Family caregivers’ facilitation of daily adult prescription medication use

https://doi.org/10.1016/j.pec.2017.12.018Get rights and content

Highlights

  • Caregivers facilitate safe medication use at home, during medical visits and at the pharmacy.

  • Home medication management strategies are routinely used on behalf of patients.

  • Caregivers facilitate medical visit and pharmacist communication.

Abstract

Objective

To describe ways family members assist adult patients with prescription medications at home, during medical visits and at the pharmacy.

Methods

Online survey of 400 adults (caregivers) who help another adult (care recipient) with prescription medication use. Regression modeled the contribution of caregiver communication during recipients’ medical visits, evaluation of physicians’ medication communication and discussions with the dispensing pharmacist on caregivers’ assistance with home medication management.

Results

Female (68%) family members (94%) assisted care recipients with multimorbidity (mean 2.9 conditions) and polypharmacy (mean 3.2 prescriptions). On average, caregivers performed 3 visit communication behaviors (e.g., notetaking) and implemented 2.6 home medication management strategies (e.g., filling/monitoring pill boxes). Communication-related variables explained 17% of home medication management assistance; including caregivers' visit communication (std. beta 0.31), physicians’ medication communication (std. beta 0.15) and pharmacist discussions (std. beta 0.10). The final model included recipients’ multimorbidity and caregiver education (std. betas 0.21 and 0.13) explaining 22% of caregiver assistance with home medication management.

Conclusion

Caregivers' assistance with safe and effective home medication use crosses care contexts and is facilitated by clinician and pharmacist communication.

Practice implications

Support for caregiver engagement in healthcare conversations can contribute to patient adherence and family-centered, high quality care.

Introduction

Medication safety and effectiveness is jeopardized by both errors in administration and poor adherence [1]. While these threats are significant for all people, they are especially critical to the health and well-being of adults with multiple chronic conditions who are often expected to follow complex medication regimens [2,3]. It is this population that most often needs and receives support from family caregivers (defined broadly as spouses, partners, adult children and other relatives, and friends) for safe and effective medication use [4]. DiMatteo noted in her landmark review of evidence linking social support and treatment adherence, that this relationship may moderate the well-established link between social support and health, particularly for older adults with multimorbidities and polypharmacy [5]. Receipt of practical support increased adherence with treatment recommendations by more than three-fold and that adherence was 1.7 times higher among patients from cohesive families. DiMatteo concluded that while receipt of practical support from functional families substantially enhances the likelihood of adherence, there are complex and multi-faceted moderators not commonly assessed in studies that are likely to be in play.

One of these factors may be the communication role family members assume when accompanying patients to their medical visits. Estimates are that 40% of older adults are routinely accompanied to their medical visits, most commonly by family caregivers [6,7]. Observational studies have identified a specific array of facilitative communication behaviors commonly performed by caregivers, including note taking, clarifying clinicians’ instructions and recommendations, asking questions, and providing current and historical information about the patient’s medical condition and treatment [8,9]. These same communication behaviors were reported by patients as performed by family companions present at their medical visits in the Medicare Current Beneficiary Survey (MCBS); moreover, the more of the behaviors performed, the more satisfied the beneficiaries reported they were with their physicians’ informativeness and interpersonal skill [10]. The positive consequences of family facilitation of communication seen in the MCBS study may extend beyond patient satisfaction to patient adherence. Relevant to this speculation is a meta-analysis of physician communication and treatment adherence that found physicians who were evaluated by their patients as being good communicators had 19% higher adherence rates than poor communicators [11]. The authors suggest that the positive evaluation of physician communication reflects skill in transmission and retrieval of clinical information, enhancement of patient involvement in treatment decision making and positive interpersonal rapport.

While the relationship between patient adherence and family provision of practical support for adherence has been established [5], as has the relationship between patient adherence and skillful medical visit communication [11], few studies have considered these factors in tandem or have proposed pathways through which family provision of practical communication support might enhance patient adherence. In the current study, we have furthered this line of inquiry by suggesting a family-centered communication adherence framework (Fig. 1) by proposing pathways linking family engagement in medical visit and pharmacy communication with caregivers’ ability and motivation to provide practical support for medication management in the home. As depicted in Figure I, the first pathway suggests that caregiver engagement in visit communication along the lines noted above [[8], [9], [10]] may help physicians more effectively deliver and tailor medication-related communication to meet the informational, decisional and emotional needs of both patients and caregivers, consistent with the mechanisms suggested by Zolnierek and DiMatteo [11]. In this way physician communication may moderate caregivers’ employment of medication management strategies in the home on behalf of the patient. An additional pathway suggests caregiver communication with the dispensing pharmacist may similarly moderate adherence through caregivers’ assistance with medication management strategies.

Caregiver and patient characteristics are also noted in the framework as affecting the proposed pathways and may include such variables as caregiver age, education, numeracy, and work status and patient age, gender, health status, multimorbidity and polypharmacy.

This study does not assess adherence, that outcome and direct correlates are shaded in the framework for completion, however, we do investigate likely antecedents of adherence, including family provision of practical assistance with medication management. We hypothesize that family member engagement in visit communication helps physicians’ better tailor medication-related visit communication to the needs of patients and caregivers thereby positively influencing caregivers’ implementation of home medication management strategies. In addition, we hypothesize that frequent caregiver discussion with the dispensing pharmacist also influences caregivers’ implementation of medication management strategies in the home.

Section snippets

Study design

The study used a cross-sectional, online survey of adults recruited through a commercially-available consumer panel of adults who have consented to be contacted for research purposes. Panel membership is geographically and demographically reflective of the US population. A sample of 1600 adults met inclusion criteria and completed the one-time online survey in Nov-Dec 2013.

Participants

The current analysis is limited to a subset of 400 adults who reported having primary responsibility for helping another

Characteristics of caregivers and recipients

As reflected in Table 1, caregivers were predominantly female (68%), white (80%), married or living with a partner (53%), and on average, 41 years of age (range 18–74). Caregivers were overwhelmingly family members, most commonly an adult child (40%), spouse (23%), grandchild (15%) or other relative (9%). The majority of caregivers shared a home with the recipient (71%). Only 25% of caregivers reported that they had provided assistance to the recipient for less than a year while 53% had been

Discussion

This study contributes a detailed analysis of the variety of health care contexts in which family caregivers provide practical assistance to patients for safe and effective prescription medication use. As hypothesized, we found that caregiver engagement in the communication processes of care during medical visits and in pharmacies represent critical links to their provision of practical assistance for home medication management. Most notably, active caregivers’ facilitation of communication

Acknowledgements, conflicts of interest, and funding sources

An earlier version of the manuscript was presented at the International Conference for Communication in Healthcare (ICCH), in Heidelberg, Germany in 2016.

This work was supported by the U.S. Food and Drug Administration, Center for Drug Evaluation and Research under grant number 5U18FD004653-01. Project web site: www.Talkbeforeyoutake.org

Disclaimer: The U.S. Food and Drug Administration, Center for Drug Evaluation and Research funded this project under a grant to the National Council on Patient

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