How to engage healthcare providers in preventing medication waste through individualized prescribing and dispensing: A qualitative study.

BACKGROUND: Medication waste is a threat to healthcare's sustainability. To prevent medication waste in patients' homes, medication quantities prescribed and dispensed to patients could be individualized. Perspectives of healthcare providers on engaging in this strategy however remain unclear. OBJECTIVE(S): To identify factors influencing healthcare providers in preventing medication waste through individualized prescribing and dispensing. METHODS: Individual semi-structured interviews were conducted via conference calls with pharmacists and physicians prescribing and dispensing medication to outpatients of eleven Dutch hospitals. An interview guide based on the Theory of Planned Behaviour was developed. Questions related to participant's view on medication waste, current prescribing/dispensing behaviour and intention to personalising prescribing/dispensing quantities. Data was thematically analysed, following a deductive approach based on the Integrated Behavioural Model. RESULTS: Nineteen out of 45 (42%) healthcare providers were interviewed, of whom eleven were pharmacists and eight physicians. Factors influencing individualized prescribing and dispensing by healthcare providers were identified and categorized in seven themes: (1) attitude: beliefs about consequences of waste, as well as perceived benefits and concerns of the intervention; (2) perceived norm: professional and social responsibilities; (3) personal agency: available resources; (4) knowledge and skills: intervention complexity; (5) salience of behaviour: perceived need from past experiences and evaluation of actions; (6) habit: prescribing and dispensing habits; and (7) situational factors: support for change, momentum for sustainable actions, need for guidance, triad collaboration and information provision. CONCLUSIONS: Healthcare providers perceive a strong professional and social responsibility to prevent medication waste yet feel bound by limited resources available to engage in individualized prescribing and dispensing. Situational factors, including leadership, organizational awareness and strong collaborations, could help healthcare providers to engage in individualized prescribing and dispensing. Through the identified themes, this study offers directions for designing and implementing an individualized prescribing and dispensing program to prevent medication waste.

Patients' views on Self-administration of Medication during hospitalisation: a mixed-methods study.

Background: Inpatient Self-administration of Medication (SAM) increases patient involvement in medication management and may increase medication safety. Its implementation is impeded. Successful and sustainable implementation of SAM strongly depends on patients' willingness to participate. This study aimed to identify and quantify patients' views on SAM, related (dis)advantages and prerequisites, patient's willingness to engage in SAM schemes, and their preferences in medication management during hospitalisation. Methods: A mixed-methods study was conducted among hospitalised adult patients in four Dutch hospitals during December 2018 and March 2019. Semi-structured one-to-one interviews were performed to identify patients' views on SAM. Interview transcripts were subjected to thematic-content analysis. These outcomes were used to construct a questionnaire about patient's willingness to engage in SAM schemes, their preferences for inpatient medication management and level of agreement with statements about SAM's (dis)advantages and prerequisites of SAM. Data were descriptively analysed. Results: Nineteen hospitalised patients [mean (standard deviation; SD) age 61.0 (13.4) years old; 52.6% male] were interviewed. Most patients had a positive view on SAM, but some doubted the necessity to change standard care. Also, patients expressed concerns about medication safety. Prerequisites for SAM implementation were identified. These covered four main themes: information provision, accessible and safe storage, assurance of safety, and clear responsibilities. A total of 234 patients [mean (SD), age 65.3 (13.5) years; 54.7% male] participated in the questionnaire. Although 50.0% of the patients were willing to self-administer medication, patients were ambivalent as only 36.5% preferred SAM over nurse-led administration. Conclusion: The majority of patients were positive about SAM. Although half of the patients were willing to perform SAM, most patients did not prefer SAM over standard care. This ambivalent attitude may be overcome when the stated prerequisites are met and patients experience SAM in clinical practice. Based on patients' views, it can be concluded that implementation of SAM seems possible. Plain Language Summary: Research to identify patients' views on Self-administration of Medication during hospitalisation Background: Patient involvement is desired by patients. Nevertheless, currently healthcare providers take over patient's medication management when hospitalised. Capable patients administering their own medication during hospitalisation, known as 'Self-administration of Medication' (SAM) is one possible way to increase patient involvement in hospital care and to improve medication safety. Understanding patients' views on SAM, before its actual practice, could help to successfully implement it. In this research, we aimed to identify and measurepatients' views on SAM,(dis)advantages of and requirements for SAM stated by patients,patients' willingness to self-administrate medication,patients' preferences in medication management during hospitalisation.Methods: Our study consisted of two parts and was conducted among hospitalised adult patients in four Dutch hospitals during December 2018 and March 2019. First, patients were interviewed to identify patients'views on SAM,requirements for SAM.Second, the outcomes of these interviews were used to construct a questionnaire aiming to identify patient'swillingness to self-administrate,preferences for self- or nurse-led medication administration,level of agreement with statements about SAM's (dis)advantages and requirements.Results: Nineteen hospitalised patients were interviewed. Most patients had a positive view on SAM, some doubted the necessity to change nurse-led medication administration. Patients mentioned many advantages of SAM, such as increased patient empowerment and contribution to sustainability. Some patients had concerns about medication safety, for example, risking omissions or double administrations.In total, 234 patients completed the questionnaire. Half (50%) of the patients were willing to self-administer medication. However, only 37% of patients preferred SAM over nurse-led medication administration which indicates that the majority of patients were hesitant to actually self-administer medication. The most important requirements for SAM by patients were, 'I want to be informed before my hospitalisation that I have to bring my own medication' (80% agreed) and 'Healthcare professionals must assess per patient whether the patient is able to manage and use his or her own medication' (74% agreed).Conclusion: Most patients mentioned many advantages and had positive views on SAM. Although half of the patients were willing to perform SAM, most patients did not prefer SAM over nurse-led medication administration. This reservation may be overcome when the stated requirements are met and patients experience SAM when admitted to hospital.