A review of interventions used to improve adherence with medication in older

Background: Medication mismanagement is a continuous problem particularly in older people. Numerous interventions have been developed and tested in an attempt to improve adherence with medication in this client group. Objectives: This review aimed to examine the simple to complex interventions that have been used to assess and improve adherence with medication in older people. Design: An extensive review of the literature was performed and 20 relevant research papers and one report were chosen. Findings: Research papers were evaluated according to design, RCTs were analysed using the JADAD scoring system, systematic reviews and reviews of the literature were reviewed using the Critical Appraisal Skills Programme and subjected to a narrative analysis. This process assisted the development to emerging themes. Four themes were developed: patient barriers, health professional involvement, and health related outcomes and formation giving. Conclusions: The salient findings of the review infer that there is no clear definition of non–adherent behavior. Quantitative interventions fail to assess patient choice in relation to medication taking. Pharmacist-driven interventions are resource intensive. Health care outcomes and clinical effectiveness are seldom addressed in interventions. Among the many difficulties encountered when attempting to use interventions to promote adherence with medication in older people is their perceptions and beliefs, the appropriateness of the medicines prescribed as well as the impact of lifestyle patterns; smoking, alcohol and diet. Many intervention studies are of poor quality and do not include a theoretical framework to underpin the interventions being used. More focused research is needed to improve understanding of the theoretical knowledge that underpins the complexities of adherence with medication in older people. In-depth qualitative studies can be used to develop such theory. In addition, the quality of intervention research can be improved by the inclusion of a research framework such as the Medical Research Council model

Multimodal Shared-Control Interaction for Mobile Robots in AAL Environments

This dissertation investigates the design, development and implementation of cognitively adequate, safe and robust, spatially-related, multimodal interaction between human operators and mobile robots in Ambient Assisted Living environments both from the theoretical and practical perspectives. By focusing on different aspects of the concept Interaction, the essential contribution of this dissertation is divided into three main research packages; namely, Formal Interaction, Spatial Interaction and Multimodal Interaction in AAL. As the principle package, in Formal Interaction, research effort is dedicated to developing a formal language based interaction modelling and management solution process and a unified dialogue modelling approach. This package aims to enable a robust, flexible, and context-sensitive, yet formally controllable and tractable interaction. This type of interaction can be used to support the interaction management of any complex interactive systems, including the ones covered in the other two research packages. In the second research package, Spatial Interaction, a general qualitative spatial knowledge based multi-level conceptual model is developed and proposed. The goal is to support a spatially-related interaction in human-robot collaborative navigation. With a model-based computational framework, the proposed conceptual model has been implemented and integrated into a practical interactive system which has been evaluated by empirical studies. It has been particularly tested with respect to a set of high-level and model-based conceptual strategies for resolving the frequent spatially-related communication problems in human-robot interaction. Last but not least, in Multimodal Interaction in AAL, attention is drawn to design, development and implementation of multimodal interaction for elderly persons. In this elderly-friendly scenario, ageing-related characteristics are carefully considered for an effective and efficient interaction. Moreover, a standard model based empirical framework for evaluating multimodal interaction is provided. This framework was especially applied to evaluate a minutely developed and systematically improved elderly-friendly multimodal interactive system through a series of empirical studies with groups of elderly persons

Touch screen technology adoption and utilisation by educators in early childhood educational institutions

The adoption of information and communication technology (ICT) in early childhood educational settings, in particular touch screen technology such as interactive whiteboards and tablet computing devices has potential for use within early childhood educational institutions. We conducted a literature review in order to understand what literature currently exists in this research area. The nature of ICT implementations as a dynamic, complex process and organizational innovations were considered when examining articles. We demonstrate that there is a significant gap in the body of knowledge in regards to touch screen technology in early childhood, particularly from a process perspective, and suggest that further research is required to understand the interplay between individual actions and organisation structural influences to the development of understanding that can support the successful implementation of touch screen technology within early childhood educational institutions

Hypertensive Black Men\u27s Perceptions of a Nurse Administered Medication Protocol

Abstract Hypertension in the elderly population is a serious problem with approximately 65 million hypertensive adults in the United States. One important factor contributing to uncontrolled hypertension in the elderly population is medication non-adherence. The director of a cardiology clinic in Southern Georgia noted that older Black male patients were not taking their blood pressure medication as prescribed and as result had uncontrolled hypertension. It was proposed that a nurse protocol with tools to address non-adherence was an approach to address this problem. This qualitative key informant study identified a purposive sample of 10 Black men 65- 70 with a primary diagnosis of hypertension that was non-adherent in taking their hypertensive medication. The nurse conducted individual 45 minute teaching session with each participant that included tools to help them take their medication. A 15 minute follow-up phone call was done after one week. Participants were then interviewed about their perception of taking hypertensive medication. The interviews were recorded, transcribed, and coded for themes using constant comparative analysis. Six themes emerged: Medication Bottle Guides Medication Usage; Confusion about Side Effects; Reasons for Not Taking Medications; New Behavior; Unchanged Behavior, and Discovery of Other Problems. The overall result was that older Black men perceived that they were more adherent in taking their hypertensive medication following a nurse administered medication protocol. Key terms: Hypertensive, uncontrolled hypertensive, medication compliance, medication adherence, hypertensive in black men, and medication adherence protoco

Use of Grounded Theory in Cardiovascular Research

While grounded theory is often cited in the qualitative literature as the methodology, there are few good examples of publications that follow the principles of grounded theory and result in an actual theory. The purpose of this paper is to demonstrate how the Corbin and Strauss (2015) method of grounded theory was used in a study looking at how patients with cardiovascular disease and diabetes develop health literacy skills that are used to manage their condition. The key principles of grounded theory include theoretical sampling, constant comparison, open, axial, and selective coding, the use of memoing, and theoretical saturation. Data collection in this study was in the form of semi-structured interviews of 16 patients with cardiovascular disease and diabetes, and 19 healthcare professionals that care for or educate these patients. Patients were recruited from a primary care medical practice, a cardiology medical practice, patient focused programs provided by the American Heart Association, and social media. Healthcare professionals were recruited from the medical practices, the American Heart Association, and social media. Each interview was recorded, transcribed, and coded. Insights from these interviews led to the development of the health literacy instructional mode, which explores the use of digital tools, instructional approaches, social support, and self-directed learning in the development of health literacy skills, and is an example of the use of grounded theory in cardiovascular research

Interactive simulator for e-Learning environments: a teaching software for health care professionals

There is an established tradition of cardiovascular simulation tools, but the application of this kind of technology in the e-Learning arena is a novel approach. This paper presents an e-Learning environment aimed at teaching the interaction of cardiovascular and lung systems to health-care professionals. Heart-lung interaction must be analyzed while assisting patients with severe respiratory problems or with heart failure in intensive care unit. Such patients can be assisted by mechanical ventilatory assistance or by thoracic artificial lung. "In silico" cardiovascular simulator was experimented during a training course given to graduate students of the School of Specialization in Cardiology at \u27Sapienza\u27 University in Rome. The training course employed CARDIOSIM(C): a numerical simulator of the cardiovascular system. Such simulator is able to reproduce pathophysiological conditions of patients affected by cardiovascular and/or lung disease. In order to study the interactions among the cardiovascular system, the natural lung and the thoracic artificial lung (TAL), the numerical model of this device has been implemented. After having reproduced a patient\u27s pathological condition, TAL model was applied in parallel and hybrid model during the training course. Results obtained during the training course show that TAL parallel assistance reduces right ventricular end systolic (diastolic) volume, but increases left ventricular end systolic (diastolic) volume. The percentage changes induced by hybrid TAL assistance on haemodynamic variables are lower than those produced by parallel assistance. Only in the case of the mean pulmonary arterial pressure, there is a percentage reduction which, in case of hybrid assistance, is greater (about 40%) than in case of parallel assistance (20-30%). At the end of the course, a short questionnaire was submitted to students in order to assess the quality of the course. The feedback obtained was positive, showing good results with respect to the degree of students\u27 learning and the ease of use of the software simulator

An Educational Intervention to Increase Advance Directive Completion

In the United States, it is common for patients to receive prolonged, aggressive medical care at the end of life (Levi & Green, 2010). This level of medical care may or may not be in alignment with patients’ wishes. Advance directives developed as a response to this situation. Despite the widespread availability of advance directives and the impetus for health care facilities to discuss advance directives with patients, most Americans do not have a completed advance directive. The average completion rate for advance directives in all populations in the United States is about 25% (Silveira, Witala, & Piette, 2014). This study supports earlier work suggesting that patient education to increase completion of advance directives should include a discussion with a provider along with written education. The study demonstrated a significant increase in advance directive completion for patients who received this educational intervention compared to patients who did not. Limitations of this project include a small sample of cardiology patients that may not be representative of the general population. The study also did not address an assessment of patients’ knowledge about advance directives resulting from the intervention. The greatest implication of this study is that education for patients that includes a discussion with a provider as well as written information, if expanded throughout a hospital system, has the potential to greatly increase the completion of advance directives

Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals

Objective: To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. Materials and Methods: A prospective observational study in Dutch hospitals using BCMA to administer medication. Direct observation was used to collect data. Primary outcome measure was the proportion of medication administrations with one or more medication administration errors. Secondary outcome was the frequency and types of workarounds and medication administration errors. Univariate and multivariate multilevel logistic regression analysis were used to assess the association between workarounds and medication administration errors. Descriptive statistics were used for the secondary outcomes. Results: We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%). Discussion: Workarounds are associated with medication administration errors in hospitals using BCMA. These data suggest that BCMA needs more post-implementation evaluation if it is to achieve the intended benefits for medication safety. Conclusion: In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors