A community-based nurse-led medication self-management intervention in the improvement of medication adherence in older patients with multimorbidity: protocol for a randomised controlled trial

Abstract

Background Older patients suffering from multimorbidity are at high risk of medication nonadherence. It has been well established that self-management support is an effective strategy to enhance medication adherence for patients with chronic conditions. However, little is known about the effect of the medication self-management intervention in older patients with multimorbidity. This paper presents the protocol for a study that aims to evaluate the effectiveness of a nurse-led medication self-management intervention in improving medication adherence and health outcomes for community-dwelling older patients with multimorbidity. Methods The study protocol follows the recommendations of the Standard Protocol Items: Recommendations for Interventional Trials 2013 statement. This study is a multicentre, single-blind, two-arm randomised controlled trial. Older patients with multimorbidity will be recruited from three community health centres in Changsha, China. A total of 136 participants will be randomly allocated to receive usual care or usual care plus the medication self-management intervention. The intervention will be delivered by community nurses. The 6-week intervention includes three face-to-face education sessions and two weekly follow-up phone calls. Participants in the control group continue to receive all respects of usual care offered by community healthcare providers, including chronic disease management, drug prescription, referral to hospital specialists, health education and consultations regarding patients’ diseases and treatments during centre visits. The primary outcome is medication adherence as measured by the 5-item Medication Adherence Report Scale. Secondary outcomes include medication self-management capacity (medication knowledge, medication beliefs, medication social support, medication skills, and medication self-efficacy), treatment experiences (medication treatment satisfaction and treatment burden), quality of life, and utilisation of healthcare services. All outcomes will be measured at baseline, immediately post-intervention, and at 3-month post-intervention. Discussion This study will provide evidence about the effectiveness of a medication self-management intervention, delivered by nurses, for older patients with multimorbidity and adherence problems. It is expected that the results of the study, if proven effective in improving patients’ adherence and health outcomes, will provide evidence-based self-management support strategies for healthcare providers in routine chronic disease management in community settings. Trial registration The trial is registered at ChiCTR.org.cn (ChiCTR2000030011; date February 19, 2020).

Tools to measure barriers to medication management capacity in older adults: a scoping review

“…For distance functional vision, only visual acuity [95% CI – 0.69, – 0.29]; p 0.001) was statistically significant predictor. Yang, C., et al, [ 44 ] 2021 China Medication-Specific Social Support Questionnaire (MSSS) The Self-Efficacy for Appropriate Medication Use Scale (SEAMS) Protocol for a randomised controlled trial To implement an evidence-based, theory-informed, and nurse-led medication self-management intervention among older patients with multimorbidity and examine its effects in community settings. Community-dwelling older patients with multimorbidity.…”

“… 5-10 minutes Self-reported NA NA [ 95 ] + Age Household size Medication-taking errors. (External validity) 0.88 for the busyness scale and 0.74 for the routine scale Environmental Medication-Specific Social Support Questionnaire (MSSS) [ 44 ] To identify how often participants received help for their medication taking over a three-month period 8 items 0-4 NR Self-reported NA NA [ 96 ] + Various diseases, drugs 0.92 Multidimensional Scale of Perceived Social Support (MSPSS) [ 57 ] To assess an individual’s perception of the social support he or she receives from family, friends and significant others 12 item 7-point Likert type scale 5-10 minutes Self-reported NA NA [ 97 ] + 0.91 0.95 Perceived Social Support from Friends (PSS-Fr) and the Perceived Social Support from Family (PSS-Fa) [ 14 ] To measure the extent to which an individual perceives that his/her needs are fulfilled by friends and family 20 item 0-20 NR Self-reported NA NA [ 98 ] + …”

Comparative analysis of the prevalence 3-HIT concept in people living with HIV and seronegative patients with chronic conditions. Cross-3HIT Project.

“…The PAM tool, originally created by Hibbard et al , allows us to enquire about various aspects of knowledge and skills, as well as the patient’s beliefs related to their treatment and self-care, among other factors 21. There are already studies that indirectly relate training in treatment and improved adherence in elderly patients with multimorbidity patterns 22. In addition, there are articles that have found an association of lack of adherence to the presence of comorbidities and treatment-related factors such as polypharmacy 23…”

Association between medication literacy and medication adherence and the mediating effect of self-efficacy in older people with multimorbidity

“…Medication adherence, defined as patients taking their medications as prescribed, is essential to achieve optimal disease control [ 6 ]. Recent guidelines and studies have highlighted the importance of medication adherence as a cornerstone for managing and preventing long-term complications in patients with multimorbidity [ 7 , 8 ]. Timely, regular, and long-term adherence to medication could effectively improve symptoms and further control the development of the disease.…”

“…Timely, regular, and long-term adherence to medication could effectively improve symptoms and further control the development of the disease. Some studies [ 7 , 9 , 10 ] have also recognized that higher medication adherence could effectively improve multimorbidity patient’s quality of life, decrease complications and mortality. However, medication adherence is especially difficult to ensure, especially in the elderly.…”