Browsing by Author "Patel, Tejal"

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An Evaluation of the Effect of Primary Care Pharmacist Interventions on Patients with Chronic Pain
(University of Waterloo, 2017-01-20) Chen, Mo; Chang, Feng; Patel, Tejal
Background: Chronic pain is a common condition that has significant impact on patients’ physical and psychological well-being. Pharmacotherapeutic management of chronic pain differs on the basis of the cause pain. Pharmacists’ expertise of pharmacological knowledge and patient care make them key players in managing chronic pain. Methods: A three-month prospective pilot study was carried out at primary care settings including community pharmacies and family health teams. Patients were seen by pharmacists at the initial visit, 2-week follow-up, and 3-month follow-up visit. Pharmacists’ interventions consisted of patient assessments, medication reviews, care plan recommendations, and patient education. Pain, quality of life, and medication adherence were measured with Brief Pain Inventory (BPI), Short Form-36, and Morisky Medication Adherence Scales-8, respectively. Results: Thirteen patients were enrolled, one withdrew. There was no significant improvement in pain or quality of life at 3-month follow-up. However, trends toward improvement were found. Conclusions: This study showed that interventions of primary care pharmacists had no significant effect on pain or quality of life of patients with chronic pain. However, positive trends towards reducing pain intensity and pain interference with patients’ general activity, mood, normal work, and sleep were found. The reason for this could be due to small sample size, low implementation rate of pharmacist recommendations by physicians, low patient adherence, or extended study period.
Exploring and prioritizing content to include a medication self-management toolkit for persons with spinal cord injury/dysfunction concept mapping approach
(Public Library of Science (PLOS), 2024) Cadel, Lauren; El-Kotob, Rasha; Hitzig, Sander L.; McCarthy, Lisa M.; Hahn-Goldberg, Shoshana; Packer, Tanya L.; Ho, Chester H.; Patel, Tejal; Cimino, Stephanie R.; Lofters, Aisha K.; Guilcher, Sara J. T.
Background Adults with spinal cord injury/dysfunction (SCI/D) face challenges with medications they take to manage their secondary conditions (e.g., pain, urinary tract infections, autonomic dysreflexia). With many healthcare providers typically involved in care, there are additional challenges with care fragmentation and self-management. Prior research emphasized the desire for more support with medication self-management among this population. Objective To explore what content should be included in a medication self-management resource (i.e., toolkit) for adults with SCI/D, as well as considerations for delivery from the perspectives of adults with SCI/D, caregivers, healthcare providers, and representatives from community organization. Methods A concept mapping study was conducted. Participants took part in one or more of three activities: brainstorming; sorting and rating; and mapping. Participants generated ideas about the content to include in a medication self-management toolkit. Participants sorted the statements into conceptual piles and assigned a name to each. All statements were rated on a five-point Likert-type scale on importance and realistic to include in the toolkit. Participants decided on the final cluster map, rearranged statements, and assigned a name to each cluster to create visual representations of the data. Results Forty-four participants took part in this study. The final map contained eight clusters: 1) information-sharing and communication; 2) healthcare providers interactions and involvement; 3) peer and community connections; 4) supports and services for accessing prescription medications and medication information; 5) information on non-prescription medication and medication supplies; 6) safety and lifestyle considerations; 7) general medication information; and 8) practical information and strategies related to medication-taking. Safety and lifestyle considerations was rated as the most important and realistic to include in the toolkit. Conclusions Give the limited tools to help adults with SCI/D with managing their medications, there is great potential to better support this population across all areas of medication self-management.
Integration of Smart Multidose Blister Packaging for Medication Management
(University of Waterloo, 2022-04-26) Faisal, Sadaf; Patel, Tejal
Medication non-adherence can lead to non-optimal management of chronic diseases and poor health outcomes. Numerous innovative dispensing products offering real-time medication intake monitoring are being developed and marketed to address medication non-adherence and support the in-home medication management process. The integration of emerging medication dispensing devices with real-time medication intake monitoring by patients with chronic diseases for in-home medication administration and within the workflow of community pharmacies is unknown. The overall goal of this thesis was to investigate the medication-taking behaviour and in-home medication management processes of patients with chronic diseases (including storage, organization and administration of medications), examine the integration (described as usability, acceptability, and functionality) of a prototype smart technology-based smart multidose blister package (SMBP) in patients’ homes and explore the feasibility of implementation of a real-time adherence monitoring, multidose dispensing system in community pharmacies. This thesis is comprised of five studies and one reflexivity activity. The first two studies identified and analyzed relevant literature on the integration of smart oral multidose dispensing systems into the daily use of patients and the features and characteristics of smart medication adherence products for in-home patient use respectively. These two literature reviews identified various smart adherence products with variable features, however there was limited evidence related to in-home integration of such products. The third study aimed to understand the meanings associated with in-home medication management processes and storage practices of older adults with chronic diseases. This study was a qualitative study that utilized a modified ethnographic approach via digital photography walkabouts, observation protocols, and field notes to document in-home medication organization and storage locations. Data consisting of digital photos and observation protocols were analyzed thematically. Ten older adults with an average age of 76 years, of which 80% were female, participated in the study. On average, participants reported five medical conditions, while the average number of medications was 11.1. The thematic analysis of 30 photographs, 10 observation protocols, and field notes resulted in three themes and five sub-themes for the in-home medication management study. Themes included choice of storage location, knowledge regarding appropriate medication storage conditions, and systems to manage in-home medication intake. The fourth study was a mixed-method study in which study participants who were recruited for the first study, used the SMBP to manage their medications for eight weeks. To examine the integration of SMBP, data was collected using qualitative methods such as in-home observations, photo-elicitation, field notes, and semi-structured interviews along with quantitative methods, including System Usability Scale (SUS) and Net Promoter Score (NPS). The interview guide was developed with constructs from the Technology Acceptance Model (TAM), Theory of Planned Behaviour (TPB), and Capability, Opportunity, Motivation, Behaviour (COM-B) Model. Interview data were analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL) framework to generate themes and subthemes, which were mapped back to TAM, TPB, and COM-B Model. The qualitative analysis identified three themes and 17 sub-themes including factors influencing medication intake behaviour, facilitators to the product use, and barriers to the product use. The average SUS score was 75.50 and the overall NPS score was 0. The fifth study was conducted at the respective community pharmacies of patients. Pharmacists and pharmacy assistants packaged and dispensed medications in SMBPs and monitored real-time medication intake via the web portal. This was a mixed-method study, where pharmacy staff participated in semi-structured interviews, and completed the SUS to assess usability. The interview guide was developed with constructs from the TAM, TPB, and COM-B Model. Interview transcripts were analyzed thematically utilizing Braun & Clark’s thematic analysis framework, and findings were mapped back to the TAM, TPB, and COM-B Model. Three pharmacists and one pharmacy assistant with a mean of 19 years of practice were interviewed. Three themes and 12 subthemes were generated. Themes included: pharmacy workflow factors, integration factors, and pharmacist perceived patient factors. The mean SUS was found to be 80.63. The sixth and the last chapter of this thesis was comprised of a reflexivity activity conducted by the pharmacist-researcher during the ethnographic fieldwork. This study provided reflection of a practicing pharmacist and the benefit of reflexivity practice to identify a clinician-researcher's assumptions and beliefs and their impact on the research. The findings from this thesis indicated that in-home medication management reflects older adults’ perspectives regarding privacy, medication-taking routine, knowledge about safe and effective storage, and organization systems. The SMBP was found to be easy to use and acceptable by older adults. However, clinicians should assess an older adult’s medication intake behavior and barriers and facilitators to product use before recommending a technology-based adherence product for managing medications. Future research should be designed to understand the impact and effectiveness of these products on health outcomes and examine the sustainability of product induced behaviour change in patients managing complex therapies on regular basis. This research project identified that although pharmacists valued products with real-time adherence monitoring capabilities, it is imperative to carefully assess the infrastructure, including pharmacy workload, workforce, and financial resources, for the successful implementation of such interventions in a community pharmacy setting. Future research should focus on developing frameworks for full-scale implementation of such products in the community pharmacy settings.
Medication Review in Cognitive Impairment and Dementia: Comparison of Instruments
(University of Waterloo, 2023-12-19) Sharma, Rishabh; Patel, Tejal
Background: - Cognitive impairment (CI) and dementia are significant concerns in older adults in Canada. Drug-related problems (DRPs) are common and can cause up to 30% of hospitalizations in older individuals, including adverse drug reactions, drug interactions, potentially inappropriate medication (PIM) use, and medication adherence. Prescribing in older patients with multiple morbidities, especially with dementia, is a complex process that demands regular review of medications to provide quality care to dementia patients. Objective: - The primary objective was to compare the mean number of DRPs using the Medication Review in Cognitive Impairment and Dementia (MedRevCiD) Checklist to the Medication Appropriateness Index (MAI) criteria in older adults with CI and/or dementia. The secondary objective was to identify which explicit tool, Beers Criteria 2023, or the Screening Tool of Older People Potentially Inappropriate Prescriptions (STOPP) Criteria 2023, identified more PIM use among older adults with CI or dementia. Methods: - A cross-sectional study was carried out with older adults receiving care for CI or dementia. Forty-four patients from the Multi-specialty Interprofessional Team-based (MINT) memory clinic were recruited to participate in the study. The researcher employed two distinct tools, namely the MAI and the MedRevCiD Checklist, to conduct a medication review. PIMs were identified utilizing the Beers Criteria 2023 and the STOPP Criteria 2023. The Wilcoxon signed-rank test was used to assess whether there is a significant difference in the mean number of DRPs identified by the MedRevCiD versus MAI. Bivariate logistic regression analysis was employed to identify potential factors associated with DRP and PIM use. Results: - A total of 134 DRPs were identified in 44 patients per the MedRevCiD checklist. The average number of DRPs identified was 3.05, with a standard deviation (SD) of 4.0 DRPs per person. Notably, over half of the DRPs (53%, n= 71) identified fell into domain 6 of the MedRevCiD checklist (optimizing medication use). In comparison, 81 DRPs were identified in 44 patients per MAI criteria (mean: 1.84 per person, SD 2.9) DRPs per person. The majority of the DRPs identified using MAI criteria (44.4%, n= 36) were from clinically significant drug-disease/condition interactions. There was a significant difference in the mean number of DRPs between the two instruments (Z= -4.735, p-value <0.001). In this study, at least one PIM was used by 47.7% (n= 21) and 27.2% (n= 12) of participants based on Beers and STOPP criteria, respectively. Binary logistic regression revealed a statistically significant association between the number of comorbidities (P= 0.002), number of medications per day (P= 0.032) with DRP use as per MAI criteria. For each additional comorbidity, there was 1.86 times higher odds of experiencing DRPs and 1.20 times higher odds of having DRPs according to MAI criteria. Individuals with nine or more comorbidities had 8.4 times higher odds of being prescribed PIMs (p = 0.027, 95% confidence interval (CI): 1.27 – 55.39); given the wide range of the confidence interval it is essential to note that there was considerable uncertainty about the strength of the association. Discussion: - The findings of this study provided insights into the higher prevalence of DRPs among older adults with CI or dementia. The MedRevCiD Checklist emerged as a valuable tool, demonstrating a heightened ability to uncover DRPs in this population. This underscores the importance of utilizing tools tailored to the unique needs of individuals with dementia when assessing DRPs. Furthermore, identifying PIMs using Beers and STOPP criteria highlights the significance of addressing PIMs in this demographic. This study adds valuable insights to the progressing comprehension of medication complexities in older adults facing CI and/or dementia.
Pharmacist experience with providing care for patients with chronic pain in the community setting: A qualitative study
(University of Waterloo, 2017-01-20) Tabeefar, Hamed; Chang, Feng; Patel, Tejal
Objectives: Chronic pain is a condition pharmacists frequently encounter in practice; however, the pharmacist’s role in the management of chronic pain is under-investigated. This study examines pharmacist perceptions and experiences in providing care to patients with chronic pain in the community setting. Methods: Practicing primary care pharmacists in Ontario were recruited and interviewed using a semi-structured guide. Interviews were analyzed using modified grounded theory. Sample recruitment continued until saturation was achieved. Results: Twelve pharmacists responded to the email invitation. Two did not meet eligibility criteria and one withdrew. The sample consisted of 6 female and 3 male pharmacists with a mean age of 47 years (range: 27 – 63) and mean of 20 years (range: 2 – 40) of practice. Five themes emerged from the content analysis: (1) perception of chronic pain (2) concern about opioid use (3) lack of support for patients, (4) communication with prescribers, and (5) knowledge gaps. Participants were comfortable with their knowledge of chronic pain and were empathetic of their patients’ suffering. They also felt their role is limited within the current healthcare system. Participants reported that misuse of opioids is the most challenging; issues included high potential for misuse, inadequate monitoring and under-use of other medications and resources for the treatment of chronic pain. Additionally, participants believed that patients suffer from lack of support by their family, employers and the health care system. Furthermore, trust was identified as the most important parameter in building a collaborative relationship with physicians. Finally, participants felt more training on legal issues related to opioids is required. Conclusion: Pharmacists were empathetic towards patients with chronic pain; however, they felt their role is limited in current climate. Deficiencies in the current system of managing chronic pain were identified including opioid use as the most challenging. Future research should investigate expansion of pharmacist roles to optimize chronic pain management.
Usability of an automated medication dispension device and adherence dashboard: A study protocol
(Public Library of Science (PLOS), 2024) Patel, Tejal; Laeer, Christoph; Darabi, Hamed; Lachance, Maxime; Anawati, Michelle; Chomienne, Marie-Helene
Non-adherence to prescribed medication regimens can lead to suboptimal control of chronic health conditions and increased hospitalizations. Older adults may find it particularly challenging to self-manage medications due to physical and cognitive limitations, resulting in medication non-adherence. While automated medication dispensing technologies may offer a solution for medication self-management among older adults, these technologies must demonstrate usability before effectiveness can be investigated and products made available for widespread use. This study will aim to measure usability, workload, and unassisted task completion rates of an automated medication dispenser and medication adherence dashboard on the Medipense portal with older adults and their clinicians, respectively. This study is designed as a convergent parallel mixed-methods observational study with older adults and their clinicians. Usability will be examined with the use of the System Usability Scale (SUS) while NASA Load Index (NASA-TLX) will be utilized to assess the workload of both the device and the adherence monitoring platform. Cognitive walkthrough will be utilized prior to usability testing to identify series of steps required to use the automated dispenser and adherence dashboard. This study will assess the unassisted task completion rates to successfully operate the device. Semi-structured interviews with both types of participants will provide qualitative data with which to comprehensively gauge the automated dispenser user experience. The results of this study will allow us to examine usability of both the automated medication dispenser and the adherence dashboard. In clinical practice, usability of technology is important to establish prior to full-scale implementation. Products that are not user friendly, add to workload, impact workflow, or are difficult to navigate by both clinicians and population in general may not be adopted. Usability permits an evaluation of the products, to identify problems that must be addressed prior to implementation and to ensure products are useful in clinical practice,
USER EXPERIENCE WITH MEDICATION ADHERENCE TECHNOLOGY: DETERMINING USABILITY BY CAPABILITIES
(University of Waterloo, 2024-05-27) Baby, Bincy; Patel, Tejal
Background: As populations worldwide grow older, the prevalence of chronic conditions and the complexity of managing multiple medications significantly increase. This challenge is further complicated by a range of barriers older adults face, including physical limitations, cognitive impairments, sensory issues, motivational challenges, and non-supportive environments. Such barriers can lead to a decline in capacity to self-manage medications, resulting in poor adherence to prescribed medication regimens, which in turn can cause increased hospitalizations and a decrease in quality of life. Medication Adherence Technologies (MATech), which range from simple electronic devices to more complex smart devices with connectivity and real-time monitoring capabilities, are recognized as one of the solutions to these challenges. However, the design and features of these technologies vary significantly, influencing how they are used by different users. Usability varies widely; some older adults may find certain features of these devices challenging to use due to their barriers. Hence, it is crucial to ensure that MATech are accessible and user-friendly for all older adults, regardless of their individual challenges. This study aims to identify the most suitable MATech for older adults with various physical, cognitive, sensory, motivational, and environmental limitations, tailored to their unique needs and abilities. Objectives: The primary objectives of this study were to evaluate the usability and user experience (UX) of thirteen MATech devices among older adults facing various barriers to medication self-management and to gather comprehensive feedback on the usability and features of these technologies. Secondary objectives included determining how different barriers affect the usability outcomes of these technologies and identifying design features that best meet the needs of this demographic to enhance their independence and well-being. Methods: The study used a mixed-methods approach to evaluate the usability of MATech. Eighty older adults, aged 60 and older, were recruited through convenience, purposive, and snowball sampling methods from various settings across Ontario, including academic and residential facilities. Data collection was conducted in three steps after obtaining informed consent from the participants. The first step involved measuring barriers to medication self-management using various scales such as the Self-Medication Assessment Tool (SMAT) for physical, cognitive, and vision barriers; the Whisper Test for hearing barriers; the Self-Efficacy for Medication Adherence Scale (SEAMS) for motivational barriers; and the Martin and Park Environmental Demands (MPED) Questionnaire for environmental barriers. The second step involved usability and user experience testing of three smart devices and ten electronic devices, to measure various performance-based metrics (task success rate, total task completion time, efficiency, error rate) and perception-based usability metrics (System Usability Scale (SUS) score, NASA-TLX workload score, Single Ease of Use Question (SEQ), and Subjective Mental Effort Question (SMEQ)). The third step consisted of in-depth qualitative interviews to explore feedback regarding the features of various MATech tested. Quantitative data were statistically analyzed using descriptive statistics and univariate and multivariate regression to assess usability across various devices, while qualitative responses were analyzed using inductive thematic analysis. Results: Quantitative Results: Cognitive impairments were identified in 20% of participants, physical limitations in 33.75%, hearing impairment (both ears) in 60%, and vision impairments in 11.25%. Backward stepwise multivariate regression analysis identified critical predictors for task success rates, including 'SEAMS score' (p<0.001) which measures motivational barrier positively influencing outcomes, whereas 'Low vision score' negatively affected success rates (p<0.001). Moreover, Old 'age' (p<0.001) and 'number of subtasks for product' (p<0.001) notably extended the total task completion times, and 'physical score' (p<0.001) increased error rates, suggesting necessary improvements in MATech design for better usability. While no predictors significantly impacted the SUS scores, the NASA TLX identified 'old age', 'vision impairment', and the ‘number of products tested’ as significant factors in perceived task load, particularly noting that using multiple products increased task load considerably, underscoring their profound impact on user experience and workload management. Predictive models were also developed to determine each participant's ability to successfully complete subtasks. For example, the model for a participant characterized by significant cognitive, physical, hearing, motivational and environmental impairments, but with high vision capacity, indicated high success probabilities for visually intensive subtasks such as "scroll the screen options" (92%) and "locate and touch an icon on a screen" (87%). Conversely, tasks requiring more physical interaction like "flip device" showed much lower success probabilities (45%). Qualitative Findings: Five themes were identified: (1) the practicality of device design, (2) the impact of technological complexity, (3) the necessity for inclusivity in device functionality, which includes considerations for impairments, security, and privacy, (4) the influence of socio-economic and environmental factors, and (5) the importance of feedback for iterative design. Discussion: The findings from this study underscore the critical importance of designing MATech that are not only functional but also tailored to the unique needs of older adults who face multiple barriers to effective medication management. Key findings from the regression analyses highlighted the importance of addressing physical and sensory impairments in MATech design, as these significantly influence user performance and error rates. Additionally, factors such as age and the complexity of device operations significantly influence usability and workload, suggesting the need for simpler, more intuitive designs that minimize cognitive and physical strain. Overall, the research emphasizes the need for a user-centered design approach in developing MATech, emphasizing simplicity, accessibility, and personalization to better support older adults in managing their medications effectively. This approach not only aids in improving medication adherence but also contributes to the broader goal of facilitating a more independent, quality life for older adults.