gms | German Medical Science

17th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

25.11. - 26.11.2010, Osnabrück

Self-management support in chronic illness and multiple medication regimes in home care – results of an intervention study

Meeting Abstract

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  • corresponding author Gabriele Müller-Mundt - Universität Bielefeld, Fakultät für Gesundheitswissenschaften, Bielefeld, Germany
  • Doris Schaeffer - Universität Bielefeld, Fakultät für Gesundheitswissenschaften, Bielefeld, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 17. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Osnabrück, 25.-26.11.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10gaa04

DOI: 10.3205/10gaa04, URN: urn:nbn:de:0183-10gaa040

Published: November 22, 2010

© 2010 Müller-Mundt et al.
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Outline

Text

Introduction: Managing chronic illness and long-term drug-therapies is a challenging task, especially in older age. In health care systems with a higher degree of professionalization in nursing self-management support is provided by nurses. The given research project aimed to develop an intervention to integrate self-management support in multiple medications in home care in Germany (The project is part of the Nursing Research Network NRW “Patients' Perspectives in Chronic illness – New Concepts of Health Care”, funded by the German Federal Ministry of Education and Research, 04/2004 – 12/2010, AZ 01GT0315/01GT0615. Ethical approval for the intervention study was obtained from the Research Ethics Committee of the Medical Council Westphalian-Lippe and the Medical School of the Wilhelms-University Münster, AZ: 2007-241-f-S.).

Methods: Based on a qualitative exploration of the patients' and professionals' view a two-tired intervention was developed, covering a training and a practice guideline. It serves to improve the nurses competencies to provide self-management support in home care. A prospective control study was carried to determine the effect of the intervention on the nurses' and patients' side. Structured patient interviews and a postal nurse questionnaire were conducted prior intervention in spring 2008 (t1) and six months after the end of the intervention phase in autumn 2009 (t2). 54 primary nurses and 89 patients out of 26 home care agencies meeting the inclusion criteria were recruited at baseline. For the comparative data-analysis non-parametric statistical tests were performed.

Results: Conducting the study proved to be difficult. Main barriers were the reduced health status of the patients and constraints in personnel recruitment and retention in the home care agencies. The results indicate an improvement in the nurses competencies. On the patients' side the high degree of self-reported adherence remained unchanged, while health care utilization increased in both – the intervention and control group. Further descriptive data analysis show that also compared to the control group the patients of the intervention group felt themselves at follow-up significant more encouraged by their nurses to bring up medication related problems in the medical encounter.

Discussion and conclusion: Strengthen home care nurses competencies in counseling and geriatric pharmacology to provide self-management support in a coaching manner offers the opportunity to encourage elderly patients to take over a more active role and to communicate problems with their medication. Further research including the development of robust outcome measures is needed.

Conflicts of interest: No conflicts of interest are to declare.