Exploring the perspectives on medication self-management among persons with spinal cord injury/dysfunction and providers

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

doi:10.1016/j.sapharm.2020.01.014

Exploring the perspectives on medication self-management among persons with spinal cord injury/dysfunction and providers

Res Social Adm Pharm. 2020 Dec;16(12):1775-1784. doi: 10.1016/j.sapharm.2020.01.014. Epub 2020 Jan 30.

Authors

Lauren Cadel¹, Amanda C Everall², Tanya L Packer³, Sander L Hitzig⁴, Tejal Patel⁵, Aisha K Lofters⁶, Sara J T Guilcher⁷

Affiliations

¹ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. Electronic address: [email protected].
² Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. Electronic address: [email protected].
³ Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, NS, Canada. Electronic address: [email protected].
⁴ St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: [email protected].
⁵ School of Pharmacy, University of Waterloo, Kitchener, ON, Canada; Centre for Family Medicine Family Health Team, Kitchener, ON, Canada; Department of Family Medicine, DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address: [email protected].
⁶ Women's College Hospital, Toronto, ON, Canada; Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. Electronic address: [email protected].
⁷ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: [email protected].

PMID: 32057689
DOI: 10.1016/j.sapharm.2020.01.014

Abstract

Rationale: Spinal cord injury/dysfunction (SCI/D) is an exemplar condition with a high prevalence of secondary complications, chronic conditions and use of multiple medications (polypharmacy). Optimizing medication self-management is important for persons with SCI/D to improve outcomes; however, there is a lack of research on how healthcare/service providers and persons with SCI/D experience medication self-management.

Objective: To explore attitudes and experiences of medication self-management from the perspectives of persons with SCI/D and providers, and to explore the extent to which the Taxonomy of Everyday Self-management Strategies (TEDSS) framework captured participants' experiences with medication self-management.

Methods: In-depth, semi-structured interviews were conducted by telephone until data saturation was reached. Interviews were transcribed verbatim and analyzed using constant comparative approaches. The TEDSS framework was adapted and applied deductively.

Results: Fifty-one individuals participated in this study, 32 providers and 19 persons with SCI/D. Disease controlling strategies was the domain discussed in most detail by all participants. In this domain, participants discussed managing medications and treatments, monitoring/managing side effects, and controlling complications. Process strategies (problem-solving, decision-making) and resource strategies (seeking support) were the next most frequently discussed domains. Among all participant groups, there was a lack of detailed discussion of social interactions, health behaviour, and internal strategies. Medication self-management support was not extensively discussed by any group.

Conclusion: This study highlighted the complex nature of medication self-management. While persons with SCI/D and providers discussed similar components of the TEDSS framework, providers had minimal reflections on the impact of medication self-management on everyday life. This study identified the need for explicit discussions between providers and persons with SCI/D, involving all components of self-management and self-management support in order to improve medication self-management.

Keywords: Canada; Medication management; Medication-taking behaviour; Qualitative; Self-management; Spinal cord injury.

Publication types

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

MeSH terms

Chronic Disease
Health Behavior
Humans
Polypharmacy
Self-Management*
Spinal Cord Injuries* / drug therapy