University of Wisconsin-Madison School of Pharmacy, Social and Administrative Sciences Division, 777 Highland Ave., Madison, WI, USA.
Sonderegger Research Center, University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave., Madison, WI, USA.
Res Social Adm Pharm. 2021 Dec;17(12):2116-2126. doi: 10.1016/j.sapharm.2021.07.005. Epub 2021 Jul 7.
Adults aged 65+ (older adults) disproportionately consume 30% of over-the-counter (OTC) medications and are largely responsible for making OTC treatment decisions because providers lack awareness of their consumption. These treatment decisions are complex: older adults must navigate age-related body/cognitive changes, developed comorbidities, and complex medication regimens when selecting the right OTC. Yet little is known about how older adults make such decisions.
This study characterizes older adults' cognitive decision-making process when seeking to self-medicate with OTCs from their community pharmacy, and demonstrates how hierarchical task analysis (HTA) can be used to evaluate a pharmacy intervention's impact on their decision-making.
A pre-/post-implementation approach, using a think-aloud interview process, was conducted with older adults within a community pharmacy setting as they completed a hypothetical scenario to treat either pain, sleep, or cough/cold/allergy symptoms. HTA developed a conceptualization of older adult decision-making regarding OTC selection and use before/after Senior Section implementation.
An HTA constructed from 12 purposefully-selected interviews (pre-n = 9/post-n = 3), consisting of 8 goals/15 sub-goals. While selecting an OTC, older adults considered quantity, cost, form, regimen, safety, strength, appropriateness of OTC safety, generic/name-brand, past experiences, and ingredients. The intervention reduced by half the number of factors considered.
Older adult decision-making is more complex than just selecting OTC medication from a pharmacy shelf. HTA-informed decision profiles can provide pharmacists critical insights into safety issues that older adults may not be considering (e.g., factors related to safety, strength, or appropriateness of OTC for symptoms) so that pharmacists can support their decision-making.
65 岁及以上的成年人（老年人）不成比例地消费了 30%的非处方（OTC）药物，并且在很大程度上负责做出 OTC 治疗决策，因为提供者缺乏对他们消费的了解。这些治疗决策很复杂：老年人在选择合适的 OTC 时，必须应对与年龄相关的身体/认知变化、已有的合并症和复杂的药物治疗方案。然而，人们对老年人如何做出这些决策知之甚少。
本研究描述了老年人在从社区药房自我用药时的认知决策过程，并展示了如何使用层次任务分析（HTA）来评估药房干预对他们决策的影响。
在社区药房环境中，使用出声思维访谈过程，对老年人进行了预/后实施方法，让他们完成一个假设情景，以治疗疼痛、睡眠或咳嗽/感冒/过敏症状。HTA 构建了一个关于老年人在 Senior Section 实施前后对 OTC 选择和使用的决策概念化。
从 12 次有针对性的访谈（预 n=9/后 n=3）中构建了一个 HTA，包括 8 个目标/15 个子目标。在选择 OTC 时，老年人考虑了数量、成本、形式、治疗方案、安全性、强度、OTC 安全性的适当性、通用/品牌名称、过去的经验和成分。干预措施将考虑的因素数量减少了一半。
老年人的决策比仅仅从药店货架上选择 OTC 药物要复杂得多。HTA 驱动的决策分析可以为药剂师提供有关老年人可能没有考虑的安全问题的关键见解（例如，与安全性、强度或 OTC 对症状的适当性相关的因素），以便药剂师可以支持他们的决策。
