Addressing issues with medications compliance amongst seniors in the community

Transcription

1 Addressing issues with medications compliance amongst seniors in the community Dr Caroline Bulsara 1,2, Ms Anne McKenzie 2, Professor Jon Emery 2 1. Brightwater Care Group 2.The University of Western Australia

2 Consumer and community involvement Collaboration with the Health Consumers Council WA to hold three community forums to: Inform the community about the research Invite input into the issues around medications safety that consumers thought the researchers should study Invite ongoing involvement in the following 3 ways: Consumer Panel Focus groups Questionnaire Health Consumers Council WA

3 Consumer Panel established Focus groups identified 3 core interacting themes Panel met regularly with researchers Provided input into 6 focus groups and research findings Generic medicines Safe use of medicines Packaging & labelling

4 Methodology Those who attended the forums (N=104) were invited to participate in the focus groups. A series of six focus groups were organised and facilitated over a three month period. Overall, 58 participants attended the focus groups. There were six focus groups each with a different theme for discussion. Themes for focus groups as decided upon by the panel and researchers were as follows: The role of GP and pharmacist in managing medicines. Side effects and interactions. Over the counter and complementary medicines. Chronic illness self management. Chronic illness accessing information. Carer specific issues with medication safety.

5 Key issues around medications compliance Time factor during appointments. The role of GP and pharmacist time factors etc. GP reactions to concerns over side effects. Reviews and opportunity to discuss prescribing practices. Accessing the right information about medications. Concealing information from GPs.

6 The time factor Both implicit and explicit time issues during the consult meant that seniors were unwilling to discuss problems at length. I don t like it when the doctor stands up and walks towards the door. In other words, it is time you went! Time also impacted on care for some participants. One became ill due to being unable to obtain a doctor s appointment for a follow up post discharge. I wasn t very happy but what can you do when there are no doctors about?

7 The perceived role of the GP If you ve known a GP for a long time it is an advantage because you can ask any questions about your illness. Seniors value a longer term relationship with their GP for a number of reasons. Seniors struggled to adapt to the perceived changing face of modern general practice. Just take your pick with the part time ones who come and go. I don t like feeling that there is no ongoing care.

8 Preference for pharmacy advice Part time GPs and larger practices - more difficult to establish a relationship with GP. Many had long term relationship with a pharmacist instead of the GP. Pharmacist was perceived to be more knowledgeable than GP with medicines. He knows more about the drugs than the doctor does. He has the facilities for you to pick up the phone if you don t understand the doctor. Or if the doctor hasn t had time to tell you or even if the doctor hasn t understood it.

9 Side effects and interactions You just have to learn to live with it. GP noted as trivializing patient adverse reactions. GPs unlikely to advise on food interactions with medicines. Seniors unable to get urgent appointments with GP when side effects were noted. Tendency to split medicines and self-dose / alter dosage without notifying GPs. Well you know your own self and your own health and when they say things like that it makes it a bit annoying. It would be the same with what P said about putting on weight. If I went as well they would say oh well that s just a middle aged thing or whatever, but it s not necessarily that at all, so it s getting them to listen really.

10 GP prescribing practices Samples of a medicine should be more readily available - Perceived cost saving. Waste problematic - seniors stop taking a medicine due to a side effect or adverse reaction. Repeat prescriptions were charged for and no updated tests performed. Incorrect diagnoses meant unplanned repeat visits to the GP which had to be paid for each time. Referrals were sometimes not essential - an unnecessary cost to seniors. Health checks regular health checks were regarded as reassuring. I think it is important with chronic illness to have a regular review because it is very easy to think nothing has changed I ve had whatever for 20 years but a good look means that something might have changed and things do change!

11 Accessing the right information Difficulties in gaining access to information about a new treatment or medication. You have to do the research yourself as it is very difficult to make a choice. You are left in limbo and then you don t know where to go and are left feeling very confused. There was also an element of mistrust amongst participants with regard to pharmaceutical companies. And that s true too, not necessarily a new drug, not necessarily a better drug. It s just sometimes just a new drug. And it s about making money and it s not necessarily a benefit. And it s which drug reps walk through the door lately too sometimes.

12 Concealing information Dividing tablets. No continuity meant reluctance to share information. Trust issues. Confusion with tablets and multiple medicines not disclosed. Use of complementary and alternative meds not disclosed.

13 Recommendations from the Consumer Panel The organisation tends to target the client and not the GPs. It should be the other way round with medication safety. GPs should have access to the organisations with the current information. GP time limited have a designated person within the practice to monitor medicines and respond to queries as and when required. They would: take calls and answer queries / concerns Provide a point of reference for carers and seniors to check on dosages, sort out any confusion regarding generics, organise repeat prescriptions and facilitate better community quality use of medicine. More resources needed to address concerns amongst seniors about medicines, side effects and interactions between other medicines and food. More focus on Home Medicine Reviews and awareness regarding confusion about generic medicines. Sensitivities towards seniors specific issues. Better access to credible health information including CMIs.

14 The team would like to specially acknowledge the help and expert advice of the seniors consumer panel in this project. Thankam Abraham, Hope Alexander, Dorothy Broun-Barton, Ellen Dzienisz, Beatrice Hitt, Beth Solich, Bill Solich, Bill Morris, Ruth Kershaw, Mike Watteau.

15 Acknowledgement of contributors to the consumer and community participation strategy The Consumer Panel Thankam Abraham, Dorothy Broun-Barton, Ellen Dzienisz, Beatrice Hitt, Ruth Kershaw, Bill Morris, Beth Solich, Bill Solich, Mike Watteau. The Health Consumers Council WA Michele Kosky, Cheryl Rugdee, Maxine Drake, Beatriz Cuesta-Briand, Rosemary Caithness, Laura Elkin, Tim Benson. The Researchers D Arcy Holman, Jon Emery, James Semmens, Di Rosman, David Preen, Frank Sanfillipo, Max Bulsara, Rachael Moorin, Caroline Bulsara, Kristjana Einarsdottir, Sylvie Price, David Gibson, Qun Mai, Shauna Trafalski, Jennifer Dodd, Raelene Reeve. The Health Professionals Nick Bretland, Amanda Bryce, Mark Coles, Helen Brown. All Forum Attendees and Focus Group Participants Contact: Caroline.bulsara@brightwatergroup.com