Delesha M. Carpenter

The effect of conflicting medication information and physician support on medication adherence for chronically ill patients

OBJECTIVE This article explores the effect of conflicting information, defined as contradictory information about medication topics from different sources, on medication adherence in a sample of chronically ill patients. We specifically investigate whether conflicting information and physician support directly affect medication adherence or whether the effect is mediated by adherence self-efficacy and outcome expectations for medications. METHODS Vasculitis patients (n = 228) completed two on-line questionnaires which contained measures of conflicting information, adherence self-efficacy, outcome expectations, physician support, and medication adherence. We conducted a mediation analysis using a bootstrapping approach to generate point estimates and 95% confidence intervals to test the significance of each mediated effect. RESULTS A majority of patients (51.3%) received conflicting medication information. Conflicting information had a direct negative effect on medication adherence, which was not mediated by self-efficacy or outcome expectations. Alternatively, self-efficacy mediated the positive effect of physician support on medication adherence. CONCLUSION Patients who encounter conflicting medication information are less adherent to their medications. The presence of a supportive physician may counteract the negative effect of conflicting medication information. PRACTICE IMPLICATIONS Physicians should initiate conversations about conflicting medication information with their patients. Consensus-based guidelines that address medication discrepancies may also reduce the availability of conflicting information.

Communication During Pediatric Asthma Visits and Self-Reported Asthma Medication Adherence

OBJECTIVE: Our objectives were to examine how certain aspects of provider-patient communication recommended by national asthma guidelines (ie, provider asking for child and caregiver input into the asthma treatment plan) were associated with child asthma medication adherence 1 month after an audio-taped medical visit. METHODS: Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at 5 pediatric practices in nonurban areas of North Carolina. All medical visits were audio-tape recorded. Children were interviewed 1 month after their medical visits, and both children and caregivers reported the child’s control medication adherence. Generalized estimating equations were used to determine if communication during the medical visit was associated with medication adherence 1 month later. RESULTS: Children (n = 259) completed a home visit interview ∼1 month after their audio-taped visit, and 216 of these children were taking an asthma control medication at the time of the home visit. Children reported an average control medication adherence for the past week of 72%, whereas caregivers reported the child’s average control medication adherence for the past week was 85%. Child asthma management self-efficacy was significantly associated with both child- and caregiver-reported control medication adherence. When providers asked for caregiver input into the asthma treatment plan, caregivers reported significantly higher child medication adherence 1 month later. CONCLUSIONS: Providers should ask for caregiver input into their child’s asthma treatment plan because it may lead to better control medication adherence.

Child and caregiver involvement and shared decision-making during asthma pediatric visits.

Objective. The purpose of this study was to examine (1) the extent to which caregivers and children asked asthma management questions during pediatric asthma visits; (2) the extent to which providers engaged in shared decision-making with these caregivers and children; and (3) the factors associated with question asking and shared decision-making. Methods. Children aged 8–16 years with mild persistent asthma, moderate persistent asthma, or severe persistent asthma and their caregivers were recruited at five pediatric practices in non-urban areas of North Carolina. All of the medical visits were audio tape recorded. Generalized estimating equations were used to analyze the data. Results. Only 13% of children and 33% of caregivers asked one or more questions about asthma management. Caregivers were more likely to ask questions about their child’s medications. Providers obtained child input into their asthma management plan during only 6% of encounters and caregiver input into their child’s asthma management plan during 10% of visits. Conclusion. Given the importance of involving patients during healthcare visits, providers need to consider asking for and including child and caregiver inputs into asthma management plans so that shared decision-making can occur more frequently.

Communication during Pediatric Asthma Visits and Child Asthma Medication Device Technique 1 Month Later

Objective. This study investigated how provider demonstration of and assessment of child use of asthma medication devices and certain aspects of provider–patient communication during medical visits is associated with device technique 1 month later. Methods. Two hundred and ninety-six children aged 8–16 years with persistent asthma and their caregivers were recruited at five North Carolina pediatric practices. All of the medical visits were audio-tape recorded. Children were interviewed 1 month later and their device technique was observed and rated. Results. If the provider asked the child to demonstrate metered dose inhaler technique during the medical visit, then the child was significantly more likely to perform a greater percentage of inhaler steps correctly 1 month later. Children with higher asthma management self-efficacy scores were significantly more likely to perform a greater percentage of diskus steps correctly. Additionally, children were significantly more likely to perform a greater percentage of diskus steps correctly if the provider discussed a written action plan during the visit. Children were significantly more likely to perform a greater percentage of turbuhaler steps correctly if they asked more medication questions. Conclusions. Providers should ask children to demonstrate their inhaler technique during medical visits so that they can educate children about proper technique and improve child asthma management self-efficacy. Providers should encourage children to ask questions about asthma medication devices during visits and they should discuss asthma action plans with families.

Health-related quality of life for patients with vasculitis and their spouses

OBJECTIVE Chronic disease affects both patients and spouses, yet the effect of vasculitis on the spouses of patients has not been systematically examined. We addressed this research gap by describing 8 dimensions of health-related quality of life (HRQOL) for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) patients and their spouses and compared patients and spouses with norms for the general US population. We also determined whether the impact of AAV on HRQOL differs by sex for patients or their spouses. METHODS Ninety-seven patients with AAV and their spouses completed a mailed questionnaire that included demographic information and a measure of HRQOL (Medical Outcomes Study Short Form 36.) Using the RAND method, we calculated 8 HRQOL dimensions: general health, physical functioning, emotional role limitations, physical role limitations, social functioning, mental health, bodily pain, and energy/vitality. Using norm-based scores, we compared the HRQOL of patients and spouses with the general US population. We then used multivariate analysis of covariance (MANCOVA) test for sex differences in HRQOL for patients and spouses. RESULTS Patients with AAV scored lower than the US norm on all HRQOL subscales with the exception of bodily pain. In contrast, spouses scored similarly to national norms. When age, education, race, illness duration, and disease severity were controlled, there were no significant sex differences in HRQOL for patients or spouses. CONCLUSION AAV negatively impacts HRQOL for patients; whereas, spouses do not appear to be as negatively impacted. Long-term marriages may attenuate the effect of sex on HRQOL. Quality of life should be assessed throughout the disease course for both patients and spouses.

The availability, functionality, and quality of mobile applications supporting medication self-management.

OBJECTIVE To systematically review mobile applications currently available to patients to support outpatient medication self-management. METHODS Three online stores were searched in March 2013 using nine distinct search terms. Applications were selected if they supported general outpatient medication self-management for adults; they were excluded if they focused on only one medication or condition, provided only a medication list or reference, only ordered refills, were written in a non-English language, or were for local pharmacy/hospital patients only. A multi-step review process was utilized by two independent reviewers to identify eligible applications. A standardized form was used to abstract data. User reviews were compiled from a subsample of applications and qualitatively coded to identify common criticisms. RESULTS 14,893 applications were initially identified. After the multi-step review process, 424 applications were deemed eligible for inclusion by reviewers (κ=0.85). On average, applications were rated 2.8 stars (out of 5) from 107 reviews. Almost all provided medication reminders (91.0%), half enabled patients to create a medication history or log (51.5%), and 22% could email the log to a third party. Few helped patients organize their regimen (6.2%), check for drug interactions (2.8%), or identify pills (4.0%). User reviews (N=1091) from the subsample of 26 applications revealed common criticisms, including technical malfunctions, poor compatibility with certain medications, and absence of desired features. CONCLUSIONS Hundreds of applications exist in the marketplace to support medication self-management. However, their quality, content, and functionality are highly variable. Research is needed to determine optimal capabilities, evaluate utility, and determine clinical benefit.

Conflicting Medication Information: Prevalence, Sources, and Relationship to Medication Adherence

Conflicting medication information has been defined as contradictory information about a medication topic from two or more sources. The objective of this study was to determine whether arthritis patients are exposed to conflicting medication information, to document sources of conflicting information, and to explore whether conflicting information is associated with sociodemographic factors, clinical characteristics, and medication adherence. Using an online survey, arthritis patients (N = 328) reported how often they received conflicting information about 12 medication topics as well as sources of conflicting information, demographic/clinical characteristics, and medication adherence. A linear regression model, which controlled for various demographic/clinical factors, determined whether conflicting information was associated with medication adherence. The majority of patients (80.1%) received conflicting information and were most likely to receive conflicting information about medication risks. Physicians, media sources, and the Internet were the most common sources of conflicting information. Less conflicting information (B =−0.13, p < .05), more information source use (B = 0.22, p < .01), and lower perceived regimen complexity (B =−0.17, p < .05) were associated with better medication adherence. In conclusion, conflicting medication information is pervasive, comes from a variety of sources, and may negatively affect patient health outcomes. To potentially decrease exposure to conflicting information, providers should direct patients to high-quality medication information sources.

Using videos to teach children inhaler technique: a pilot randomized controlled trial

Abstract Objective: This primary objective of this pilot randomized, controlled trial was to determine whether a brief video intervention delivered after a pediatric office visit could improve inhaler technique in children with asthma immediately and one month later. The intervention’s effect on children’s inhaler self-efficacy and asthma control was also evaluated. Methods: Children (n = 91) ages 7–17 years with persistent asthma were recruited at two pediatric practices in North Carolina. Eligible children demonstrated their inhaler technique for metered dose inhalers (MDIs) either with or without a spacer. A trained research assistant used a validated inhaler technique checklist to record which steps children performed correctly. After a regularly scheduled office visit, children were randomized to watch either a 3-min MDI video (intervention group) or a nutrition video (control group) in English or Spanish. Children’s technique was assessed again after watching the video and one month later. Results: Children were primarily male (56%) and non-White (60%). When compared with the control group, children in the intervention group demonstrated a significant improvement in MDI technique post-intervention [mean = 1.12 steps, 95% CI (0.73, 1.50)] but the improvement was not sustained at 1-month follow-up. The intervention did not lead to significant improvements in inhaler self-efficacy or asthma control. Conclusions: A brief video intervention offered during pediatric clinic visits can lead to immediate improvements in children’s inhaler technique. Future studies should evaluate whether booster training videos can help maintain improvements in children’s inhaler technique over time.

Brief Report: Factors Associated with Asthma Management Self-Efficacy Among 7th and 8th Grade Students

OBJECTIVE Examine correlates of asthma self-management among 12,154 adolescents with physician-diagnosed asthma. METHODS All 7th and 8th grade students in North Carolina completed a survey to assess asthma prevalence and self-management behaviors among those with asthma. RESULTS Adolescents who were allowed to carry their inhaled medication at school, shown how to use a peak flow meter, and had access to more asthma care resources were more confident that they could prevent an asthma exacerbation. Adolescents who were allowed to carry their inhaled medication at school and who had a private doctor were more confident that they could control their symptoms. Adolescents taking anti-inflammatory medicine were less confident that they could prevent an exacerbation and control their symptoms. CONCLUSIONS Various indicators of autonomy and control were associated with greater self-efficacy for managing asthma. Adolescents who require anti-inflammatory medicines would benefit from additional intervention efforts to improve their asthma management self-efficacy.

Determinants of Self-Reported Barriers to Glaucoma Medicine Administration and Adherence A Multisite Study

Background: Many factors influence glaucoma medication adherence. A better understanding of the relationships between health literacy, depressive symptoms, and patient-reported problems in using glaucoma medications may reveal opportunities for intervention that could improve patients’ clinical outcomes. Objective: To examine the relationship between patient characteristics (demographics, health literacy, and depressive symptoms) and patient-reported problems in using glaucoma medications and to assess factors related to patients’ self-reported adherence to glaucoma medications. Methods: Patients diagnosed with primary open-angle glaucoma (n = 228) currently taking intraocular pressure–lowering medications were recruited at 6 ophthalmology clinics. Patients were interviewed to identify problems using glaucoma medications, and self-reported medication adherence was determined using a Visual Analog Scale. Questionnaires were administered to assess health literacy, depressive symptoms, outcome expectations, and medication self-efficacy. Results: Younger patients (P = 0.03), patients with depressive symptoms (P = 0.02), and patients who reported more medication problems (P = 0.005) were significantly less adherent to their glaucoma medications. Patients with higher glaucoma medication self-efficacy adherence scores (P = 0.003) and higher outcome expectations (P = 0.03) were significantly more adherent. Conclusions: Providers should consider using tools to screen glaucoma patients for depressive symptoms and for problems in using medications to identify patients who are at higher risk of nonadherence to treatment and who might benefit from follow-up with primary care providers.