Using a teach-back intervention significantly improves knowledge, perceptions, and satisfaction of patients with Nurses' discharge medication education.

BACKGROUND: Evidence indicates that patients desire medication information, but clinicians often fail to teach this information in an understandable way. Teach-Back promotes effective clinician-patient communication and enhances medication adherence, satisfaction with education, and hospital experiences. AIMS: This study examined effects of a nurse-led Teach-Back intervention, Teaching Important Medication Effects (TIME), compared with usual care on patients' knowledge, experiences, and satisfaction with medication education before and after discharge. The aims were to examine patients' priority learning needs, group differences in new medication knowledge before and after discharge, and post-discharge experience and satisfaction with medication instruction. METHODS: A longitudinal pretest/post-test, 2-group design was used with 107 randomly selected medical-surgical patients from an academic hospital. After receiving medication instructions, patients were interviewed before and within 72 h after discharge. Bivariate analyses were used to assess group differences in demographic and outcome variables. RESULTS: Usual care (n = 52) and TIME (n = 55) groups' characteristics were equivalent. Knowing new medication names and side effects were top learning priorities. Medication side effect knowledge was better in TIME versus usual care groups at discharge (94.3% vs. 72.5%, p = .003) and follow-up (93.9% vs.75.8%, p = .04). TIME positively influenced patients' medication education experiences; specifically, nurses always explained why a new medication was needed and its side effects. TIME was associated with patients being very satisfied with nurses' education versus usual care (97% vs. 46.9%, p < .001). LINKING EVIDENCE TO ACTION: TIME was significantly and positively associated with knowledge of new medication side effects over time and experiences and satisfaction with nurses' medication education. Teach-Back was effective in educating patients about new medications. It is an essential approach for patient education, requiring clinicians to confirm patients' retention and understanding of new information with each encounter.

Evaluating Providers' Prescription Opioid Instructions to Pediatric Patients.

Receiving an opioid prescription during childhood increases the risk of hazardous prescription opioid (PO) use during emerging adulthood. Instruction on how to safely use POs plays an essential role in pediatric patients' capacity to utilize as well as to discontinue POs appropriately. This study aimed to evaluate pediatric PO label instructions provided to a large sample of pediatric outpatients. Data were extracted from the electronic healthcare records system identifying pediatric patients who received a PO between 2016 and 2019 from pediatric outpatient medical clinics were affiliated with a northwestern United States medical center and children's hospital. Pediatric patients (n = 12,613) between 0−17 years old who received a PO during outpatient care were included. Patients with chronic health conditions (e.g., cancer) or who received their PO from an inpatient medical setting were excluded. Patient demographics, medication instructions, associated diagnoses, and other prescription information (e.g., name of medication, dose, and quantity dispensed) were examined using automated text classification. Many label instructions did not include any indication/reason for use (20.8%). Virtually none of the POs (>99%) included instructions for how to reduce/wean off POs, contact information for questions about the POs, and/or instructions around how to dispose of the POs. Efforts are needed to ensure that pediatric PO instructions contain essential elements to improve comprehension of when and how to use POs for pediatric patients.

Strategies to optimize comprehension of numerical medication instructions: A systematic review and concept map.

OBJECTIVE: To develop evidence-based recommendations for improving comprehension of quantitative medication instructions. METHODS: This review included a literature search from inception to November 2021. Studies were included for the following: 1) original research; 2) compared multiple formats for presenting quantitative medication information on dose, frequency, and/or time; 3) included patients/lay-people; 4) assessed comprehension-related outcomes quantitatively. To classify the studies, we developed a concept map. We weighed 3 factors (risk of bias in individual studies, consistency of findings among studies, and homogeneity of the interventions tested) to generate 3 levels of recommendations. RESULTS: Twenty-one studies were included. Level 1 recommendations are: 1) use visualizations of medication doses for liquid medications, and 2) express instructions in time-periods rather than times per day. Level 2 recommendations include: validate icons, use panels or tables with explanatory text, use visualizations for non-English speaking populations and for those with low health literacy and limited English proficiency. CONCLUSIONS: Visualized liquid medication doses and time period-based administration instructions improve comprehension of numerical medication instructions. Use of visualizations for those with limited health literacy and English proficiency could result in improved outcomes. PRACTICE IMPLICATIONS: Practitioners should use visualizations for liquid medication instructions and time period-based instructions to improve outcomes.

Tool development to improve medication information transfer to patients during transitions of care: A participatory action research and design thinking methodology approach.

BACKGROUND: Medication changes during transitions of care is a recognized challenge that has been linked to adverse events. The delivery of medication instructions during transition from hospital to home is a priority area for improvement. OBJECTIVE: The goals of this work were to 1) understand the current experiences of patients and families; and 2) co-design tools to improve medication information transfer during transitions of care together with patients, families, and providers. METHODS: A participatory action approach, using mixed methods within a design thinking framework was used. Participants were chosen from patient groups at higher risk of adverse events, guided by extreme user design, which posits that needs of extreme users can also fit the majority. Providers, patients and family (users) were interviewed to understand current experiences with medication information transfer during transitions of care and to solicit input on potential elements to inform tool design. Users were engaged in iterative creation of prototypes. RESULTS: A total of 116 patients, family caregivers, and providers were engaged throughout this project. Findings highlighted challenges currently experienced, strengthening the case for tools that engage the patient and family in medication information transfer. Important information included why medications were prescribed, how to take them, side effects, and an explanation of the role of community pharmacists. Displaying information in a grid format was preferred. Two tools were prototyped: (1) A Medication Whiteboard for engaging patients and families in creating their medication routine, and (2) A Patient Oriented Medication List for providing medication instructions and as a reference once patients are home. CONCLUSIONS: Through the use of mixed methods within a design thinking framework, the team was able to understand the challenges and design prototypes of tools that both engage patients and families in developing their medication routine and improve medication information transfer during transitions of care.

Pharmacist medication instructions are associated with continued medication self-management in older adults: a retrospective observational study.

BACKGROUND: Various factors are related to self-management of medication. However, few reports comprehensively examine the factors related to patients, medication levels, and other factors related to the recuperative environment, such as family support. The aim of this study was to investigate factors affecting the continuation of medication self-management among hospitalized older adults receiving convalescent rehabilitation. METHODS: We conducted a retrospective observational study with 274 consecutive patients newly admitted to the convalescent rehabilitation wards at a single hospital in Japan between January 2017 and May 2018. Participants who were assessed for their ability to take their medication using the Japanese Regimen Adherence Capacity Tests, were deemed to be self-manageable, and were able to successfully continue to self-manage their medication from admission to discharge were categorized as the "continuation group," and those who were not able to continue were categorized as the "non-continuation group." We analyzed the groups' demographic data, laboratory data, and Functional Independence Measure. The primary outcome was the continuation of medication self-management from admission to discharge. RESULTS: After enrollment, 134 patients (median age 82 years; 62.7% women) were included in the final analysis. Some 60.4% of eligible patients were able to maintain medication self-management during their hospitalization. The multiple logistic regression analysis for the continuation of medication self-management during hospitalization after adjusting for confounding factors revealed that pharmacist medication instructions were independently and positively correlated with successful continuation of medication self-management (odds ratio: 1.378; 95% confidence interval 1.085-1.831; p = 0.0076). CONCLUSION: Successful continuation of medication self-management is associated with pharmacist medication instructions among hospitalized older adults undergoing rehabilitation. TRAIL REGISTRATION: The Ethics Committee's registration number is "TGE01216-066".

A bula de medicamentos e a regulação de suas configurações em termos de forma e conteúdo no Brasil / The medicine package leaflet and the regulation of its configurations in terms of form and content in Brazil

A bula é um documento técnico – científico, direcionado a profissionais da saúde e pacientes, que acompanha o medicamento para informar sua composição, características e uso. Considerando a importância e complexidade dessas informações técnico-científicas, houve transformações na regulação de seu conteúdo e de seus elementos representativos. Questiona-se, contudo, quais as representações que a informação técnico-científica assumiu em relação à compreensão de seus usuários. Com o objetivo de conhecer e analisar as diversas configurações contemporâneas que a bula de medicamento tem sofrido sob influência dos marcos regulatórios ao longo do tempo, evidenciaram-se as representações que a informação técnico-científica da bula de medicamento vêm assumindo para compreensão de seus usuários. Para tanto, realizou-se este estudo qualitativo centrado em levantamento, identificação, sistematização e análise comparativa dos instrumentos jurídicos que compõem o marco regulatório nacional dessas bulas. Os resultados demonstram que sua regulação possui um arcabouço legal histórico, que vem se desenvolvendo há sete décadas, juntamente com a criação de órgãos de fiscalização em saúde e em vigilância sanitária. É possível notar que o desenvolvimento do processo regulatório das bulas de medicamento, apesar de ocorrer entre longos espaços de tempo, a partir da criação da Agência Nacional de Vigilância Sanitária (1999) e das consultas públicas, começou a ser realizado com um pouco mais de frequência. Assim, nos últimos dez anos, a regulação da bula de medicamento passou a ser mais específica, principalmente quanto aos aspectos de forma e conteúdo...

The medicine package leaflet (MPL) is a technical – scientific document regulated by the government, directed at health professionals and patients in order to inform and instruct its users about the use of a medicine. Considering the importance and complexity of the MPL technical - scientific information for its users, there have been changes in the regulation of MPL´s content and representative elements. It is questionable, however, which representation the MPL technical – scientific information assumed for users’ comprehension. In order to identify and analyze the various configurations the MPL has undergone over time due to the influence of regulatory frameworks, we looked at the representations the MPL technical – scientific information has taken to become adaptable to users’ comprehension. A qualitative study was conducted, focused on surveying, identifying, organizing and reading the legal instruments that constitute the MPL national regulatory framework, observing changes in the regulation over time. The results show that its regulation has a legal history, which has been developing for seven decades, along with the establishment of institutions in health and health surveillance by the government. It is also observed that, in spite of MPL´s regulatory process development occurring over long periods of time, since the foundation of the National Agency for Sanitary Surveillance (1999) and its public inquiries, this process started to be renewed and improved with a little more frequency. Thus, in the last ten years, MPL regulation has become more specific, regarding form and content...

Avaliação do programa de tuberculose em Sapucaia do Sul (RS): indicadores, 2000-2008 / Evaluation of the tuberculosis program in Sapucaia do Sul, state of Rio Grande do Sul: indicators, 2000-2008

OBJETIVO:descrever a tendência dos indicadores da tuberculose em relação à sua prevalência e incidência e os percentuais dos desfechos dos casos no encerramento (cura, abandono ao tratamento ou óbito) dos pacientes que ingressaram no Programa em Sapucaia do Sul, RS, entre 2000 e 2008. MÉTODOS: Foi realizada uma análise ecológica das taxas. Foram apresentadas as taxas brutas de frequência e os respectivos intervalos de confiança a 95%. Verificaram-se as estimativas das taxas através das variações percentuais médias anuais. Foram realizadas médias móveis a cada três anos. RESULTADOS: As taxas médias de prevalência e incidência foram de 64,3 e 58,0 por 100.000 habitantes respectivamente. As análises dos indicadores não apresentaram diferenças estatisticamente significativas entre as taxas anuais ou nas médias móveis durante o período. DISCUSSÃO: Os desfechos estavam abaixo das metas propostas pela Organização Mundial de Saúde o que compromete o controle da doença, já que não se consegue interromper a cadeia de transmissão.

The scope of this study was to describe the trends of tuberculosis indicators in relation to their prevalence, incidence and the case outcome percentages (cure, abandonment of treatment or death) for the patients who entered in the Program in Sapucaia do Sul, state of Rio Grande do Sul, between 2000 and 2008. An ecological analysis of the incidence was conducted and the gross frequency rates and respective confidence intervals of 95% were presented. The rate estimates were verified by means of average annual percent change as well as the mobile averages every three years. The prevalence rate was 64.3 and the incidence rate was 58.0 per 100.000 inhabitants. Analysis of the indicators did not reveal statistically significant differences between the annual rates or in the mobile averages during the period. The outcomes were below the targets proposed by the World Health Organization, what compromises control of the disease, as it is not proving possible to interrupt the chain of transmission.