Patient Education and Counseling 97 (2014) 434
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Letter to the Editor Do you have any questions about your medication? To date, lack of knowledge is still one major reason for medication administration errors [1]. Administration errors may occur frequently, particularly if lay-persons are entrusted with this task. Therefore, health care providers make every effort to close knowledge gaps among patients to ensure a safe drug administration. We would like to highlight that, although well-intentioned, the question ‘‘Do you have any questions about your medication?’’ falls short to identify knowledge gaps and training needs among patients. In focus group discussions with community-dwelling patients, that were initially planned to identify drug-related administration problems and training needs, it became alarmingly evident that our patients, instead of reporting potential difficulties with drug administration (Patient statement: ‘‘There is no problem!’’), were rather not aware that the administration process may contain pitfalls they should pay attention to (‘‘I don’t think about problems, – so I don’t have them!’’). We do not doubt that there are very well-informed patients who know all the essentials for a correct drug administration. However, we hypothesize that most patients have never questioned their daily drug administration routine and therefore do not know what to ask. By asking these patients ‘‘Do you have any questions about your medication?’’ they regularly fall through the cracks because they are unaware of errors, feel safe with their drug use, do not feel competent to ask questions (‘‘What should I ask? I don’t know!’’), and therefore will not ask for help. Indeed, patients feel well informed without actually being well informed [2]. Consequently, one major challenge for health care providers is to identify and motivate such patients in order to create a basis for a behavioral change. According to the transtheoretical model individuals progress through five stages, i.e. pre-contemplation, contemplation, preparation, action, and maintenance, to finally change their behaviors [3,4]. Despite of multifactorial causes of medication administration errors, we hypothesize that health care providers must include basic behavioral principles and models of behavioral change in order to provide adequate patient information. Indeed, interventions to enhance adherence based on the transtheoretical model have demonstrated effectiveness in many therapeutic areas, including diabetes or hypertension [4,5]. The resulting challenge is to identify the patients’ individual stages and to meet them with tailored interventions.
http://dx.doi.org/10.1016/j.pec.2014.08.018 0738-3991/ß 2014 Elsevier Ireland Ltd. All rights reserved.
Acknowledgements AL received a personal scholarship from the ‘‘Dr. August und Dr. Anni Lesmu¨ller Stiftung’’. HS and WEH received no funding related to this work. The funding source had no influence on the preparation, review or approval of the letter, and the decision to submit the letter for publication. References [1] Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, et al. Systems analysis of adverse drug events, ADE Prevention Study Group. J Am Med Assoc 1995;274:35–43. [2] Broune´us F, Macleod G, Maclennan K, Parkin L, Paul C. Drug safety awareness in New Zealand: public knowledge and preferred sources for information. J Prim Health Care 2012;4:288–93. [3] Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol 1992;47:1102–14. [4] Adherence to long-term therapies: evidence for action. World Health Organization, 2003. Available at: http://www.who.int/chp/knowledge/publications/ adherence_report/en/ [accessed 26.06.14]. [5] Ficke DL, Farris KB. Use of the transtheoretical model in the medication use process. Ann Pharmacother 2005;39:1325–30.
Anette Lamperta,b Walter E. Haefelia,b Hanna M. Seidlinga,b,* a Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany b Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany *Corresponding author at: Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Tel.: +49 (0)6221 56 38736; fax: +49 (0)6221 56 4642 E-mail address: [email protected] (H.M. Seidling).
26 June 2014
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Letter to the Editor Do you have any questions about your medication? To date, lack of knowledge is still one major reason for medication administration errors [1]. Administration errors may occur frequently, particularly if lay-persons are entrusted with this task. Therefore, health care providers make every effort to close knowledge gaps among patients to ensure a safe drug administration. We would like to highlight that, although well-intentioned, the question ‘‘Do you have any questions about your medication?’’ falls short to identify knowledge gaps and training needs among patients. In focus group discussions with community-dwelling patients, that were initially planned to identify drug-related administration problems and training needs, it became alarmingly evident that our patients, instead of reporting potential difficulties with drug administration (Patient statement: ‘‘There is no problem!’’), were rather not aware that the administration process may contain pitfalls they should pay attention to (‘‘I don’t think about problems, – so I don’t have them!’’). We do not doubt that there are very well-informed patients who know all the essentials for a correct drug administration. However, we hypothesize that most patients have never questioned their daily drug administration routine and therefore do not know what to ask. By asking these patients ‘‘Do you have any questions about your medication?’’ they regularly fall through the cracks because they are unaware of errors, feel safe with their drug use, do not feel competent to ask questions (‘‘What should I ask? I don’t know!’’), and therefore will not ask for help. Indeed, patients feel well informed without actually being well informed [2]. Consequently, one major challenge for health care providers is to identify and motivate such patients in order to create a basis for a behavioral change. According to the transtheoretical model individuals progress through five stages, i.e. pre-contemplation, contemplation, preparation, action, and maintenance, to finally change their behaviors [3,4]. Despite of multifactorial causes of medication administration errors, we hypothesize that health care providers must include basic behavioral principles and models of behavioral change in order to provide adequate patient information. Indeed, interventions to enhance adherence based on the transtheoretical model have demonstrated effectiveness in many therapeutic areas, including diabetes or hypertension [4,5]. The resulting challenge is to identify the patients’ individual stages and to meet them with tailored interventions.
http://dx.doi.org/10.1016/j.pec.2014.08.018 0738-3991/ß 2014 Elsevier Ireland Ltd. All rights reserved.
Acknowledgements AL received a personal scholarship from the ‘‘Dr. August und Dr. Anni Lesmu¨ller Stiftung’’. HS and WEH received no funding related to this work. The funding source had no influence on the preparation, review or approval of the letter, and the decision to submit the letter for publication. References [1] Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, et al. Systems analysis of adverse drug events, ADE Prevention Study Group. J Am Med Assoc 1995;274:35–43. [2] Broune´us F, Macleod G, Maclennan K, Parkin L, Paul C. Drug safety awareness in New Zealand: public knowledge and preferred sources for information. J Prim Health Care 2012;4:288–93. [3] Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol 1992;47:1102–14. [4] Adherence to long-term therapies: evidence for action. World Health Organization, 2003. Available at: http://www.who.int/chp/knowledge/publications/ adherence_report/en/ [accessed 26.06.14]. [5] Ficke DL, Farris KB. Use of the transtheoretical model in the medication use process. Ann Pharmacother 2005;39:1325–30.
Anette Lamperta,b Walter E. Haefelia,b Hanna M. Seidlinga,b,* a Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany b Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany *Corresponding author at: Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Tel.: +49 (0)6221 56 38736; fax: +49 (0)6221 56 4642 E-mail address: [email protected] (H.M. Seidling).
26 June 2014
