Medication-taking Preferences & Practices of Patients With Chronic Conditions

"Patients can easily be overwhelmed, confused and many times don't fully understand their need for new medications, or when the dosages are to be administered" (patient research partner quote). The long-term goal of this study is to refine medication science by developing patient-centered assessment, monitoring and management guidelines for patients and health professionals. The objective is to advance knowledge about the medication-taking perspectives, experiences, and behaviors of older adults with multiple chronic medical conditions (MCMC) to inform future research related to patient-centered medication prescribing, monitoring and management. This pilot study addresses the following PCORI interest area: "evaluating methods that can be used to assess the patient perspective when researching behaviors and choices within the patient's control that may influence outcomes." The rationale that underlies the proposed study is that medication-taking practices are wholly within patients' control, and are foundational to reducing complications and improving outcomes for those with MCMC. To meet the overall objective of this application, the following specific aims will be pursued: 1) identify perceptions and behaviors surrounding the medication-taking process of older adults with MCMC; and 2) generate an interpretation of the meaning of medication-taking among older adults with MCMC. To achieve these aims, data will be obtained in "real time" from patients (N=30) receiving a new prescription using smart phone technology. The smart phones will include prompts to help participants record thoughts about medication use throughout the day for 30 days. Findings from electronic diaries will be logged, analyzed and qualitatively analyzed. Some patients (n=15) will provide in-depth hermeneutic interviews to provide rich descriptions and interpretive commentary about the experience of receiving a new medication prescription. The objective is to uncover previously unidentified areas of common experience in older persons with multiple chronic conditions who have received a new prescription. Common experiences and patterns of influences, that are often surprising or unexpected, will be categorized and assessed. The expected outcomes of this pilot study are improved knowledge of medication-taking perceptions, experiences, and practices of older adults with MCMC-knowledge that is critical to advance patient-centered medication science.

Study Overview

• Status: Unknown
• Conditions: Adult Disease; Pharmacological Action; Any Condition in N73.0 Specified as Chronic
• Intervention / Treatment: Other: Electronic Diaries; Other: Hermeneutic Interviews

• Study Type: Observational
• Enrollment (Anticipated): 30

Contacts and Locations

• Study Contact: Name: Roxanne K Vandermause, PhD; Phone Number: 509-324-7281; Email: rvandermause@wsu.edu

Study Locations

• United States
  • Washington
    • Spokane, Washington, United States, 99201-4813
      • Recruiting
      • Providence Medical Research Center
      • Sub-Investigator: Katherine Tuttle, MD
      • Sub-Investigator: Gail Burton, RN
      • Sub-Investigator: Duane Sunwold
    • Spokane, Washington, United States, 99210-1495
      • Recruiting
      • Washington State University
      • Contact: Joshua J Neumiller, PharmD; Phone Number: 509-368-6756; Email: jneumiller@wsu.edu
      • Principal Investigator: Roxanne Vandermause, PhD
      • Sub-Investigator: Cynthia F Corbett, RN, PhD
      • Principal Investigator: Joshua J Neumiller, PharmD
      • Sub-Investigator: Prabu David, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Persons seen at the Providence Kidney Disease and Hypertension Clinic, aged 60 years or older, with 3 chronic conditions, taking 5 or more medications, and who receive a prescription for a NEW medication will be invited to participate in the 30 day study.

Description

Inclusion Criteria:

• 60 years of age or older
• Diagnosis of at least 3 chronic medical conditions
• Receiving 5 or more medications
• Receipt of a new prescription medication at enrollment
• Ability to speak English

Exclusion Criteria:

• Any individual that does not meet the 5 inclusion criteria listed above

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Study Cohort; All participants (N=30) will be asked to identify perceptions and behaviors surrounding the medication-taking process using technology-assisted prompts and recordings. Half (n=15) of the participants will participate in two hermeneutic interviews using an interpretive phenomenological approach to generate an interpretation of the meaning of medication taking.

Other: Electronic Diaries; Participants (N=30) will maintain electronic diaries to record spontaneous thoughts and perceptions regarding the use of a newly prescribed drug over 30 days.; Other: Hermeneutic Interviews; Half of the enrolled participants (n=15) will participate in 2 hermeneutic interviews conducted in an interpretive phenomonological approach to generate an interpretation of the meaning of medication taking.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Identify perceptions and behaviors surrounding the medication-taking process of older adults with MCMC.	Data will be obtained in "real time" in that patients will audio record thoughts as they arise in the course of each day using an electronic device, over 30 consecutive days, and will answer questions related to medication use. Findings from end of day prompts will be logged using tables that compare participant demographic characteristics, whether or not the new medication or all prescribed medication was taken, and self-assessed level of wellness.	Daily electronic diaries for a duration of 30 days
Generate an interpretation of the meaning of medication taking among older adults with MCMC.	In-depth hermeneutic interviews and interpretive phenomenological analyses will be conducted for 15 of the 30 enrolled participants. Patterns and themes that capture common experiences revealed in these data provide language for further investigation and new discussion in areas that have been studied traditionally. Such findings are the characteristic "phenomenological contribution" of qualitative research. Interpretive commentary in the context of social and cultural evidence and extant literature on medication use will be generated.	2 Interviews: 1 at enrollment and 1 at 30 days

Collaborators and Investigators

• Sponsor: Washington State University
• Collaborators: Providence Medical Research Center
• Investigators: Principal Investigator: Joshua Neumiller, PharmD, Washington State University; Principal Investigator: Roxanne Vandermause, PhD, Washington State University

Study record dates

Study Major Dates

• Study Start: October 1, 2012
• Primary Completion (Anticipated): October 1, 2013
• Study Completion (Anticipated): November 1, 2013

Study Registration Dates

• First Submitted: June 1, 2012
• First Submitted That Met QC Criteria: June 6, 2012
• First Posted (Estimate): June 7, 2012

Study Record Updates

• Last Update Posted (Estimate): December 21, 2012
• Last Update Submitted That Met QC Criteria: December 19, 2012
• Last Verified: December 1, 2012

More Information

Terms related to this study

• Keywords: Older Adults; Multiple Chronic Conditions; New Prescription
• Additional Relevant MeSH Terms: Pathologic Processes; Disease
• Other Study ID Numbers: PI-12-001