Medication adherence for persons with spinal cord injury and dysfunction from the perspectives of healthcare providers: A qualitative study

Sara J T Guilcher; Amanda C Everall; Tejal Patel; Tanya L Packer; Sander L Hitzig; Aisha K Lofters

doi:10.1080/10790268.2019.1637644

Medication adherence for persons with spinal cord injury and dysfunction from the perspectives of healthcare providers: A qualitative study

J Spinal Cord Med. 2019 Oct;42(sup1):215-225. doi: 10.1080/10790268.2019.1637644.

Authors

Sara J T Guilcher^{1

2

3}, Amanda C Everall¹, Tejal Patel^{4

5}, Tanya L Packer⁶, Sander L Hitzig^{2

7

8}, Aisha K Lofters⁹

Affiliations

¹ Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Canada.
² Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto , Canada.
³ Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto , Canada.
⁴ School of Pharmacy, University of Waterloo , Kitchener , Canada.
⁵ Department of Family Medicine, DeGroote School of Medicine, McMaster University , Hamilton , Canada.
⁶ School of Occupational Therapy and Health Administration, Dalhousie University , Halifax , Canada.
⁷ St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre , Toronto , Canada.
⁸ Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto , Canada.
⁹ Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto , Toronto , Canada.

Abstract

Context: People with spinal cord injury and dysfunction (SCI/D) often take multiple medications (i.e. polypharmacy) to manage secondary health complications and multiple chronic conditions. Numerous healthcare providers are often involved in clinical care, increasing the risk of fragmented care, problematic polypharmacy, and conflicting health advice. These providers can play a crucial role in assisting patients with medication self-management to improve medication adherence. Design: A qualitative study involving telephone interviews, following a semi-structured guide that explored healthcare providers' conceptualization of factors impacting medication adherence for persons with SCI/D. The interviews were transcribed and analyzed descriptively and interpretively using a constant comparative process with the assistance of data display matrices. Analysis was guided by an ecological model of medication adherence. Setting and participants: Thirty-two healthcare providers from Canada, with varying clinical expertise. Intervention: Not Applicable. Outcome measures: Not Applicable. Results: Providers identified several factors that impact medication adherence for persons with SCI/D, which were grouped into micro (medication and patient-related), meso- (provider-related) and macro- (health system-related) factors. Medication-related factors included side effects, effectiveness, safety, and regimen complexity. Patient-specific factors included medication knowledge, preferences/expectations/goals, severity and type of injury, cognitive function/mental health, time since injury, and caregiver support. Provider-related factors included knowledge/confidence and trust. Health system-related factors included access to healthcare and access to medications. While providers were able to identify several factors influencing medication adherence, micro-level factors were the most frequently discussed. Conclusion: Findings from this study indicate that strategies to optimize medication adherence for persons with SCI/D should be multi-faceted.

Keywords: Medication adherence; Medication management; Patient preference; Polypharmacy; Spinal cord injury.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Health Knowledge, Attitudes, Practice*
Health Personnel / psychology*
Humans
Male
Medication Adherence / psychology
Medication Adherence / statistics & numerical data*
Middle Aged
Polypharmacy*
Spinal Cord Injuries / complications*
Spinal Cord Injuries / drug therapy
Spinal Cord Injuries / psychology

Grants and funding

This project was funded by the Craig H. Neilsen Foundation (Psychosocial Research Pilot Grant #441259) and the Connaught New Investigator Award (University of Toronto). Dr. Guilcher is supported by a Canadian Institutes for Health Research Embedded Clinician Scientist Salary Award on Transitions in Care (2016-2020).