only half of those, the list was updated within the last year. After the intervention, 6% of the respondents indicated being familiar with the campaign those being more likely to possess a list (69.7% N = 83/119 vs. 50.2% N = 999/1,988). CONCLUSION: The campaign did not change overall possession rate, but respondents who were familiar with the campaign were more likely to possess such a list.

Developing a Shared Patient-Centered, Web-Based Medication Platform for Type 2 Diabetes Patients and Their Health Care Providers: Qualitative Study on User Requirements.

BACKGROUND: Information technology tools such as shared patient-centered, Web-based medication platforms hold promise to support safe medication use by strengthening patient participation, enhancing patients' knowledge, helping patients to improve self-management of their medications, and improving communication on medications among patients and health care professionals (HCPs). However, the uptake of such platforms remains a challenge also due to inadequate user involvement in the development process. Employing a user-centered design (UCD) approach is therefore critical to ensure that user' adoption is optimal. OBJECTIVE: The purpose of this study was to identify what patients with type 2 diabetes mellitus (T2DM) and their HCPs regard necessary requirements in terms of functionalities and usability of a shared patient-centered, Web-based medication platform for patients with T2DM. METHODS: This qualitative study included focus groups with purposeful samples of patients with T2DM (n=25), general practitioners (n=13), and health care assistants (n=10) recruited from regional health care settings in southwestern Germany. In total, 8 semistructured focus groups were conducted. Sessions were audio- and video-recorded, transcribed verbatim, and subjected to a computer-aided qualitative content analysis. RESULTS: Appropriate security and access methods, supported data entry, printing, and sending information electronically, and tracking medication history were perceived as the essential functionalities. Although patients wanted automatic interaction checks and safety alerts, HCPs on the contrary were concerned that unspecific alerts confuse patients and lead to nonadherence. Furthermore, HCPs were opposed to patients' ability to withhold or restrict access to information in the platform. To optimize usability, there was consensus among participants to display information in a structured, chronological format, to provide information in lay language, to use visual aids and customize information content, and align the platform to users' workflow. CONCLUSIONS: By employing a UCD, this study provides insight into the desired functionalities and usability of patients and HCPs regarding a shared patient-centered, Web-based medication platform, thus increasing the likelihood to achieve a functional and useful system. Substantial and ongoing engagement by all intended user groups is necessary to reconcile differences in requirements of patients and HCPs, especially regarding medication safety alerts and access control. Moreover, effective training of patients and HCPs on medication self-management (support) and optimal use of the tool will be a prerequisite to unfold the platform's full potential.

Understanding Challenges, Strategies, and the Role of Support Networks in Medication Self-management Among Patients With Type 2 Diabetes.

Purpose The purpose of this qualitative study was to investigate the challenges and strategies of patients with type 2 diabetes mellitus (T2DM) regarding daily management of their medication regimen focusing on the role of their support networks. Methods A purposeful sample of 25 patients with T2DM was recruited from local self-help groups, general practitioner practices, and a university hospital in southwestern Germany. Four semi-structured focus groups were conducted to identify the challenges patients experienced, the strategies they used, and their collaboration with support networks to assist them in self-managing their medication regimen. Sessions were audio- and video-recorded, fully transcribed, and subjected to computer-aided qualitative content analysis, guided by the Self- and Family Management Framework (SFMF). Results Patients with T2DM experienced numerous challenges affecting medication self-management arising from their personal situation, health status and resources, characteristics of their regimen, and how health care is currently organized. Patients' self-initiated strategies included activating health care, community, social, and online resources; taking ownership of medication-related needs; and integrating medication-taking into daily life. Patients drew on self-help groups, family, and friends to discuss concerns regarding medication safety and receive experience-based information and advice for navigating within the health care system as well as practical hands-on support with daily medication self-management. Conclusions Understanding the challenges and building on strategies patients with T2DM devised help diabetes educators to better address patients' needs and priorities and guide patient-centered interventions to support patients' self-management activities. Community and social support networks operating in patients' lives need to be engaged in the self-management support.

Development and Psychometric Evaluation of an Instrument to Assess Cross-Cultural Competence of Healthcare Professionals (CCCHP).

BACKGROUND: Cultural competence of healthcare professionals (HCPs) is recognized as a strategy to reduce cultural disparities in healthcare. However, standardised, valid and reliable instruments to assess HCPs' cultural competence are notably lacking. The present study aims to 1) identify the core components of cultural competence from a healthcare perspective, 2) to develop a self-report instrument to assess cultural competence of HCPs and 3) to evaluate the psychometric properties of the new instrument. METHODS: The conceptual model and initial item pool, which were applied to the cross-cultural competence instrument for the healthcare profession (CCCHP), were derived from an expert survey (n = 23), interviews with HCPs (n = 12), and a broad narrative review on assessment instruments and conceptual models of cultural competence. The item pool was reduced systematically, which resulted in a 59-item instrument. A sample of 336 psychologists, in advanced psychotherapeutic training, and 409 medical students participated, in order to evaluate the construct validity and reliability of the CCCHP. RESULTS: Construct validity was supported by principal component analysis, which led to a 32-item six-component solution with 50% of the total variance explained. The different dimensions of HCPs' cultural competence are: Cross-Cultural Motivation/Curiosity, Cross-Cultural Attitudes, Cross-Cultural Skills, Cross-Cultural Knowledge/Awareness and Cross-Cultural Emotions/Empathy. For the total instrument, the internal consistency reliability was .87 and the dimension's Cronbach's α ranged from .54 to .84. The discriminating power of the CCCHP was indicated by statistically significant mean differences in CCCHP subscale scores between predefined groups. CONCLUSIONS: The 32-item CCCHP exhibits acceptable psychometric properties, particularly content and construct validity to examine HCPs' cultural competence. The CCCHP with its five dimensions offers a comprehensive assessment of HCPs' cultural competence, and has the ability to distinguish between groups that are expected to differ in cultural competence. This instrument can foster professional development through systematic self-assessment and thus contributes to improve the quality of patient care.

[Outpatient smoking cessation: a report on 3,260 cases]. / Ambulante Raucherentwöhnung: Ein Bericht über 3.260 Fälle.

A total number of 3,260 smokers were included into a 4-week smoking cessation programme of the Regional Sickness Fund of Lower Austria in which participants were coached by health care professionals. The smoking status of each subject, as determined by measuring expired CO, resulted in a success rate of 70.6% (non-smokers and persons with smoking reduction). Success rates were emerged to increase with decreasing level of baseline nicotine dependence (determined with the Fagerström Test for Nicotine Dependence = FTND). Even in the group of heavily dependent smokers, however, (FTND Score 8-10) a non-smoking rate of 33.9% was achieved. Moreover, an additional 27.6% of the persons of this group had reduced the number of cigarettes smoked daily. The positive effect of nicotine replacement therapy (NRT) could be demonstrated by the high rate of 69.3% non-smokers in this group of participants, which was clearly higher than in participants who did not use NRT.