Peri J. Ballantyne

The role of pharmacists in primary care

Needs reconsideration in light of the evidence of an unfavourable impact on patient outcomes

Older Adults Living with Osteoarthritis: Examining the Relationship of Age and Gender to Medicine Use

L’ostéoarthrite (OA) chez les personnes âgées constitue une condition chronique et répandue associée à des douleurs importantes d’invalidité. L’utilisation d’analgésiques par voie orale est un élément central de la gestion des symptômes. L’utilisation de médicaments par cette population, cependant, est complexe et la nécessité de contrôler les symptômes doivent être mis en balance avec les préoccupations concernant la sécurité des médicaments. Notre étude s’est concentrée à illustrer et à explorer les variations entre divers médicaments différents utilisés pour gérer les symptômes liés à l’ostéoarthrite. Nous avons analysé les données provenant d’un échantillon de personnes âgées de 55 ans et plus, qui vivent dans les communautés, et qui souffrent d’arthrite de la hanche ou du genou pour examiner les facteurs sociaux et médicaux associés à la variation dans les médicaments rapporté. Une conclusion principale est que les types de médicaments utilisés par les patients atteints d’ostéoarthrite varient selon l’âge et le sexe, indépendamment de la maladie et du contexte médical et social. Les explications possibles ont été considérés comme relatives aux préférences des patients et des professionnels. Osteoarthritis (OA) in older adults is a prevalent chronic condition associated with substantial pain and disability. Oral analgesic use is a central component of symptom management. Medication use in this population, however, is complex and must balance the need for symptom control with drug safety concerns. Our study focus was to illustrate and discuss the variability in the medications used to manage OA-related symptoms. We analysed data from a sample of community-dwelling persons aged 55 and older with hip or knee arthritis to examine social and medical factors associated with reported variation in OA drugs. A key finding is that drug types used by OA patients vary by age and gender, independent of disease, and medical and social context. Possible explanations related to patient and professional preferences are considered.

HIV isn't me…: HIV+ adolescents' experiences in a positive context of support and treatment.

Abstract We describe the experiences of a sample of Canadian HIV+ youth whose intact adolescent identities contrast sharply with the expected identity challenges of persons living with a serious, chronic disease. We first showcase the positive HIV+ identities emerging from the successful management of HIV+ status through long-term HIV-related medical care and established pharmaceutical regimes. Second, we describe the medical, familial, and broader social context of support in which these adolescents are negotiating HIV. Finally, we highlight the youths expectations of future, specific identity and role challenges regarding intimacy and sexuality-related to disclosure of their private HIV+ identities and their embodied HIV+ status. Continued social and medical supports will be key to their emergence into adulthood as healthy HIV+ persons; with such supports, these youths’ experiences highlight the capacity for living optimally with HIV.

Becoming Old as a 'Pharmaceutical Person': Negotiation of Health and Medicines among Ethnoculturally Diverse Older Adults *

Parce que la prescription et lutilisation des médicaments sont devenus un aspect normatif des soins de santé pour les personnes âgées, nous cherchons à comprendre comment les individus gérer lutilisation des médicaments dordonnance dans le contexte du vieillissement. Nous soutenons que, pour ceux qui sont ambulatoires, lutilisation de médicaments est susceptible dêtre influencée par des considérations ethno-culturelles en matière de la santé et des expériences avec dautres approches aux soins de santé. En conséquence, nous avons méné une étude qualitative, avec des entrevues en profondeur, sur un échantillon diversifié de personnes âgées afin didentifier leurs perceptions et utilisations de médicaments. Nos conclusions dépeignent les personne âgées comme des agents actifs - qui sappuient sur une vie dexpérience et de connaissances - qui prennent la responsabilité de ladhésion (our non-adhésion) aux médicaments et leurs effets liés sur leur propre corps. Nous représentons la personne âgée comme une « personne pharmaceutique » dont les expériences du vieillissement sont inextricablement liée à la négociation des soins de santé dépendent sur les médicaments.Because medication prescribing and use have become a normative aspect of health care for older adults, we seek to understand how individuals navigate prescribed-medication use within the context of aging. We reasoned that, for those who are ambulatory, medication use is likely influenced by ethnocultural meanings of health and experiences with alternative approaches to health care. Accordingly, we conducted a qualitative study, with in-depth interviews, on a diverse sample of older adults in order to identify elderly persons perceptions and uses of medicines. Our findings depict older adults as active agents - who draw on a lifetime of experience and knowledge - who take responsibility for adherence (or non-adherence) to medicines and their associated effects on their own bodies. We represent the older person as a pharmaceutical person whose experiences of aging are inextricably tied up with the negotiation of medicine-reliant health care.

Poverty status of worker compensation claimants with permanent impairments

Poverty levels have proven to be pernicious in Canada, with particular groups at heightened risk of poverty. Given that people with disabilities are consistently identified as among those ‘at risk’, we seek to determine the extent to which injured workers/worker compensation claimants who had sustained bodily impairments live in poverty. Employing two poverty indicators, we describe the poverty levels of Ontario injured workers with permanent impairments at an average of 52 months post-injury. For one indicator, we describe proximity to/depth of poverty; and in bivariate and multivariate analyses, we examine the factors associated with poverty in the post-injury period. Estimated poverty rates for the injured worker sample – ranging from 17 to 26% – compare unfavourably to published estimates of poverty in the general population of working-aged Canadians/Ontarians and equate to those of Canadians/Ontarians with disabilities. Pre-injury employment characteristics and income status only partly account for post-injury poverty, pre-injury health does not. Sample members in post-injury poverty were more likely to report having sustained multiple injuries at the workplace, were less likely to have returned to employment or to have recovered pre-injury earnings, and yet contributed significantly more to post-injury household incomes than those not in post-injury poverty. We discuss the implications of the findings for worker compensation boards that adjudicate and have final authority on worker claims for compensation for harms sustained in the workplace.

Interpretation in Cross-Language Research: Tongues-Tied in the Health Care Interview?

Medication prescribing and use is a normative aspect of health care for the elderly, rendering medication taking by elderly persons problematic. In an earlier qualitative study, we examined how medicine-use is negotiated (used/refused/resisted, and assessed against expected outcomes) by older persons with limited fluency in English—the main language of health care in the study setting. In the present article, we describe a reflexive methodological review of that study’s design, with a particular focus placed on interpreter-mediated data collection. We illustrate that what was heard in open-ended interviews (what became data) was influenced by not only what was asked and how, but also by how the interpreter ‘heard’ and conveyed dialogue to and from study participants. We illustrate differing accounts of the dialogue between an interviewer and participant provided via real-time interpretation and through a reflexive re-interpretation of talk-to-text transcripts, reflecting the different stakes in the research, and different capital available to study- and review-interpreters. Implications for research design and practice of cross-cultural and cross-language research are highlighted.

The future of medicines use and access research: using the Journal of Pharmaceutical Policy and Practice as a platform for change.

Scientific journals are most often used to disseminate the end products of research, but also have an important role as instruments of change. One year after the launch of the Journal of Pharmaceutical Policy and Practice, the focus of articles published has been on pharmaceutical health systems research, including contemporary issues related to medicines management, socio-behavioral aspects of pharmacy and macro pharmaceutical issues. Our most cited articles ranged from those on generic medicines in Jordan [1], antibiotics sensitivity, usage and access in India and Namibia [2,3], to a review of national medicines policies around the globe [4]. At this point the Journal has successfully provided a forum to publish within its specified themes. However, given the technological and social changes in health, medicines and public policy, we are keen to promote the Journal of Pharmaceutical Policy and Practice as a platform for change, in order to advance specific agendas. We would argue that this change agenda is underpinned by the following issues:

Understanding Users in the ‘Field’ of Medications

The numbers of medicinal drugs available for human consumption have increased rapidly in the past several decades, and physician prescribing practices reflect the growing reliance on medicines in health care. However, the nature of medicines-as-technology makes problematic taken-for-granted relationships among actors involved in the delivery, or who are the recipients of medicines-reliant health care. In this article, I situate the medicine user in the ‘field’ of medications—where interests, actions and outcomes are continually negotiated among and between the various players—physicians, pharmacists, government regulatory bodies, the pharmaceutical industry and users of medicines. The objective of the paper is to illuminate the complex context in which the medicine-user—the target of the pharmacy profession’s service to the public—accesses and uses medicines.