People with dementia (PwD) face unique challenges with medicines management, yet little is known about these challenges from the perspectives of primary healthcare professionals, particularly general ...practitioners (GPs) and community pharmacists. Few medicines management interventions have been developed which are aimed at community-dwelling PwD. This study sought to develop an intervention to improve medicines management for PwD in primary care using a theory-informed approach.
Semi-structured interviews were conducted with GPs (n = 15) and community pharmacists (n = 15) to explore participants' views and experiences of medicines management for PwD, and their perceptions of barriers and facilitators to successful medicines management for PwD. The 14-domain Theoretical Domains Framework was the underpinning theoretical guide, allowing key theoretical domains to be identified and mapped to behaviour change techniques (BCTs) which are considered the 'active ingredients' of an intervention. Draft interventions were developed to operationalise selected BCTs and were presented to GPs and community pharmacists during task groups. Final selection of an intervention for feasibility testing was guided by feedback provided during these task groups and through application of the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria.
Participants expressed a number of concerns about medicines management for PwD, particularly monitoring adherence to medication regimens and conducting medication review. Two draft interventions comprising selected BCTs ('Modelling or demonstration of behaviour'; 'Salience of consequences'; 'Health consequences'; 'Social and environmental consequences'; 'Action planning'; Social support or encouragement', 'Self-monitoring of behaviour') were developed, each targeting GPs and community pharmacists. Following the task groups and discussions within the research team, the community pharmacy-based intervention was selected for future feasibility testing. The intervention will target community pharmacists to conduct a medication review (incorporating an adherence check) with a PwD, delivered as an online video demonstrating key behaviours. The video will include feedback emphasising positive outcomes of performing the behaviours. Action planning and a quick reference guide will be used as complementary intervention components.
A community pharmacist-based intervention has been developed targeting medicines management for PwD in primary care using a systematic, theory-informed approach. Future work will determine the usability and acceptability of implementing this intervention in clinical practice.
Little is known about prescribing appropriateness for community-dwelling people with dementia (PWD).
To estimate potentially inappropriate prescribing (PIP) prevalence among PWD in primary care in ...Northern Ireland, and to investigate associations between PIP, polypharmacy, age, and gender.
A retrospective cross-sectional study was conducted, using data from the Enhanced Prescribing Database. Patients were eligible if a medicine indicated for dementia management was dispensed to them during 1 January 2013-31 December 2013. Polypharmacy was indicated by use of ≥4 repeat medications from different drug groups. A subset of the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria, comprising 36 indicators, was applied to the dataset. Overall prevalence of PIP and the prevalence per each STOPP criterion was calculated as a proportion of all eligible persons in the dataset. Logistic regression was used to investigate associations between PIP, polypharmacy, age, and gender.
The study population comprised 6826 patients. Polypharmacy was observed in 81.5% (n = 5564) of patients. PIP prevalence during the study period was 64.4% (95% CI 63.2- 65.5; n = 4393). The most common instance of PIP was the use of anticholinergic/antimuscarinic medications (25.2%; 95% CI 24.2-26.2; n = 1718). In multivariable analyses, both polypharmacy and gender (being female) were associated with PIP, with odds ratios of 7.6 (95% CI 6.6-8.7) and 1.3 (95% CI 1.2-1.4), respectively. No association was observed between PIP and age, after adjustments for gender and polypharmacy.
This study identified a high prevalence of PIP in community-dwelling PWD. Future interventions may need to focus on certain therapeutic categories and polypharmacy.
Objective
Identify facilitators and barriers to successful medicines management for people with dementia (PwD) in primary care from the perspectives of community‐dwelling PwD and carers.
Methods
...Semi‐structured interviews conducted with PwD and carers in Northern Ireland. The 14‐domain Theoretical Domains Framework guided data collection and analysis. Interviews explored participants' experiences and perceptions of medicines management. PwD also completed the Beliefs about Medicines Questionnaire indicating their level of agreement with statements about medicines. Qualitative data were analysed using the framework method and content analysis. Quantitative data were analysed descriptively.
Results
Eighteen PwD and 15 carers were interviewed. PwD believed they were competent with medicines management (‘beliefs about capabilities’). Most PwD reported having strategies to prompt them to take their medicines (‘memory, attention and decision processes’). Carers played an important role in supporting PwD with medicines management (‘social influences’) and monitoring adherence (‘behavioural regulation’) and anticipated having to take on a greater role as patients' cognitive impairment worsened (‘beliefs about consequences’). Participants highlighted assistance provided by community pharmacies with medicines acquisition and delivery (‘environmental context and resources’) and placed great trust in primary healthcare professionals (‘social influences’). PwD had positive attitudes towards medication and believed strongly in the necessity of their medicines.
Conclusions
This is the first study to use a theoretical approach to explore medicines management for community‐dwelling PwD. The findings provide new insights into the critical role of carers in facilitating optimal medicines management and will inform future intervention development, in which carers' needs assessment and involvement will be key.
Key Points
This study used qualitative methods to explore the experiences of community‐dwelling people with dementia (PwD) and their carers about medicines management. The beliefs of PwD about medicines were also determined using a validated questionnaire
PwD generally did not perceive medicines management to be an issue for them at the time of interview and they displayed positive beliefs about medicines. All of the PwD interviewed had carer assistance with medicines. Carers were concerned about the future and how medicines management may become more problematic as the PwD's cognitive and functional abilities declined
These findings are in contrast with the views of primary healthcare professionals and other findings previously reported in the literature, where issues and concerns about adherence to medication in particular are highlighted
Carers will be a fundamental part of any future intervention that is developed to improve medicines management for PwD. Understanding how PwD, and especially those living alone, manage their medicines at different stages of the disease trajectory is needed to inform future interventions
Abstract
Background
people with dementia (PWD), and their carers, face challenges with medicines management activities. As interventions to support medicines management for PWD are developed, ...consideration must be given to the outcomes chosen to measure their effectiveness. A Core Outcome Set (COS) is a minimum set of outcomes to be measured in all trials in a particular clinical area, which seeks to reduce heterogeneity of outcome reporting across trials.
Objective
to develop a COS for trials assessing the effectiveness of medicines management interventions for PWD in primary care.
Methods
a comprehensive list of outcomes was compiled through a systematic review and semi-structured interviews with PWD (n = 18), their carers (n = 15), community pharmacists (n = 15) and general practitioners (n = 15). These outcomes were rated by a Delphi panel (n = 52) on a nine-point Likert scale from 1 (limited importance) to 9 (critical) during three sequential rounds of questionnaire distribution. The Delphi panel comprised participants with expertise in dementia and medicines management, including academics and healthcare professionals. An outcome was eligible for inclusion in the COS if ≥70% of participants rated it critical and <15% of participants rated it of limited importance.
Results
twenty-nine outcomes identified from the systematic review and stakeholder interviews were presented to the Delphi panel. Consensus was reached on 21 outcomes, of which the 7 most highly rated were recommended for inclusion in the COS.
Conclusion
this study used robust methodology to develop a COS for medicines management interventions for PWD. Future work should identify the most appropriate tools to measure these outcomes.
Background:
The University College Dublin (UCD) PPI Ignite Connect Network will fundamentally embed public and patient involvement (PPI) in health-related research, education and training, ...professional practice and administration in UCD’s institutional structures and procedures. A significant focus of the programme of work is on actively engaging and developing long-term reciprocal relationships with seldom heard groups, via our ten inaugural partners.
Methods:
This rapid realist review will explore what are the mechanisms that are important in actively engaging seldom heard groups in health and social care research. The review process will follow five iterative steps: (1) clarify scope, (2) search for evidence, (3) appraise primary studies and extract data, (4) synthesise evidence and draw conclusions, and (5) disseminate findings. The reviewers will consult with expert and reference panels to focus the review, provide local contextual insights and develop a programme theory consisting of context–mechanism–outcome configurations. The expert panel will oversee the review process and agree, via consensus, the final programme theory. Review findings will follow the adopted RAMESES guideline and will be disseminated via a report, presentations and peer-reviewed publication.
Discussion:
The review will update and consolidate evidence on the mechanisms that enable the reciprocal engagement and participation of ‘seldom heard’ groups in health and social care research. Via the expert and reference process, we will draw from a sizeable body of published and unpublished research and grey literature. The local contextual insights provided will aid the development of our programme theories. This new evidence will inform the design and development of the UCD PPI Ignite program focused on ensuring sustained reciprocal partnerships.
In this study we have investigated the structure of a sialo-tetrasaccharide (A2a) released from bovine submaxillary mucin by alkaline borohydride treatment. The structure, determined by a combination ...of 1-D and 2-D (COSY and RELAYED-COSY), ¹H n.m.r. experiments at 270MHz, was as follows: Galβ(1 → 4)GlcNAcβ(1 → 3)NeuAcα(2 → 6) GalNAcol. We also present evidence for the occurrence of a second sialo-tetrasaccharide (A2b), Galβ(1 → 4)GlcNAcβ(1 → 3)NeuGcα(2 → 6)GalNAcol, shown to be present by h.p.l.c. and by ¹H n.m.r. spectroscopy in a mixture with oligosaccharide (A2a). This is the first report of the isolation from bovine submaxillary mucin of a sialylated tetrasaccharide. Structure (A2a) has previously been found in cystic fibrosis bronchial mucin as well as rat and human colonic mucin, while structure (A2b) is novel.
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