The Effects of a Nurse-led Medication Self-management Program on Medication-related Outcomes and Health Outcomes in Older Patients with Multimorbidity

Multimorbidity is highly prevalent among older patients in community settings. Older patients with multimorbidity are at a high risk of medication nonadherence, which leads to adverse health outcomes and unnecessary health care utilization. However, current evidence mainly focuses on patients with a single disease. Effective interventions that improve medication adherence are needed for this group of patients. The aims of this study were to design a nurse-led medication self-management intervention for older patients with multimorbidity and to evaluate the effectiveness of the intervention on medication-related outcomes and health outcomes.The intervention mapping methodology was used to guide this study. The study consisted of three phases to achieve the study aims. The Phase I study was the needs assessment to establish a comprehensive understanding of the adherence problem, which included a review of literature relevant to medication adherence, a systematic review of interventions for improving medication adherence, and a theoretically based cross-sectional study. The Phase II study was the development of the medication self-management intervention. The 6-week intervention consisted of three face-to-face educational sessions and two follow-up phone calls. In the Phase III study, a randomized controlled trial was conducted to evaluate the effectiveness of the intervention. The intervention group received the medication self-management intervention plus usual care, whereas the control group only received usual care. The primary outcome was medication adherence. Secondary outcomes included medication self-management capacity, treatment experiences, quality of life, and utilization of health care services. Outcomes were measured at baseline (T0), in the week immediately post-intervention (T1), and at 3-month post-intervention (T2).The systematic review in the Phase I study included a total of nine studies. Results showed that self-management interventions had a significant and modest effect (SMD = 0.52) on medication adherence. In the cross-sectional study, 254 older patients with multimorbidity were recruited. Based on the extended Information-Motivation-Behavioral Skills model, six predictors of medication adherence were identified, including adherence information, personal motivation, social motivation, behavioral skills, medication treatment satisfaction, and treatment burden. In the Phase II study, a medication self-management intervention was developed based on the findings from the Phase I study.In Phase III of the study, a total of 136 older patients with multimorbidity were recruited and randomly allocated into either the intervention group (n = 67) or the control group (n = 69). There were significant improvements in medication adherence, medication-related knowledge, beliefs, self-efficacy, and treatment satisfaction for the intervention group compared to the control group at T1. Compared to the control group at T2, the intervention group demonstrated significantly greater improvements in medication-related knowledge, beliefs, self-efficacy, and burden. However, no significant effects were found on medication-related social support and skills, quality of life, and utilization of health care services.The findings demonstrated that the medication self-management intervention was effective in increasing medication self-management capacity, which led to improved medication adherence for older patients with multimorbidity. The medication self-management intervention could be incorporated into routine health care to improve medication adherence and treatment effectiveness.共病在社區老年人群中非常普遍。老年共病患者不依從於藥物處方的風險較高，可能導致不良的健康結局及不必要的衛生服務利用。然而，目前證據主要集中於單一慢病患者。本研究旨在針對老年共病患者設計一項用藥自我管理幹預方案，並探究其對改善患者用藥相關結局及健康結局的效力。應用幹預映射方案指引整個研究。研究共包括三個階段。第一階段為需求評估，旨在全面理解共病患者依從性的問題。本階段包括一項用藥依從性文獻綜述、一項依從性幹預的系統綜述及一項基於理論的橫斷面研究。第二階段為幹預項目的構建。該項目共持續六周，包括三次面對面的教育課程以及兩次電話隨訪。第三階段是一項隨機對照實驗，旨在評估該項目的效力。幹預組除接受常規慢病管理外，還接受藥物自我管理幹預。對照組僅接受常規慢病管理。研究主要結果為用藥依從性，次要結果包括用藥自我管理、治療體驗、生活品質及健康服務利用。結果指標收集時間為基線（T0）、幹預後（T1）和幹預三個月後（T2）。系統綜述共納入9篇研究。結果顯示自我管理幹預能顯著提高患者用藥依從性（SMD = 0.52）。共有254名老年共病患者參與了橫斷面研究。基於資訊-動機-行為技術擴展模型確定了六項用藥依從性的影響因素，包括依從性資訊、個體動機、社會動機、行為技術、用藥治療滿意度和治療負擔。根據需求評估結果，設計了用藥自我管理項目。第三階段研究共招募136名老年共病患者並隨機分為幹預組（67人）和對照組（69人）。與對照組相比，幹預組在T1的用藥依從性、用藥相關知識、信念、自我效能及滿意度均有顯著改善。在T2時，相比於對照組，幹預組用藥相關知識、信念、自我效能和負擔有顯著改善。然而，幹預並沒有對患者的用藥社會支持和技巧、生活品質和健康服務利用有顯著影響。本研究證明用藥自我管理能夠改善老年共病患者用藥自我管理能力，從而提高用藥依從性。護士主導的用藥自我管理有望整合到目前基礎醫療以提高用藥依從性，從而實現用藥治療的預期效力。YANG, Chen.Ph.D. Chinese University of Hong Kong 2021.Includes bibliographical references (leaves )Abstracts in English and Chinese.Title from PDF title page (viewed on ...