Using a learning health system to understand the mismatch between medicines supply and actual medicines use among adults with cystic fibrosis.

BACKGROUND: Studies in separate cohorts suggest possible discrepancies between inhaled medicines supplied (median 50-60%) and medicines used (median 30-40%). We performed the first study that directly compares CF medicine supply against use to identify the cost of excess medicines supply. METHODS: This cross-sectional study included participants from 12 UK adult centres with ≥1 year of continuous adherence data from data-logging nebulisers. Medicine supply was measured as medication possession ratio (MPR) for a 1-year period from the first suitable supply date. Medicine use was measured as electronic data capture (EDC) adherence over the same period. The cost of excess medicines was calculated as whole excess box(es) supplied after accounting for the discrepancy between EDC adherence and MPR with 20% contingency. RESULTS: Among 275 participants, 133 (48.4%) were females and mean age was 30 years (95% CI 29-31 years). Median EDC adherence was 57% (IQR 23-86%), median MPR was 74% (IQR 46-96%) and the discrepancy between measures was median 14% (IQR 2-29%). Even with 20% contingency, mean potential cost of excess medicines was £1,124 (95% CI £855-1,394), ranging from £183 (95% CI £29-338) for EDC adherence ≥80% to £2,017 (95% CI £1,507-2,526) for EDC adherence <50%. CONCLUSIONS: This study provides a conservative estimate of excess inhaled medicines supply cost among adults with CF in the UK. The excess supply cost was highest among those with lowest EDC adherence, highlighting the importance of adherence support and supplying medicine according to actual use. MPR provides information about medicine supply but over-estimates actual medicine use.

The effects of structural and psychological empowerment on perceived respect in acute care nurses.

BACKGROUND: The recruitment and retention crisis has catalyzed interest in workplace empowerment for nurses. Many nurses feel that they do not receive the respect they deserve in hospital settings; however, there are few systematic studies of respect for nurses. OBJECTIVE: The purpose of this study was to examine the relationships between structural and psychological empowerment and their effects on hospital nurses' perceptions of respect. METHOD: A secondary analysis was conducted of data from a larger study of 500 randomly selected hospital staff nurses. A predictive, non-experimental survey design was used to test a hypothesized model derived from Kanter's Work Empowerment Theory. RESULTS: Both structural and psychological variables were significant independent predictors of respect, although structural empowerment had considerably greater explanatory power. CONCLUSIONS: The findings support Kanter's theory. Hospital nurses who perceive themselves to be structurally and psychologically empowered are more likely to feel respected in the workplace. IMPLICATIONS FOR NURSING MANAGEMENT: Changing workplace structures is within the mandate of nurse managers in their roles as advocates for and facilitators of high-quality care. Nurse managers have the influence and resources to facilitate empowering work conditions that can increase nurses' feelings of being respected. In addition, promoting collaborative inter-professional and intra-professional relationships and assuring continuous support to nurses are particularly important strategies for building respect.