| Objectives To construct a phased progressive patient participation in medication safety management plan for elderly patients with cardiovascular disease,and to verify the feasibility and effectiveness of the plan.Methods This study was performed in two phases.1.The first phase was the construction of the intervention plan.Based on the analysis of the related literature at home and abroad,a qualitative study of the elderly patients with chronic diseases in drug safety,motivational interviewing and the theoretical framework of patient participation in patient safety,the intervention plan was initially constructed.Through the expert consultation,and combined with the analysis of the current situation of medication errors and preliminary test,a patient participation in medication safety management plan was established,which was easy to operate and easy to accept.2.The second phase was the implementation of the intervention plan.From December 2015 to December 2016,8 residential areas under the jurisdiction of the community health service center were selected.104 cases of elderly patients with cardiovascular disease were conveniently selected from the community health service center of Zhengzhou City,and were randomly assigned into intervention group and control group according to the number of residents of each residential area.Finally,51 cases in the intervention group,53 cases in the control group.The intervention group received patient participation in medication safety management intervention plan,a total of 12 weeks.Control group received the same health education for only first three weeks which was similar to the intervention group,and the rest weekly routine follow-up.Data were collected in the follow time points: pre-intervention,post-intervention,1 and 3 months post intervention.The evaluation tools included Medication Error Questionnaire,Self-efficacy for Appropriate Medication Use Scale(SEAMS)and Patient Activation Measure(PAM).Data were analyzed with IBM SPSS Statistics 21.0,using the descriptive statistics,T test,chi-square text,Kruskal-Wallis rank sum test,multiple correspondence analysis,generalized estimating equation,repetitive measurement analysis of variance.Results 120 cases were included at first in this study,16 cases were lost,and the loss rate was 13.3%.Then the final effective samples were 104 cases.The cases age were 65~87 years old,mean age(73.25±5.40)years old.The intervention group(n =51)with mean age(73.86±4.25)and control group(n =53)with mean age(72.66±6.29).1.The variation of 7 types of medication errors were analyzed by generalized estimating equation.(1)Medication errors which had significant difference in group effect included omission error(Wald?~2=47.223,P<0.001),wrong time error(Wald?~2=31.371,P<0.001),improper dose error(Wald?~2=35.759,P<0.001),unauthorized error(Wald?~2=6.773,P=0.009),non adherence doctor orders error(Wald?~2=4.319,P=0.038)and monitoring error(Wald?~2=6.755,P=0.009).(2)Medication errors which had no significant difference in group effect included prescription error not concerned(Wald?~2=1.834,P=0.176).(3)Medication errors which had significant difference in time effect included prescription error not concerned(Wald?~2=74.437,P<0.001),omission error (Wald?~2=112.197,P<0.001),wrong time error(Wald?~2=114.940,P<0.001),improper dose error(Wald?~2=100.171,P<0.001),unauthorized error(Wald?~2=70.691,P<0.001),non adherence doctor orders error(Wald?~2=77.856,P<0.001)and monitoring error(Wald?~2=87.052,P<0.001).In addition,increased with time,the degree of omission error,wrong time error and improper dose error decreased at first and then remained unchanged;the degree of prescription error not concerned,non adherence doctor orders error and monitoring error decreased at first and then increased;the degree of unauthorized error firstly decreased and then increased,and there was no statistically significant difference(P=0.102)between 3 months after the intervention and the baseline.2.After intervention,the results of repeated-measures analysis of the SEAMS indicated that the difference were statistically significant between groups(F=31.632,P<0.001)and time effect(F=832.994,P<0.001).There was an interaction between the group effect and time effect(F=367.434,P<0.001).The contour interactive graph showed that with the prolongation of time,the SEAMS scores of the intervention group decreased.3.After intervention,the PAM scores in the intervention group were higher than that of the control group,and the difference was statistically significant(P<0.001).Further analysis were as follows:(1)The results of repeated-measures analysis indicated that the difference were statistically significant between group effect(F=42.698,P<0.001)and time effect(F=305.557,P<0.001).There was an interaction between the group effect and time effect(F=270.424,P<0.001).The contour interactive graph showed that with the prolongation of time,the PAM scores of the intervention group decreased.(2)The generalized estimating equation was used to analyze the patients number of the two groups in different PAM level.There were group effect(Wald?~2=24.553,P<0.001)and time effect(Wald?~2=38.474,P<0.001).And increased with time,the degree of PAM level firstly increased and then decreased.Conclusions 1.The patient participation in medication safety management plan is easy to accept and operate,which can fully mobilize the enthusiasm of patients,and promote their active participation,or under the assistance of their families actively participate in the medication safety management.2.After implementing the patient participation in medication safety management plan,can reduce the incidence of common medication errors in elderly patients with cardiovascular disease,and improve the self efficacy and patients' activation. |
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