Browsing by Subject "medications"

Now showing 1 - 4 of 4
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    Evaluation of a “Meds-to-Beds” program on 30-day hospital readmissions
    (ACCP, 2020-05) Zillich, Alan J.; Jaynes, Heather A.; Davis, Hannah B.; Lantaff, Wendy M.; Myers, Jaclyn; Perkins, Susan M.; Shan, Mu; Snyder, Margie E.; Biostatistics, School of Public Health
    Background Effective programs for transitional care from hospital to home are needed to improve patient outcomes. Purpose To evaluate readmissions among patients who received a medication discharge program compared with control patients who did not receive the program. Methods This was a retrospective, observational cohort study during a 1-year period in a medium-sized Midwestern health system. The “meds-to-beds” program consisted of a pharmacist and/or technician delivering patient's medications to bedside prior to discharge. When indicated, the pharmacist provided medication counseling, reviewed discharge medications, and provided an updated medication list to patients. The intervention cohort was defined as all hospitalized patients eligible for and opting into the “meds-to-beds” program. The control cohort was defined as hospitalized patients eligible for the program who did not opt-in to receive it. Data were collected through both a retrospective chart review and an administrative claims data warehouse. The primary outcome was defined as any 30-day readmissions. Secondary outcomes were defined as any preventable 30-day readmissions using the Agency for Healthcare Research and Quality's potentially avoidable hospitalization for ambulatory care sensitive conditions classification. Multivariable logistic regression models examined the odds of 30-day readmissions between the intervention and control groups. Results Data were collected for 500 intervention and 1591 control patients. Both groups were similar with respect to age, gender, race, co-morbid conditions, and previous health care utilization. In the multivariable model, all-cause readmissions within 30 days were not significantly different between the intervention and control groups (odds ratio [OR] = 0.67; 95% confidence interval [CI]: 0.42-1.07, P = .09). The most common preventable readmissions were for pneumonia (43.2%), heart failure (18.9%), and dehydration (16.2%). In the multivariable model, patients in the intervention group were less likely to be readmitted for a preventable cause within 30-days than patients in the control group (OR = 0.49; 95% CI: 0.28-0.89, P = .02). Conclusion This “meds-to-beds” program was not associated with a significant reduction in 30-day all-cause readmissions but was associated with a reduction in 30-day preventable hospital readmissions.
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    Examining adherence to oral anticancer medications through a human factors engineering framework: Protocol for a scoping review
    (PLOS, 2022-09-22) Lin, Irene D.; Shotts, Matthew B.; Al-Hader, Ahmad; Weddle, Kellie Jones; Holden, Richard J.; Mueller, Emily L.; Macik, Monica R.; Ramirez, Mirian; Abebe, Ephrem; Medicine, School of Medicine
    Background The number of oral anticancer medications has increased over the past few decades, opening new possibilities in cancer care and improving convenience for patients and caregivers. However, adherence levels continue to be suboptimal, potentially jeopardizing therapeutic benefits. Poor adherence levels may indicate gaps in current strategies and interventions aimed at enhancing medication adherence and the extent to which they address the complex and multi-faceted medication management needs of patients and their caregivers. Beyond commonly understood barriers (e.g., forgetting to take medications), adherence interventions must address systemic barriers that may not be fully appreciated by members of the healthcare system. This scoping review aims to apply a systems framework (human factors engineering framework) to examine system elements targeted by adherence enhancing interventions. Methods Studies published in English, reporting adherence interventions for oral anticancer medications with adherence and/or persistence as primary outcome measures will be included in this review. We will search the following electronic databases with no limits on dates: Ovid MEDLINE, Cochrane Library, Web of Science Core Collection, Embase, CINAHL Complete, PsycInfo, and Scopus. Two reviewers will independently screen study titles and abstracts for inclusion with a third reviewer adjudicating conflicts. Full text of included articles will be used to extract information on systemic barriers targeted by adherence interventions as well as information about intervention type, outcomes, and study characteristics. Extracted information will be synthesized to generate a summary of work system factors targeted by adherence interventions. Discussion Through application of a systems-based approach, this scoping review is expected to shed light on the complex and multifaceted nature of factors influencing adherence to oral anticancer agents. The review may also identify areas that are ripe for further research.
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    Provider Beliefs, Practices, and Perceived Barriers to Dietary Elimination Therapy in Eosinophilic Esophagitis
    (Wolters Kluwer, 2022-09-01) Chang, Joy W.; Kliewe, Kara; Katzka, David A.; Peterson, Kathryn A.; Gonsalves, Nirmala; Gupta, Sandeep K.; Furuta, Glenn T.; Dellon, Evan S.; Pediatrics, School of Medicine
    INTRODUCTION: Despite effective dietary treatments, physicians prefer medications for eosinophilic esophagitis (EoE). METHODS: We conducted a web-based survey of providers to assess the perceived effectiveness, practice patterns, and barriers to EoE dietary therapy. RESULTS: Providers view diet as the least effective treatment. The greatest barrier was the belief that patients are disinterested and unlikely to adhere (58%). With less access to dietitians (56%), non-academic providers often manage diets without dietitian guidance (41%). CONCLUSIONS: Given high patient acceptance for diets and multiple treatment options for EoE, clinicians need evidence-based knowledge on EoE diets, access to dietitians, and awareness of patient preferences.
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    Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults
    (Elsevier, 2019) Holden, Richard J.; Campbell, Noll L.; Abebe, Ephrem; Clark, Daniel O.; Ferguson, Denisha; Bodke, Kunal; Boustani, Malaz A.; Callahan, Christopher M.; Medicine, School of Medicine
    Background Mobile health technology can improve medication safety for older adults, for instance, by educating patients about the risks associated with anticholinergic medication use. Objective This study's objective was to test the usability and feasibility of Brain Buddy, a consumer-facing mobile health technology designed to inform and empower older adults to consider the risks and benefits of anticholinergics. Methods Twenty-three primary care patients aged ≥60 years and using anticholinergic medications participated in summative, task-based usability testing of Brain Buddy. Self-report usability was assessed by the System Usability Scale and performance-based usability data were collected for each task through observation. A subset of 17 participants contributed data on feasibility, assessed by self-reported attitudes (feeling informed) and behaviors (speaking to a physician), with confirmation following a physician visit. Results Overall usability was acceptable or better, with 100% of participants completing each Brain Buddy task and a mean System Usability Scale score of 78.8, corresponding to “Good” to “Excellent” usability. Observed usability issues included higher rates of errors, hesitations, and need for assistance on three tasks, particularly those requiring data entry. Among participants contributing to feasibility data, 100% felt better informed after using Brain Buddy and 94% planned to speak to their physician about their anticholinergic related risk. On follow-up, 82% reported having spoken to their physician, a rate independently confirmed by physicians. Conclusion Consumer-facing technology can be a low-cost, scalable intervention to improve older adults’ medication safety, by informing and empowering patients. User-centered design and evaluation with demographically heterogeneous clinical samples uncovers correctable usability issues and confirms the value of interventions targeting consumers as agents in shared decision making and behavior change.