Psychometric properties of the Chinese version of the Problem Areas in Diabetes scale (SG-PAID-C) among high-risk polypharmacy patients with uncontrolled type 2 diabetes in Singapore.

AIMS/INTRODUCTION: Undetected diabetes distress is a cause of concern. However, the lack of a validated questionnaire is a barrier to screening for diabetes distress. The aim of the present study was to examine the validity and reliability of the Chinese version of the Problem Areas in Diabetes scale (SG-PAID-C), and its association with sociodemographic and clinical parameters in patients with type 2 diabetes. MATERIALS AND METHODS: This cross-sectional study was carried out in four outpatient healthcare institutions in Singapore. Chinese-speaking patients with uncontrolled type 2 diabetes, polypharmacy, and multiple comorbidities were administered the SG-PAID-C and European Quality of Life-5 Dimensions questionnaires as quality of life measures. The factorial construct, convergent validity and internal consistency of SG-PAID-C were evaluated. RESULTS: The exploratory factor analysis resulted in a three-factor structure of SG-PAID-C with subscales on emotional- and management-related problem (11 items), ability to cope with diabetes problem (3 items) and support-related problem (2 items). The findings also showed good model fit in the confirmatory factor analysis, and provided support for the construct and convergent validity of SG-PAID-C. Overall, the internal consistency of SG-PAID-C was good (Cronbach's alpha = 0.900). Sex and duration of diabetes were positively associated with the 16-item SG-PAID-C, whereas age and type of antidiabetic agents were inversely associated with the 16-item SG-PAID-C. CONCLUSIONS: The 16-item SG-PAID-C is a valid and reliable instrument for use among patients with uncontrolled type 2 diabetes in Singapore. Future studies on its clinical utility should be carried out.

A Systematic Review of Health Economic Evaluation Studies Using the Patient's Perspective.

BACKGROUND: Patient-centered care has become increasingly important and relevant for informed health care decision making. OBJECTIVE: Our study aimed to perform a systematic review of health economic evaluation studies from the patient's perspective. METHODS: PubMed, EMBASE, and Cochrane Central databases were searched through May 2014 for cost-effectiveness, cost-utility, and cost-benefit studies using the patient's perspective in their analysis. The reporting quality of the studies was evaluated on the basis of Consolidated Health Economic Evaluation Reporting Standards. RESULTS: We identified 30 health economic evaluations using the patient's perspective, of which 7 were conducted in the United States, 9 in Europe, and 14 in Asian or other countries. Seventeen of 23 health conditions evaluated were chronic in nature. Among 12 studies that justified the use of the patient's perspective, patient's financial burden associated with medical treatment was the most commonly cited rationale. A total of 29, 17, and 15 studies examined direct medical, direct nonmedical, and indirect costs, respectively. Seventeen studies also included societal, governmental or payer's, and/or provider's perspective(s) in their analyses. Based on Consolidated Health Economic Evaluation Reporting Standards, more than 20% of the reporting items in these studies were either partially satisfied or not satisfied. CONCLUSIONS: There is a paucity of health economic evaluations conducted from the patient's perspective in the literature. For those studies using the patient's perspective, the true patient costs were not fully explored and study reporting quality was not optimal. With the increasing focus on patient-centered outcomes in health policy research, more frequent use of the patient's perspective in economic studies should be advocated.

Putting words into action: A simple focused education improves prescription label comprehension and functional health literacy.

OBJECTIVES: To assess the effectiveness of an educational intervention on prescription (Rx) label comprehension and functional health literacy (FHL) in older adults. Outcomes were compared between current and redesigned Rx labels. Additional objectives were to examine the correlation between 2 outcome measures and to determine the characterizing variables that are predictors for the outcome measures. SETTING: Southern California, January 2013 to March 2015. PRACTICE DESCRIPTION: Older adults (>55 y) taking 2 or more Rx medications daily were recruited at senior and community centers by a trained data collection team. PRACTICE INNOVATION: The validated Modified LaRue Tool (MLT) tested Rx label comprehension before and after a short, focused educational intervention and correlated it with FHL. INTERVENTIONS: A simple one-on-one education provided by student pharmacists that was focused on critical elements of an Rx label. EVALUATION: Short Test of Functional Health Literacy in Adults (STOFHLA) and MLT scores of all current and redesigned label participants at baseline and follow-up. RESULTS: Participants using redesigned Rx labels (n = 90) showed significantly higher MLT scores than with current Rx labels (n = 28) both before (23.0 ± 2.3 vs. 21.0 ± 2.4; P <0.001) and after educational intervention (23.8 ± 1.7 vs. 22.1 ± 3.1; P <0.001). With the use of analysis of covariance, intervention participants using redesigned label (n = 48) showed significant improvement in both MLT (23.1 ± 2.0 to 24.3 ± 1.0; P <0.001) and STOFHLA (29.8 ± 7.5 to 31.5 ± 5.7; P = 0.011) scores, whereas intervention participants using current Rx label (n = 16) did not show significant improvement in either MLT (P = 0.530) or STOFHLA (P = 0.215) scores. Effect size of intervention (redesigned label) was 0.77, indicating practical significance. MLT and STOFHLA scores were significantly correlated with each other, and age and education level were common significant predictors for both outcomes. CONCLUSION: Older adults using redesigned Rx labels showed improved Rx label comprehension and FHL after educational intervention, as well as higher comprehension compared with those using current Rx labels. Use of a redesigned Rx label and a simple educational intervention should be encouraged to improve Rx label comprehension and FHL.

Prediction of pharmacist intention to provide medication disposal education using the theory of planned behaviour.

RATIONALE, AIMS AND OBJECTIVES: Lack of familiarity with proper medication disposal options among patients can lead to personal and environmental safety concerns, besides signalling non-adherence. Given that community pharmacists are in a position to educate patients, this study assessed community pharmacists' knowledge on medication disposal and examined the utility of the theory of planned behaviour (TPB) in predicting their intention to provide medication disposal education to their patients. METHODS: A cross-sectional, self-administered survey was distributed to community pharmacists in California. Descriptive statistics were reported for all survey items. Cronbach's alpha and Pearson correlation were used to determine the reliability for the four TPB constructs (attitude, subjective norm, perceived behavioural control and intention). Multiple linear regressions were performed to predict intent using the other three TPB constructs. RESULTS: Pharmacists (n = 142) demonstrated a positive intention to provide education (mean = 5.91 ± 1.22; range: 2 to 8), but most (67.9%) provided this information once a month or less. Attitude (ß = 0.266, P = 0.001), subjective norm (ß = 0.333, P < 0.001) and perceived behavioural control (ß = 0.211, P = 0.009) were significant predictors of intention, accounting for 40.8% of the variance in intention to provide disposal education. Scale reliability ranged from 0.596 to 0.619 for the four constructs. Few pharmacists accurately selected all of the appropriate recommendations of disposal for non-controlled and controlled substances (15.9% and 10.1%, respectively). CONCLUSION: Pharmacists showed favourable attitude, subjective norm, perceived behaviour control and intention in providing such education. However, their knowledge in this area may be lacking and they are not consistently providing this information to their patients.

Taking stock of medication wastage: Unused medications in US households.

BACKGROUND: Despite the potential deleterious impact on patient safety, environmental safety and health care expenditures, the extent of unused prescription medications in US households and reasons for nonuse remain unknown. OBJECTIVE: To estimate the extent, type and cost of unused medications and the reasons for their nonuse among US households. METHODS: A cross-sectional, observational two-phased study was conducted using a convenience sample in Southern California. A web-based survey (Phase I, n = 238) at one health sciences institution and paper-based survey (Phase II, n = 68) at planned drug take-back events at three community pharmacies were conducted. The extent, type, and cost of unused medications and the reasons for their nonuse were collected. RESULTS: Approximately 2 of 3 prescription medications were reported unused; disease/condition improved (42.4%), forgetfulness (5.8%) and side effects (6.5%) were reasons cited for their nonuse. "Throwing medications in the trash" was found being the common method of disposal (63%). In phase I, pain medications (23.3%) and antibiotics (18%) were most commonly reported as unused, whereas in Phase II, 17% of medications for chronic conditions (hypertension, diabetes, cholesterol, heart disease) and 8.3% for mental health problems were commonly reported as unused. Phase II participants indicated pharmacy as a preferred location for drug disposal. The total estimated cost for unused medications was approximately $59,264.20 (average retail Rx price) to $152,014.89 (AWP) from both phases, borne largely by private health insurance. When extrapolated to a national level, it was approximately $2.4B for elderly taking five prescription medications to $5.4B for the 52% of US adults who take one prescription medication daily. CONCLUSION: Two out of three dispensed medications were unused, with national projected costs ranging from $2.4B to $5.4B. This wastage raises concerns about adherence, cost and safety; additionally, it points to the need for public awareness and policy to reduce wastage. Pharmacists can play an important role by educating patients both on appropriate medication use and disposal.