1. Unmet needs for medicines support: A greater role for community pharmacists in the care of stroke survivors?
Daniel. L. Da Costa, Sarah. A. Corlett, and Linda. J. Dodds
Introduction: Adherence to medicines prescribed after a stroke has been reported as 57%, thus increasing the risk of a further stroke (Naderi et al. 2012). Physical and cognitive difficulties may compromise stroke survivors’ ability to manage multiple medicines. Community pharmacists are ideally placed to support patients’ long-term. This study aimed to investigate stroke survivors’ medicine support needs and their relationships with pharmacy services.
Method: Following institutional research ethics approval, stroke survivors were recruited from local support groups using purposive sampling. Individual, face to face, semi-structured interviews, lasting on average 45 minutes, were conducted. These explored participants’ experience with their medicines and community pharmacy services. Interviews were audiotaped and transcribed. Thematic analysis was undertaken using NVivo software.
Results: Fifteen stroke survivors participated in the study. A number of unmet medicine needs were identified despite the support participants received. Some people had multiple concerns with their medicines. A number of these were related to the supply of medicines, many others to the effects of their stroke. Physical and cognitive difficulties also affected the ability of half of the participants to visit their community pharmacy. Some relied on support from carers to visit, whereas others did not visit their pharmacy at all, and therefore did not see their pharmacist. When support was received, community pharmacists enabled participants to resolve many of their medicine problems.
“Those ones where you push them out…I have great difficulty doing that. Sometimes I get half a pill, sometimes I get no pill, sometimes the pill shoots over the other side of the room… and those bloody, excuse me, those push down the lid and turn (containers)!“ S11; male, age 65, modified Rankin scale:4
“My hand is stuck now…I find it difficult with blister packs to do it with one hand, push the thing in and get the tablet out…some of them are so hard to undo”
“It’s affected my vision…sometimes you can’t always read them (medicine instructions ) properly because your eyes are a bit wafty”
Photographs are the medicines of some of the participants who took part in this study.
Conclusion: Medicine-related problems which can compromise adherence are going unrecognised risking patients’ health. Community pharmacists are well placed to provide bespoke long-term medicines support and could be integrated into the multidisciplinary care pathway. However, consideration will need to be given to commissioning domiciliary pharmacy support for those unable to access the pharmacy.
“I can put them (medicines) in the little jar, in the glass, put the water on there and leave it for a little while…then I’d completely forget …there’s been odd occasions when I’ve taken the tablets and then about an hour later thinking, well, did I take them, didn’t I take them?” “
“I’ve gone in to panic because I couldn’t find the right tablets, because it wasn’t programmed in my head”
S15; female, age 68,
modified Rankin scale:3
Unmet needs
“I couldn’t swallow it (the medicine), it would stick in my throat and make me choke”
“The doctor wanted to give me depression tablets and I didn’t want them…he (community pharmacist) told me all the options and I thought it through and that’s what I wanted to do”
S6; female, age 67,
modified Rankin scale:3
“There is a leaflet in here…I expect it would tell me what it (medicine) does….I could even read that but that would confuse me anyway…it gets muddled up inside me” S12; female, age 48,
modified Rankin scale:3
“It’s only when I start to run out I get panicky and think oh god must get some more tablets”
S13; female, age 86, modified Rankin scale:4
“The pharmacist is quite close ..if somebody could take me there or get me there”
S8; female, age 91, modified Rankin scale:4
Reference: Naderi,S.H., Bestwick,J.P.& Wald,D.S. (2012) Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med 2012; 125:
Medway School of Pharmacy, Universities of Kent and Greenwich at Medway
Chatham Maritime, Kent. ME4 4TB