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Browsing by Author "McManus, M. Sue"
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Item Illness Representation and Medication Adherence of Patients with Chronic Kidney Disease(2012-03-16) McManus, M. Sue; Welch, Janet L.; Rawl, Susan M.; Sloan, Rebecca S.; Halstead, Judith A.Chronic kidney disease (CKD) places a high personal and economic burden globally on individuals, families, and society. Although kidney protective medications slow the progression of CKD to end stage kidney disease, adherence to these medications is inadequate. The primary purposes of this study are to: 1) describe the illness and treatment beliefs of CKD patients in stage 3 guided by the Common Sense M model (CSM); and 2) examine the relationship of those beliefs with adherence to renal protective medications, ACE-I. Secondary purposes of this study include determining adherence levels of ACE-I among patients with CKD stage 3; examining relationships between individual and clinical characteristics with patient beliefs and medication adherence with ACE-I; and examining the relationship between the Medication Adherence Report Scale (MARS) and the Medication Possession Ratio (MPR). Using a descriptive cross-sectional design, a convenience sample of 92 individuals with Stage 3 CKD was obtained from a Midwestern VA medical center. Data were collected through self-administered mailed surveys and medical record reviews. Data analyses were performed using descriptive statistics, correlation, t-tests and ANOVA. Seventeen symptoms experienced were perceived as related to CKD by at least one respondent with most reporting legs/feet swelling (n=31). Top perceived cause of CKD was aging (60%). Revised Illness Perception Questionnaire (IPQ-R) items were scored from 1 to 5 with higher scores indicating perceptions of higher personal and treatment control of chronic, cyclical illness with serious consequences and negative emotional reactions. In this study, the CKD timeline was perceived as a long-term chronic rather than short-term acute condition (M = 3.8), with minimal cyclical exacerbations (M = 2.7), and moderate severity of consequences (M = 3.1). Respondents perceived having both, but more personal control than treatment control of CKD (M = 3.5 v 3.2). Participants did not perceive CKD as related to a great negative emotional response (M = 2.8). Illness Representations were not found to be significantly correlated with self-reported medication adherence. Medication adherence levels by self-report (M = 4.8 [5 = perfect adherence]) and pharmacy refill records (73% had perfect refill ratio of 1:1) reveal highly adherent levels among this sample.Item Reducing prescribing errors through creatinine clearance alert redesign(Elsevier, 2015-10) Melton, Brittany L.; Zillich, Alan J.; Russell, Scott A.; Weiner, Michael; McManus, M. Sue; Spina, Jeffrey R.; Russ, Alissa L.; Department of Medicine, IU School of MedicineBackground Literature has shown that computerized creatinine clearance alerts reduce errors during prescribing, and applying human factors principles may further reduce errors. Our objective was to apply human factors principles to creatinine clearance alert design and assess whether the redesigned alerts increase usability and reduce prescribing errors compared with the original alerts. Methods Twenty Veterans Affairs (VA) outpatient providers (14 physicians, 2 nurse practitioners, and 4 clinical pharmacists) completed 2 usability sessions in a counterbalanced study to evaluate original and redesigned alerts. Each session consisted of fictional patient scenarios with 3 medications that warranted prescribing changes because of renal impairment, each associated with creatinine clearance alerts. Quantitative and qualitative data were collected to assess alert usability and the occurrence of prescribing errors. Results There were 43% fewer prescribing errors with the redesigned alerts compared with the original alerts (P = .001). Compared with the original alerts, redesigned alerts significantly reduced prescribing errors for allopurinol and ibuprofen (85% vs 40% and 65% vs 25%, P = .012 and P = .008, respectively), but not for spironolactone (85% vs 65%). Nine providers (45%) voiced confusion about why the alert was appearing when they encountered the original alert design. When laboratory links were presented on the redesigned alert, laboratory information was accessed 3.5 times more frequently. Conclusions Although prescribing errors were high with both alert designs, the redesigned alerts significantly improved prescribing outcomes. This investigation provides some of the first evidence on how alerts may be designed to support safer prescribing for patients with renal impairment.