Managing Medications During "Sick Days" in Patients With Diabetes, Kidney, and Cardiovascular Conditions: A Theory-informed Approach to Intervention Design and Implementation

Kaitlyn E Watson; Kirnvir Dhaliwal; Eleanor Benterud; Sandra Robertshaw; Nancy Verdin; Ella McMurtry; Nicole Lamont; Kelsea M Drall; Sarah Gill; David J T Campbell; Kerry McBrien; Ross T Tsuyuki; Neesh Pannu; Matthew T James; Maoliosa Donald

doi:10.1016/j.jcjd.2024.02.003

Managing Medications During "Sick Days" in Patients With Diabetes, Kidney, and Cardiovascular Conditions: A Theory-informed Approach to Intervention Design and Implementation

Can J Diabetes. 2024 Feb 21:S1499-2671(24)00045-5. doi: 10.1016/j.jcjd.2024.02.003. Online ahead of print.

Authors

Affiliations

¹ EPICORE Centre, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: kewatson@ualberta.ca.
² Department of Medicine, Cumming School of Medicine, University of Calgary, Edmonton, Alberta, Canada.
³ Patient partner, Department of Medicine, Cumming School of Medicine, University of Calgary, Edmonton, Alberta, Canada.
⁴ Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
⁵ Department of Medicine, Cumming School of Medicine, University of Calgary, Edmonton, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Edmonton, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Edmonton, Alberta, Canada.
⁶ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Edmonton, Alberta, Canada; Departments of Family Medicine, Cumming School of Medicine, University of Calgary, Edmonton, Alberta, Canada.
⁷ EPICORE Centre, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Pharmacology, University of Alberta, Edmonton, Alberta, Canada.
⁸ Department of Medicine, Cumming School of Medicine, University of Calgary, Edmonton, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Edmonton, Alberta, Canada.

PMID: 38395301
DOI: 10.1016/j.jcjd.2024.02.003

Abstract

Objectives: Our aim in this work was to: 1) explore barriers and enablers to patient and health-care provider (HCP) behaviours related to sick-day medication guidance (SDMG), 2) identify theory-informed strategies to advise SDMG intervention design, and 3) obtain perspectives on an eHealth tool for this purpose.

Methods: A qualitative descriptive study using qualitative conventional content analysis was undertaken. Interviews and focus groups were held with patients and HCPs from January 2021 to April 2022. Data were analyzed using the Behaviour Change Wheel and Theoretical Domains Framework to inform intervention design.

Results: Forty-eight people (20 patients, 13 pharmacists, 12 family physicians, and 3 nurse practitioners) participated in this study. Three interventions were designed to address the identified barriers and enablers: 1) prescriptions provided by a community-based care provider, 2) pharmacists adding a label to at-risk medications, and 3) built-in prompts for prescribing and dispensing software. Most participants accepted the concept of an eHealth tool and identified pharmacists as the ideal point-of-care provider. Challenges for an eHealth tool were raised, including credibility, privacy of data, medical liability, clinician remuneration and workload impact, and equitable access to use of the tool.

Conclusions: Patients and HCPs endorsed non-technology and eHealth innovations as strategies to aid in the delivery of SDMG. These findings can guide the design of future theory-informed SDMG interventions.

Keywords: behaviours; chronic conditions; comportements; conception des interventions; directives sur les médicaments lors des journées de maladie; implementation; intervention design; jours de maladie; maladies chroniques; mise en œuvre; sick days; sick-day medication guidance.