Browsing by Author "Phelan, Cynthia H."

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    Impact of a pilot community pharmacy system redesign on reducing over-the-counter medication misuse in older adults
    (Elsevier, 2003) Gilson, Aaron M.; Stone, Jamie A.; Morris, Ashley O.; Brown, Roger L.; Xiong, Ka Z.; Jacobson, Nora; Holden, Richard J.; Albert, Steven M.; Phelan, Cynthia H.; Walbrandt Pigarelli, Denise L.; Breslow, Robert M.; Welch, Lauren; Chui, Michelle A.; Medicine, School of Medicine
    Background: No interventions have attempted to decrease misuse of over-the-counter (OTC) medications for adults aged 65 years or older (older adults) by addressing system barriers. An innovative structural pharmacy redesign (the Senior Section) was conceptualized to increase awareness of higher-risk OTC medications. The Senior Section contains a curated selection of OTC medications and is close to the prescription department to facilitate pharmacy staff-patient engagement to reduce misuse. Objective: This pilot study examined the Senior Section's effectiveness at influencing OTC medication misuse in older adults. Methods: A pretest-post-test nonequivalent groups design was used to recruit 87 older adults from 3 pharmacies. Using a hypothetical scenario, the participants selected an OTC medication that was compared with their medication list and health conditions, and their reported use was compared with the product labeling. Misuse outcomes comprised drug-drug, drug-disease, drug-age, and drug-label, with 5 subtypes. Patient characteristics were compiled into a propensity score matching logistic regression model to estimate their effects on the Senior Section's association with misuse at pre- or postimplementation. Results: Patient characteristics were uniform between pre- and postimplementation, and, once entered into a propensity score matching model, drug-label misuse (exceeds daily dosage) statistically significantly lessened over time (z = -2.42, P = 0.015). In addition, the Senior Section reduced drug-label misuse (exceeds single dosage) for both the raw score model (z = -6.38, P = 0.011) and the model in which the patient characteristics propensity score was added (z = -5.82, P = 0.011). Despite these limited statistical effects, misuse was found to decrease after implementation for 7 of 11 comparisons. Conclusion: These nascent outcomes begin providing an evidence base to support a well-conceived, pharmacy-based OTC medication-aisle redesign for reducing older adult OTC medication misuse. The Senior Section, when broadly implemented, creates permanent structures and processes to assist older adults to access risk information when selecting safer OTC medications.
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    A Pilot Study of Decision Factors Influencing Over-the-Counter Medication Selection and Use by Older Adults
    (Elsevier, 2020-08) Stone, Jamie A.; Phelan, Cynthia H.; Holden, Richard J.; Jacobson, Nora; Chui, Michelle A.; Medicine, School of Medicine
    Background and objectives: Despite their availability without prescription, OTC medications pose a risk for significant harm for older adults due to higher likelihood of polypharmacy, drug interactions, and age-related physiological changes. The purpose of this study is to identify the individual decision factors that influence how older adults select and use over-the-counter medications. Methods: A pilot study was conducted with 20 community-dwelling older adults. Older adults met the interviewer at a regional mass merchandise store where they were given both pain and insomnia standardized scenarios. Participants described how they would select and then hypothetically use a given medication to treat the problem described in the scenario. Results: OTC medication selection and reported use were influenced by several person-level decision-making factors including: personal beliefs/knowledge about OTCs, assessment of the ailment, and medical constraints. Conclusion: The findings from this investigation provide direction for interventions to address unsafe OTC medication selection by older adults.