Nurse and Pharmaceutical Care (NuPhaC)

SelfMADiP

The effectiveness of an in-hospital medication Self-Management intervention on medication

Adherence after Discharge in patients with Polypharmacy

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Background

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In hospital, healthcare providers usually manage medication for patients although patients are expected to self-manage their medication after hospital discharge. Currently, patients are seldom supported or educated on medication self-management. A lack of self-management competencies is found to be associated with failed medication therapy, low adherence levels and medication errors harming patients’ health. Approximately 50% of patients afflicted by chronic conditions do not adhere to prescribed medication regimens. Furthermore, patients with polypharmacy are at higher risk for medication management problems and non-adherence because of the larger number of prescribed medicines and the complexity of the medication regimen. Medication self-management is considered to be a promising strategy to optimize adherence rates and self-care competencies as well as a method to increase patient satisfaction and patient safety.

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However, a multicenter study performed in Belgium demonstrated that although up to 41% of patients would be able to self-manage their medication during hospitalization, less than 1 out of 5 wards was found to have a procedure for medication self-management and less than 10% of wards had a screening tool assessing patients’ eligibility to self-administer medication. Therefore, in a previous project (SelfMED), an evidence-based intervention supporting medication self-management during hospitalisation was developed and tested.  The SelfMED intervention consists of multiple components: 1) a procedure clarifying the medication self-management process and affiliated responsibilities (i.e., SelfMED procedure); 2) an assessment evaluating patients’ eligibility for medication self-management during hospitalization (i.e., SelfMED assessment); 3) a monitoring system allowing healthcare providers to follow adherence and detect errors in patients’ medication self-management (i.e., SelfMED monitor); and 4) measures for healthcare providers to support medication self-management in patients (i.e., SelfMED support).

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A pilot study showed that the SelfMED intervention is safe and facilitates medication self-management in hospital, yet further evaluation of the intervention is needed.  Literature on the effects of medication self-management suggested an increase in patient adherence, medication knowledge and patients’ satisfaction. These findings were, however, based on a limited number of studies and the overall quality of studies was rather low making it hard to draw any firm conclusion. In addition, these studies focused on the effects of medication self-management during hospitalisation. 

 

Therefore, the main goal of the SelfMADiP project is to evaluate the effectiveness of in-hospital medication self-management (SelfMED) on medication adherence after hospital discharge. However, prior to the evaluation of the SelfMED intervention, measures to support medication self-management will be extended and refined during this project.

 

Objectives

The SelfMADiP-project aims:

1. To explore medication self-management deficiencies after hospital discharge in patients with polypharmacy.

2. To develop and evaluate recommendations for healthcare providers to support patients with medication self-management problems.

3. To explore medication-related shared decision making (SDM) between nurses and patients as a supportive measure for medication self-management.

4. To assess the feasibility and validity of a combined set of methods measuring medication adherence (i.e., a medication diary, self-report questionnaire and pill count) in patients with polypharmacy from a longitudinal perspective.

5. To evaluate the effect of an in-hospital medication self-management intervention (SelfMED) on medication adherence after discharge in patients with polypharmacy.

 

Research output

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What happens after hospital discharge? Deficiencies in medication management encountered by geriatric patients with polypharmacy.
Mortelmans L, De Baetselier E, Goossens E, Dilles T.
Int J Environ Res Public Health. 2021 Jun 30;18(13):7031. doi: 10.3390/ijerph18137031.

 

Beliefs about medication after hospital discharge in geriatric patients with polypharmacy.

Mortelmans L, Goossens E, Dilles T.

Geriatr Nurs. 2022 Jan-Feb;43:280-287. doi: 10.1016/j.gerinurse.2021.12.007.

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Shared decision making on medication use between nurses and patients in an oncology setting: A qualitative descriptive study.

Mortelmans L., Bosselaers S., Goossens E., Schultz H., & Dilles T.
European Journal of Oncology Nursing. 2023, 102321, doi: 10.1016/j.ejon.2023.102321.

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The Development of Recommendations for Healthcare Providers to Support Patients Experiencing Medication Self-Management Problems

Mortelmans L, Goossens E, De Cock AM, Petrovic M, van den Bemt P, Dilles T.
Healthcare. 2023 May 25;11(11): 1545. doi: 10.3390/healthcare11111545.

Output:
 

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Nurses' responses to patients' medication self-management problems in hospital and the use of recommendations.
Mortelmans L, Goossens E, De Cock AM, van den Bemt P, Dilles T.
British Journal of Clinical Pharmacology. 2024. doi: 10.1111/bcp.16204. 

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​The development and evaluation of a medication diary to report problems with medication use.

Mortelmans L, Dilles T.
Heliyon. 2024, 10, e26127, doi: https://doi.org/10.1016/j.heliyon.2024.e26127.

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Evaluation of methods measuring medication adherence in patients with polypharmacy: a longitudinal and patient perspective.

Mortelmans L., Goossens E., De Graef M., Van Dingenen J., De Cock A.-M., Petrovic M., van den Bemt P,  Dilles T.

European journal of clinical pharmacology 2024, doi: 10.1007/s00228-024-03661-1.

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Effect of an in-hospital medication self-management intervention (SelfMED) on medication adherence in polypharmacy patients postdischarge: protocol of a pre-post intervention study.
Mortelmans L., Goossens E., Dilles T.
BMJ Open. 2024. doi: 10.1136/bmjopen-2023-083129.

 

Timespan

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2020 – 2025

 

Funding agency

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Since November 2021, Laura Mortelmans is funded by Research Foundation Flanders (FWO - Fonds voor Wetenschappelijk Onderzoek - Vlaanderen).