Open Access Open Access  Restricted Access Subscription or Fee Access

Perspectives of Medication Management Practices of Diverse, Low Income, Older Adults

Brian J Quilliam

Abstract


Purpose:To explore the perspectives of medication management practices among a racially/ethnically diverse sample of low-income older adults. 

Methods: This qualitative study included 11 focus groups with 105 low income older adult participants.  We recruited a stratified purposeful sample of older adults from community settings over a 5 month period (11/2007-3/2008).  Focus group discussions centered on participants’ perceptions about their medications, medication-taking habits, and adherence. The discussions were audio recorded and professionally transcribed.  Our interdisciplinary project team engaged in an iterative immersion crystallization group data analysis process.

Results:  Participants made varying yet concerted decisions about taking their medications differently than prescribed, they usually did not disclose these modifications to their physicians, and they did not recognize the potential dangers to their health that can ensue.  The burden of taking so many medications influenced decisions to stop taking medications or to skip doses. Remembering to take evening doses was more problematic than morning doses.

Conclusions: Use of multiple prescription medications and non-adherence to prescription instructions were common among diverse, low-income older adults. Taking medications “regularly” does not necessarily translate into taking medications as prescribed. Few participants stated that they reported their medication non-adherence to their physician.


Keywords


medication management; elderly; community-dwelling; adherence; low income populations

Full Text:

PDF

References


REFERENCE LIST

US Census Bureau. USA QuickFacts from the US Census Bureau. 2010 [updated 11/04/10; cited 2010 1/30/10]; Available at: http://quickfacts.census.gov/qfd/states/00000.html.

Agency for Healthcare Reseach and Quality. Health Services Research on Aging: Building on Biomedical and Clinical Research. Translating Research Into Practice Fact Sheet2000: Available at: http://www.ahrq.gov/research/tripage.htm.

Federal Interagency Forum on Aging-Related Statistics. Older Americans 2010: Key Indicators of Well-Being2010: Available at: http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/2010_Documents/Docs/OA_2010.pdf.

Baum, C, Kennedy, DL, Knapp, DE, Faich, A, Annello, C.(1987). Drug Utilization in the US-1986. Rockville, MD: Department of Health and Human Services, Food and Drug Administration.

Center on an Aging Society. Prescription Drugs: A Vital Component of Healthcare2002: Available at: http://ihcrp.georgetown.edu/agingsociety/pdfs/rxdrugs.pdf.

Moxey, ED, O'Connor, JP, Novielli, KD, Teutsch, S, Nash, DB. (2003). Prescription drug use in the elderly: a descriptive analysis. Health Care Financ Rev 24, 127-41.

Salzman, C. (1995). Medication compliance in the elderly. J Clin Psychiatry 56 Suppl 1, 18-22; discussion 3.

Morris, LS, Schulz, RM. (1993). Medication compliance: the patient's perspective. Clinical therapeutics 15, 593-606.

Wright, EC. (1993). Non-compliance--or how many aunts has Matilda? Lancet 342, 909-13.

Institute of Medicine.(1999). To Err is Human: Building a Safer Healthcare System. Washington, D.C.: National Academy Press.

Hughes, CM. (2004). Medication non-adherence in the elderly: how big is the problem? Drugs & aging 21, 793-811.

Bodenheimer, T, Lorig, K, Holman, H, Grumbach, K. (2002). Patient self-management of chronic disease in primary care. JAMA : the journal of the American Medical Association 288, 2469-75.

Donovan, JL, Blake, DR. (1992). Patient non-compliance: deviance or reasoned decision-making? Soc Sci Med 34, 507-13.

Donovan, JL. (1995). Patient decision making. The missing ingredient in compliance research. Int J Technol Assess Health Care 11, 443-55.

Conrad, P. (1985). The meaning of medications: another look at compliance. Soc Sci Med 20, 29-37.

Conrad, P. (1987). The noncompliant patient in search of autonomy. Hastings Cent Rep 17, 15-7.

Chewning, B, Boh, L, Wiederholt, JB, al, e. (2001). Does the concordance concept serve patient medication management? Int J Pharm Pract 9, 71-9.

Dowell, J, Hudson, H. (1997). A qualitative study of medication-taking behaviour in primary care. Fam Pract 14, 369-75.

Johnson, MJ, Williams, M, Marshall, ES. (1999). Adherent and nonadherent medication-taking in elderly hypertensive patients. Clin Nurs Res 8, 318-35.

Lumme-Sandt, K, Virtanen, P. (2002). Older people in the field of medication. . Sociol Health Illn 24, 285-304.

Haslbeck, JW, Schaeffer, D. (2009). Routines in medication management: the perspective of people with chronic conditions. Chronic Illn 5, 184-96.

Swanlund, SL, Scherck, KA, Metcalfe, SA, Jesek-Hale, SR. (2008). Keys to successful self-management of medications. Nurs Sci Q 21, 238-46.

Bajcar, J. (2006). Task analysis of patients' medication-taking practice and the role of making sense: a grounded theory study. Res Social Adm Pharm 2, 59-82.

Kreuger, R.(1994). Focus Groups: A Practical Guide for Applied Research: SAGE Publications.

Borkan, J. Immersion/Crystallization. In: Crabtree, B, Miller, W, editors. Doing Qualitative Research. 2nd ed. Thousand Oaks: SAGE Publications; 1999. p. 179-94.

QSR International Pty Ltd. QSR NVivo. Melbourne, Australia: QSR International Pty Ltd.; 2000.

Murray, MD, Morrow, DG, Weiner, M, Clark, DO, Tu, W, Deer, MM, Brater, DC, Weinberger, M. (2004). A conceptual framework to study medication adherence in older adults. Am J Geriatr Pharmacother 2, 36-43.

Miller, SW. (2008). Evaluating medication regimens in the elderly. Consult Pharm 23, 538-47.

George, J, Elliott, RA, Stewart, DC. (2008). A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs Aging 25, 307-24.

Wilson, IB, Schoen, C, Neuman, P, Strollo, MK, Rogers, WH, Chang, H, Safran, DG. (2007). Physician-patient communication about prescription medication nonadherence: a 50-state study of America's seniors. Journal of general internal medicine 22, 6-12.

Rifkin, DE, Laws, MB, Rao, M, Balakrishnan, VS, Sarnak, MJ, Wilson, IB. (2010). Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study. Am J Kidney Dis 56, 439-46.

Piette, JD, Heisler, M, Wagner, TH. (2004). Cost-related medication underuse: do patients with chronic illnesses tell their doctors? Archives of internal medicine 164, 1749-55.

Alexander, GC, Casalino, LP, Meltzer, DO. (2003). Patient-physician communication about out-of-pocket costs. JAMA : the journal of the American Medical Association 290, 953-8.

DeVoe, JE, Wallace, LS, Fryer, GE, Jr. (2009). Measuring patients' perceptions of communication with healthcare providers: do differences in demographic and socioeconomic characteristics matter? Health Expect 12, 70-80.

Mutchler, JE, Bacigalupe, G, Coppin, A, Gottlieb, A. (2007). Language barriers surrounding medication use among older Latinos. J Cross Cult Gerontol 22, 101-14.

Belcher, VN, Fried, TR, Agostini, JV, Tinetti, ME. (2006). Views of older adults on patient participation in medication-related decision making. Journal of general internal medicine 21, 298-303.

Stegemann, S, Ecker, F, Maio, M, et al. (2010). Geriatric drug therapy: neglecting the inevitable majority. Ageing Res Rev 9, 384-98.

Agency for Healthcare Research and Quality. AHRQ Patient Safety Network: Medication Reconciliation. [06/26/2011]; Available at: http://psnet.ahrq.gov/primer.aspx?primerID=1.

Erickson, S, Hambleton, J. (2011). A pharmacy's journey toward the patient-centered medical home. Journal of the American Pharmacists Association : JAPhA 51, 156-60.

National Committee for Quality Assurance. Standards for Patient Centered Medical Home. 2011 [06/26/2011]; Available at: http://www.iafp.com/pcmh/ncqa2011.pdf.




DOI: http://dx.doi.org/10.5750/ijpcm.v2i4.162

Refbacks

  • There are currently no refbacks.