Medicine discussion between nurse prescribers and people with diabetes: an analysis of content and participation using MEDICODE

Aim: this paper is a report of a study to identify the content of, and participation in, medicine discussion between nurse prescribers and people with diabetes in England. Background: diabetes affects 246 million people worldwide and effectively managing medicines is an essential component of successful disease control. There are now over 20,000 nurse independent prescribers in the UK, many of whom frequently prescribe for people with diabetes. With this responsibility comes a challenge to effectively communicate with patients about medicines. National guidelines on medicines communication have recently been issued, but the extent to which nurse prescribers are facilitating effective medicine-taking in diabetes remains unknown. Methods: a purposive sample of 20 nurse prescribers working with diabetes patients audio-recorded 59 of their routine consultations and a descriptive analysis was conducted using a validated coding tool: MEDICODE. Recordings were collected between January-July 2008. The unit of analysis was the medicine. Results: 260 instances of medicine discussion identified in the audio-recordings were analysed. The most frequently raised themes were ‘medication named’ (raised in 88.8% of medicines), ‘usage of medication’ (65.4%) and ‘instructions for taking medication’ (48.5%). ‘Reasons for medication’ (8.5%) and ‘concerns about medication’ were infrequently discussed (2.7%). Measures of consultation participation suggest largely dyadic medicine discussion initiated by nurse prescribers. Conclusion: MEDICODE discussion themes linked to principles of recent guidelines for effective medicine-taking were infrequently raised. Medicine discussion was characterised by a one statement-one response style of communication led by nurses. Professional development is required to support theoretically-informed approaches to effective medicines management.What is already known about this topic:• To optimise the available skills of the workforce and improve patient access to medicines, the number of nurses in England with a prescribing qualification has continued to increase. • Recommendations for professionals to enact effective medicine discussion exist and indicate that patients’ medicine beliefs are a strong predictor of medicine-taking behaviour.• Little is known about medicine discussions, content and levels of participation, between nurse prescribers who regularly prescribe diabetes medicines and diabetes patients.What this paper adds:• This structured assessment of medicine communication indicated that nurse prescribers primarily focused on instruction-based medicine communication, e.g. instructions for taking medicine, usage of medicine. • Key discussion themes linked to current recommendations for effective medicine discussion were infrequently raised during routine consultations.• The nature of nurse prescribers’ medicine discussion was in the form of dyadic discussion and largely initiated by nurses. Implications for practice and/or policy:• The content of nurse prescribers’ discussion about medicines suggests that practice is currently limited and is not likely to fully enhance patient medicine-taking.• There is a need for continuing professional development for nurse prescribers to facilitate their exploration of patients’ medicine beliefs within a patient-centred approach