Listen Carefully: Helping Patients Manage Their Meds
To treat his kidney disease, Duane Sunwold was taking about 18 pills a day. His half-dozen medications were each slotted according to a different pattern into breakfast, mid-morning, dinner, and bedtime batches. Sunwold, who teaches cooking at Spokane Community College in Washington State, says, “I found it very difficult to remember to take my medications when I wasn’t on a regular schedule.” He notes that for a period he was taking one of the medications incorrectly and became very ill.
Patients can struggle, as Sunwold did, with a medication regimen for even a single health problem, but many develop more than one chronic condition as they age. Each condition is likely to require a different set of medications, taken on a specific schedule. As the number of medications increases, so does the complexity of pill regimen. And as patients age, they may have even more difficulty staying on top of the routine.
Washington State University (WSU) researcher Roxanne Vandermause, PhD, RN, CARD, CCM, says to help older patients manage the wide array of drugs they take, healthcare providers need to learn how patients think about their medications. “The medication-taking perspectives of older adults with chronic conditions are poorly understood,” Vandermause notes.
Vandermause and WSU pharmacist Joshua J. Neumiller ara leading a team of researchers and community partners, including Sunwold, seeking to get a clearer picture of these perspectives.
“We’re looking at what it’s like for a patient to manage multiple medications, and, more importantly, what does it mean for the patient?” Vandermause explains.
The stakes are particularly high for patients with diabetes, asthma, heart ailments, and other chronic illnesses that can be well controlled by medication. Patients themselves largely determine when or whether they take their medications, so these individual decisions can have a profound impact on symptoms, as well as hospitalization and death rates.
“Whereas doctors prescribe medications to achieve certain clinical indicators—such as keeping blood sugar levels in a healthy range—patients are struggling with everyday life,” Vandermause says.
Participants in the WSU project are patients over age 60 who have at least three chronic medical conditions and take five or more medications. To capture their thoughts and behaviors related to their medications in real time, the research team provided iPads to the study’s 30 participants.
For a month after the patients received new prescriptions, the iPads prompted them daily to answer a series of true-false or multiple-choice questions about taking their drugs. They could also make a voice recording of additional thoughts. The researchers conducted in-depth interviews with half of the patients and plan to discuss all their findings with panels of healthcare providers. Two ideas stand out from the preliminary analysis of interview results. The first is: “Who am I?” Vandermause describes this identity issue as: “The fact that I have multiple medications prescribed is something about me that I need to assimilate, adjust to, deny, or respond to in some other way.
“Some people are depressed when they look at their medication bottles, some are grateful that the drugs are saving their life, some take control by putting their medications in the plastic boxes with the days of the week, but even then, that box is something that has to be part of their everyday life,” Vandermause says.
The second idea is: “Who matters most?” The researchers were surprised by the widespread view that the doctor, not the patient, is most important in clinical interactions. Vandermause says, “How people interact with their doctor is of utmost importance, but we don’t really talk about it in the medical literature.”
When the team presented these findings at a recent meeting, many people expressed strong agreement. Vandermause reports, “They said, ‘I take a lot of medications, and that looks like me.’”
The community partners on the team also indicated that those observations rang true. Sunwold recalls, “I thought, ‘Oh, my gosh, they were just nailing it.’ Everything they’d summarized was so accurate to what you feel as a chronically ill patient. Your identity goes with your disease and the medications you take.”
Vandermause notes that Sunwold and the other community partners have been very influential in the project. For example, they tested out the iPads to make sure that they’d be easy for the study participants to use. They also helped craft the questions for the interviews and iPad diaries.
“The researchers were asking questions from a medical perspective,” Sunwold recalls. “I said, ‘Patients don’t think like this. You’ve got to change your terminology. You’ve got to put it in a patient world, not a medical world.’”
Vandermause notes that the project already has implications for the use of technology in other clinical research. The participants, even those in their 80s, had no trouble using iPad diaries. “We’re seeing this as a viable possibility for other interventions,” Vandermause says.
At a Glance
Medication-Taking Preferences & Practices of Patients with Chronic Conditions
Principal Investigator: Roxanne Vandermause, RN, CARD, CCM
Goal: Use patients’ attitudes toward medications to help doctors, nurses, and pharmacists guide people to achieve the best health.
Posted: November 7, 2013
