Ellis and Mullan (2009) discussed medication sharing in recent study of data from Australia and the United States. They found the drugs most likely to be shared were opioid analgesics and other pain medications, NSAIDs, allergy medications, antibiotics, anticoagulants, and cardiovascular medications. Most preferred to borrow meds that had been prescribed to them previously.

The authors gathered from the literature that the conditions under which a patient shared or borrowed meds include:
• keeping leftover meds deliberately for next time
• wanting to help a friend
• sharing with a family member.
• asking for the same prescription so they could share with someone else
• borrower had run out of prescription medicine in the short term
Sharing meds was more likely when there were more people in the house, or the patient was single (not in a relationship).

The authors identified a number of problems borrowing and sharing meds could cause, including:
• Complications of incorrect use.
• Development of antibiotic resistance, due to people not following the full course of antibiotics.
• Poisoning of patient due to inappropriate dose.
• Damage to fetus during early pregnancy.
• Delays in seeking professional medical help which could lead to misdiagnosis or diagnosis of a disease at a later stage, leading to poorer outcomes.

Adults use their problem-solving skills to deal with issues in front of them. Patients have told me they think we don’t want them to share meds because we want to make more money. With limited information, it is logical to think saving leftover antibiotics for that next infection makes sense, or saving leftover pain killers for the next episode of pain is a good idea. We cannot expect patients to know what we don’t tell them. Unless we give them the whole picture, with all the rationales and risks, how can they make informed decisions?

The authors’ advice:
• Be proactive. Tell your patients not to share or borrow prescription medicines, and why this could be a problem.
• When a patient’s prescriptions are changed, tell the patient how to safely dispose of old medicine.
• Upon discharge from a hospital carefully reconcile meds. Tell the
patient how to discard medications that are no longer required. Tell the patient that prescriptions are for his or her use only, not to share them, and why.

Anticipatory guidance is an important part of patient education. It is a good idea to clearly tell all your patients not to share or borrow meds, how to safely dispose of meds, and why.

Source: Ellis, J., & Mullan, J. (2009). Prescription medication borrowing and sharing–risk factors and management. Aust Fam Physician, 38 (10), 816-819.

Here’s a painless way to have the latest evidence-based information, specific to your clinical area, come to you. You can now customize your e-mails or RSS-feeds based upon your particular interests. Here are their instructions:

You can go to any of the health topic pages in MedlinePlus and subscribe to updates right from the page. There are over 800 topics in English, over 770 topics en español, and a variety of other health-related e-mail lists in English and Spanish. To see how it works, go to the Diabetes page at http://www.nlm.nih.gov/medlineplus/diabetes.html, and look for the box under the summary section where you can enter your email address.

You can also visit the MedlinePlus subscription options pages for MedlinePlus and MedlinePlus en español. Whenever MedlinePlus adds new information on a topic page to which you are subscribed, you will receive an e-mail alert to notify you of the new materials. To set your subscription options, click on the “E-mail Updates and RSS” link on the lower right side of the home page. (http://www.nlm.nih.gov/medlineplus/listserv.html)

This service is also offered by other agencies, like
The CDC

http://www.cdc.gov/emailupdates/index.html

National Institutes of Health (NIH)

http://www.nih.gov/email.htm

Agency for Healthcare Research and Quality (AHRQ)

http://www.effectivehealthcare.ahrq.gov/index.cfm/join-the-email-list1/

and the US Food and Drug Administration (FDA)

http://www.fda.gov/AboutFDA/ContactFDA/StayInformed/GetEmailUpdates/default.htm

Have the news you choose come to you! Our tax money at work.

The researchers found the participants with a higher level of diet family support had lower A1C levels. Family support has a big effect on glucose control. The positive impact of family support was even more pronounced in men.

This study was specific to Korean immigrants, but it is not hard to see that it might hold true for other populations. In many families from many cultures, women manage the family food preparations. It would be easier for a patient to change eating patterns when the family encourages and supports new behaviors.

So don’t just educate the patient. Include the family, especially when the treatment includes major lifestyle changes. Eating is a family affair. Diet changes are more effective with family support.

Source: Choi, S. E. (2009). Diet-specific family support and glucose control among Korean immigrants with type 2 diabetes. Diabetes Educ, 35(6), 978-985.

However, I know there are still a lot of health care providers who don’t think their patient populations include patients with poor literacy skills. For them, I suggest they try this quick assessment test on their patients. This test takes 3 minutes to administer, and is available in both English and Spanish.

For this test, questions to ask, answer key, and information relating to its reliability and validity go to:

http://pfizerhealthliteracy.com/physicians-providers/newest-vital-sign.html

Patients are given a nutrition label from an ice cream container. They are then asked 6 questions about how they would interpret and act on the information contained on the label. Patients can and should retain the label so they can refer to it while answering questions. The questions are asked orally and the responses recorded by a health care provider on a special score sheet, which contains the correct answers. Based on the number of correct responses, the health care provider can assess the patient’s health literacy level.

The researchers found the skills needed to answer these questions correctly are the same skills needed for health literacy, such as understanding and taking prescriptions correctly, and following instructions for self-care skills.

How cool is that?

http://www.nhs.uk/planners/yourhealth/pages/selfcare.aspx

A Director of Nursing emailed me, saying she purchased a copy of No Time to Teach for each of her nursing units. A manager of a hospital department told me she purchased a copy of this book for everyone on her team – not just the nurses. She has turned several staff meetings into book club sessions, where they discuss No Time to Teach chapter by chapter, thinking about how they can apply the contents to practice. The manager is doing this to unite their efforts, improve their skills, and build their enthusiasm.

I believe that after saving lives, the most important service of health care providers is patient and family education. There is so much good information out there, but it is not easy to take the time to sort through it and figure out how to apply it to practice. I have chosen a career in dissemination of research. Knowing what the research reveals is not meaningful until it is applied and improves outcomes. No Time to Teach is a clear, practical tool to move you from knowledge to practice, and from novice to expert.

Thank you, readers, for spreading the word.

If you were in this position, what would you buy? How would you prepare it? How many fruits and vegetables would it include? Would you choose to eat enough quantity so you don’t feel hungry, or eat nutritious foods that optimize health?

What if you had high blood pressure, or high cholesterol, or diabetes? How would you feel if your health care provider told you to improve your diet? How would you respond?

Evidence shows the most effective patient education involves the learner, and individualizes teaching to the needs of the learner. Imagine how the teaching would change if the health care provider first asked, “Do you ever worry whether your food would run out before you got money to buy more?”

How often do we assess our learners to know how to individualize teaching? How often to we label someone as noncompliant, when they simply did not have the resources to follow our standardized directions?

Sources:

VU medical students slash food budgets for week, By Jennifer Brooks, The Tennessean, http://www.tennessean.com/article/20100113/NEWS04/1130361/VU-medical-students-slash-food-budgets-for-week

Nord, M., M. Andrews, and S. Carlson (2004). Household Food Security in the United States,

Panel to Review U.S Department of Agriculture’s Measurement of Food Insecurity and Hunger, N., & Council., R. (2005). Measuring Food Insecurity and Hunger: Phase 1 Report Available from http://www.nap.edu/catalog.php?record_id=11227

For example, before preparing a web-based educational intervention to increase fruit and vegetable consumption, researchers interviewed 12 focus groups (total of 137 participants) to find out their perceptions of healthy eating, and factors that promote or hinder consumption of fruits and vegetables. They also asked about features they would prefer in a web-based educational program. With this information the program was designed to meet the needs of the learners, to enhance effectiveness.

Knowing your audience is especially important when spending the time and money to create an educational program. How you present the information will determine whether or not it will be heard, understood, and applied. Modify your approach to reach your audience, and spend your resources wisely. If you don’t know how to conduct a focus group, there is much useful information on the Internet to get you started, or you can consult an expert.

Resources:

Rolnick, S. J., Calvi, J., Heimendinger, J., McClure, J. B., Kelley, M., Johnson, C., et al. (2009). Focus groups inform a web-based program to increase fruit and vegetable intake. Patient Educ Couns, 77(2), 314-318.

Basics of Conducting Focus Groups http://managementhelp.org/evaluatn/focusgrp.htm

General Guidelines for Conducting Interviews http://www.managementhelp.org/evaluatn/intrview.htm

The study discussed the importance of identifying patients who intentionally omit their insulin often. Once you know who they are, you can find out why they are choosing not to take their insulin and coach them toward making healthier choices.

The researchers found that those with a higher household income were less likely to skip doses. This may be because they have better access to medication and supplies, better access to diabetes education, better problem-solving skills, or greater control over their life routines.

Think about it. One in five of your diabetic patients may be regularly skipping insulin. How do you respond to a high A1C? By adjusting the insulin dose? Instead, you might start by asking how things are going financially. This study found lack of personal resources, especially income, is a potential warning sign of insulin omission.

Teaching the newly diagnosed diabetic about diet, testing blood sugars, and administration of insulin is just the start of their patient education. Once they master the information and skills, we need to help them apply those skills to life, and maintain healthy habits. The best way to improve health outcomes is to improve self-care behaviors through information, skills, and health coaching over time.

Resource: Peyrot, M., Rubin, R. R., Kruger, D. F., & Travis, L. B. (2010). Correlates of Insulin Injection Omission. Diabetes Care, 22, 240-245.

The site: http://m.medlineplus.gov/