Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands; Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands; Research Group Innovation in Pharmaceutical Care, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, PO Box 12011, 3501, AA, Utrecht, the Netherlands.
Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands.
Res Social Adm Pharm. 2022 Mar;18(3):2410-2423. doi: 10.1016/j.sapharm.2020.09.004. Epub 2020 Sep 16.
Medication self-management is complicated for older people. Little is known about older persons' considerations and decisions concerning medication therapy at home.
(s): To explore how older people living at home self-manage their medication and what considerations and decisions underpin their medication self-management behavior.
Semi-structured interviews with consenting participants (living at home, aged ≥65, ≥5 different prescription medications daily) were recorded and transcribed with supporting photographs. Content was analyzed with a directed approach and presented according to three phases of medication self-management (initiation, execution, and discontinuation).
Sixty people were interviewed. In the initiation phase, participants used different techniques to inform healthcare professionals and to fill and check prescriptions. Over-the-counter medication was seldom discussed, and potential interactions were unknown to the participants. Some participants decided to not start treatment after reading the patient information leaflets for fear of side effects. In the execution phase, participants had various methods for integrating the use of new and chronic medication in daily life. Usage problems were discussed with healthcare professionals, but side effects were not discussed, since the participants were not aware that the signs and symptoms of side effects could be medication-related. Furthermore, participants stored medication in various (sometimes incorrect) ways and devised their own systems for ordering and filling repeat prescriptions. In the discontinuation phase, some participants decided to stop or change doses by themselves (because of side effects, therapeutic effects, or a lack of effect). They also mentioned different considerations regarding medication disposal and disposed their medication (in)correctly, stored it for future use, or distributed it to others.
Participants' considerations and decisions led to the following: problems in organizing medication intake, inadequate discussion of medication-related information with healthcare professionals, and incorrect and undesirable medication storage and disposal. There is a need for medication self-management observation, monitoring, and assistance by healthcare professionals.
老年人的药物自我管理较为复杂。对于老年人居家药物治疗的考虑因素和决策，我们知之甚少。
（s）：探索居家的老年人如何自我管理药物，以及支撑其药物自我管理行为的考虑因素和决策。
对同意参与的（居住在家、年龄≥65 岁、每天服用≥5 种不同的处方药）参与者进行半结构化访谈，并录制和转录访谈内容，同时附有支持性照片。采用定向方法对内容进行分析，并根据药物自我管理的三个阶段（启动、执行和停止）进行呈现。
共对 60 人进行了访谈。在启动阶段，参与者使用不同的技术来告知医疗保健专业人员并填写和检查处方。他们很少讨论非处方药，并且参与者并不知道潜在的相互作用。一些参与者在阅读患者用药说明书后决定不开始治疗，因为担心副作用。在执行阶段，参与者有各种方法将新处方和慢性病药物融入日常生活。他们与医疗保健专业人员讨论用药问题，但不讨论副作用，因为参与者不知道副作用的迹象和症状可能与药物有关。此外，参与者以各种（有时不正确）的方式储存药物，并自行设计了订购和补充重复处方的系统。在停止阶段，一些参与者自行决定停止或改变剂量（因为副作用、治疗效果或缺乏效果）。他们还提到了关于药物处置的不同考虑因素，并错误地处理了他们的药物，将药物储存起来以备将来使用，或者将药物分发给其他人。
参与者的考虑因素和决策导致以下问题：组织药物摄入方面存在问题、与医疗保健专业人员对药物相关信息的讨论不足、以及不正确和不理想的药物储存和处置。医疗保健专业人员需要对药物自我管理进行观察、监测和协助。
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