Implementation of a medication adherence program in senior public housing facilities utilizing pharmacists and health educators

Background: Hypertension and diabetes disproportionately impact people of color when compared to majority populations. Medication adherence among seniors with chronic diseases has been suboptimal with the estimation that only half of those taking antihypertensives are adherent. Therefore, the purpose of The Managing Your Medications (MY Rx) program was to evaluate the effectiveness of evidence-based practices used to improve rates of medication adherence through information dissemination among diabetic and hypertensive African American, Asian American, and Hispanic residents housed in senior public housing facilities in the Greater Houston Area. The program comprised an 8-week intervention with individual and group components with small incentives provided throughout the program. Individual components included one home visit and telephone consultations conducted by pharmacists. Health educators provided two group education sessions on lifestyle modifications.&nbsp;Result: Qualitative analysis of focus group discussions revealed participant satisfaction with the MY Rx program and willingness to change after participation in the program.&nbsp;Conclusion: The Rx program showed the potential effectiveness of an innovative strategy in medication counseling using interdisciplinary pharmacists and health educators to promote health. It demonstrated the importance of using the patient-centered care framework in designing a community intervention program.&nbsp;</p

Addressing power dynamics in community-engaged research partnerships

Background: Successful community-engaged research depends on the quality of the collaborative partnerships between community -members and academic researchers and may take several forms depending on the purpose which dictates the degree to which power dynamics are handled within the collaborative arrangement. Methods: To understand the power dynamics and related concepts within community-engaged research arrangements, a secondary analysis of an existing qualitative data set was undertaken. Two models of community-engaged research, a review of literature, and the applied experiences of researchers familiar with community engagement practices confirmed the power dynamics concepts used to carry out the analysis of the qualitative data set according to the principles of directed content analysis. This analysis yielded quotes on power dynamics and related issues. Tools to address the power dynamics exposed by the quotes were selected using the literature and lived experience of the researchers. Finally, to ensure trustworthiness, the selected quotes on power dynamics and the recommended tools were subjected to naturalistic treatment using peer debriefings and triangulation. Results: Analysis of existing qualitative data made clear that community-engaged research between health practitioners and communities may take several forms depending on the purpose and dictate how power dynamics, including inequities, biases, discrimination, racism, rank and privilege, are handled within the collaborative arrangement. Three tools including implicit bias training, positionality, and structural competency may be used to address power dynamics and related concepts. Conclusion: Analysis of the qualitative data set highlighted the power dynamics within different community-engaged research models and the tools that may be used to address inequitable power dynamics including implicit bias training, positionality, and structural competency

A Qualitative Analysis to Understand Perception about Medication-Related Problems among Older Minority Adults in a Historically Black Community

Older adults taking multiple chronic medications experience an increased risk of adverse drug events and other medication-related problems (MRP). Most current literature on medication management involves researcher-driven intervention, yet few studies investigate patients&rsquo; understanding of MRP in a diverse community setting. This report investigates patients&rsquo; perception of MRP and patient-centered strategies among a cohort of the older adult group in a historically Black urban community. The study design is qualitative using structured open-ended questions in a multidisciplinary patient-centered focus group. Patients (age 65 years or older) taking seven or more medications were recruited. The group comprises patients, caregivers, pharmacists, health educators, a physician, and a nurse. Recordings of the group discussion are transcribed verbatim and analyzed using thematic content analysis and categorized by codes developed from the social-ecological model. The group reports patient-provider relationships, previous experience, fear of side effects played important roles in medication adherence. There is an unmet need for medication management education and tools to organize complex medication lists from multiple providers. This study provides important insights into MRP experienced by minority older adults and provided researchers with potential strategies for future interventions

Building Community-Engaged Multidisciplinary Partnerships to Improve Medication Management in Elderly Patients With Multiple Chronic Conditions

Purpose: Many studies in preventing adverse drug events have been researcher-driven, yet few have engaged patients in the development of a project. This project aims to engage minority elderly patients with multiple chronic conditions in the development of research questions and strategies to improve medication safety. Methods: Elderly patients (≥ 65 years old) who were prescribed 7 or more chronic medications were recruited through a university-based aging resource network in a historically African American community in Houston, Texas. Patients and a caregiver participated in a multidisciplinary workgroup comprised of a physician, pharmacists, a nurse, health educators, and a social worker. Patients were engaged by utilizing the 4 patient-centered outcomes research engagement principles. The workgroup created a strategic plan, completed an environmental scan, identified research problems, and reviewed current evidence-based approaches in the literature. Workgroup findings were presented to a broader audience within a community town hall setting, and input was collected from a community-wide survey. Results: From April 2018 to July 2018, 3 patients and 1 caregiver participated in 5 multidisciplinary workgroup meetings. A total of 74 seniors attended the town hall meeting, and 69 completed the surveys. The most common drug-related problems among survey participants were doubts about drug advertisements (79%) and drug interactions (70%). Most participants (88%) were more comfortable in receiving face-to-face counseling compared to an app or virtual visits. Findings aided in developing 3 grant proposals. Conclusion: This narrative provides a roadmap for conducting multidisciplinary, patient-centered participatory research to refine research strategies in minimizing drug-related problems