Pharmaceutical Care Research Group, School of Pharmacy, University College Cork (UCC), Cork, Ireland.
School of Pharmacy, University College Cork (UCC), Cork, Ireland.
Res Social Adm Pharm. 2019 Dec;15(12):1425-1435. doi: 10.1016/j.sapharm.2019.01.004. Epub 2019 Jan 8.
Oral medicines are commonly modified (e.g. tablets split/crushed) to meet the dosing and swallowing requirements of older adults. However, there is limited research investigating the opinions of community-dwelling patients and carers about medicine modification.
The aim of this study was to investigate the views of community-dwelling older adults and their carers about oral medicine modification.
Semi-structured, face-to-face interviews were conducted with community-dwelling older adults and carers of older adults who experienced difficulty swallowing medicines, or who required medicines to be modified. Participants were recruited from purposively selected community pharmacies using a combination of purposive, convenience and snowball sampling. Interviews were audio-recorded, transcribed verbatim and analysed thematically. The Francis method governed when data saturation had been reached.
Twenty-six interviews (13 patients, 13 carers) were conducted (76.9% female, median length 11 min (IQR 8-16 min)). Four themes emerged from the data: variation in medical needs and preferences; balancing acceptance and resignation; healthcare professional engagement and; opportunities for optimising formulation suitability. The heterogeneity of medical conditions experienced by community-dwelling older adults resulted in a variety of modifications being required. Patients and carers are accepting of their medications and formulations. However, when challenges arise, they tend to feel resigned to coping within the constraints of the current medication regimen, resulting in a lack of focused communication with healthcare professionals. Thus, healthcare professionals were unaware of their difficulties and unable to offer advice or solutions.
Healthcare professionals must engage proactively with this group. Whilst a holistic approach to medication management is ideal, the disadvantage is that no single healthcare professional may identify this as their responsibility. Whilst the input and expertise of all healthcare professionals will be required, as medication experts, the pharmacy profession should take ownership and become the champion of, and for, the patient.
口服药物通常会进行修改（例如将片剂掰开/压碎），以满足老年人的用药剂量和吞咽需求。然而，关于社区居住的患者和护理人员对药物修改的意见，相关研究有限。
本研究旨在调查社区居住的老年人及其护理人员对口服药物修改的看法。
通过有针对性的、方便的和滚雪球的抽样方法，从社区药房中招募了有吞咽困难或需要修改药物的社区居住的老年人及其护理人员。对参与者进行了半结构化的面对面访谈。访谈以录音形式记录，逐字转录，并进行主题分析。当达到数据饱和时，采用弗朗西斯方法。
共进行了 26 次访谈（13 名患者，13 名护理人员；女性占 76.9%，中位数访谈时间为 11 分钟（IQR 8-16 分钟））。数据中出现了四个主题：医疗需求和偏好的变化；接受与无奈之间的平衡；医疗保健专业人员的参与；优化制剂适用性的机会。社区居住的老年人所经历的医疗状况的异质性导致需要进行各种修改。患者和护理人员对他们的药物和制剂持接受态度。然而，当出现挑战时，他们往往感到无奈，只能在当前药物治疗方案的限制内应对，导致与医疗保健专业人员缺乏有针对性的沟通。因此，医疗保健专业人员并不了解他们的困难，也无法提供建议或解决方案。
医疗保健专业人员必须积极与这一群体接触。虽然药物管理的整体方法是理想的，但缺点是没有单一的医疗保健专业人员可能将其视为自己的责任。虽然所有医疗保健专业人员的投入和专业知识都将是必要的，但作为药物专家，药房行业应该拥有并成为患者的拥护者和代表者。
