Category: Spinal Cord Injury; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Health Services Research
Objective : To explore health care providers' experiences and perceptions of factors that impact medication adherence for individuals with spinal cord injury and dysfunction (SCI/D).
Design : A qualitative study.
Setting : Canada.
Participants (or Animals, Specimens, Cadavers) : Healthcare providers were recruited through clinical organizations and researchers' personal contacts. Participants were purposefully selected for diversity in profession and were required to be English speaking and to have provided care to at least one individual with SCI/D. Thirty-two semi-structured interviews were conducted by telephone. Participants included physicians, pharmacists, occupational and physical therapists and care coordinators.
Interventions : Not applicable.
Main Outcome Measure(s) : Healthcare providers' experiences and perceptions of factors contributing to medication adherence for their patients with SCI/D.
Results : Healthcare providers identified 12 factors that impacted medication adherence for individuals with SCI/D. Factors were categorized into micro (medication and patient-related factors), meso (clinician-related factors) and macro (health systems-related factors) levels. Medication-related factors included side effects, effectiveness, safety and regimen complexity. Patient-related factors included medication knowledge, preferences, expectations and goals, severity of injury and comorbidities, and caregiver support. Clinician-related factors included knowledge/ confidence and patient trust. Health systems-related factors included access to health care (e.g. transportation, wait times) and access to mediations (e.g. cost, medication delivery, refill policies).
Conclusions : Healthcare providers identified many factors that influence medication adherence for individuals with SCI/D. Micro-level factors were the most abundantly discussed by all types of providers. Study findings indicate medication adherence is a complex concept. Thus, strategies to optimize medication adherence for individuals with SCI/D should be multi-faceted.
Sara Guilcher– Assistant Professor, University of Toronto, Toronto, Ontario
Amanda Everall– Research Officer, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
Tejal Patel– Clinical Assistant Professor, University of Waterloo, Kitchener, Ontario
Tanya Packer– Professor, Dalhousie University, Halifax, Nova Scotia
Sander Hitzig– Scientist, St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
Aisha Lofters– Clinician Scientist, St. Michael’s Hospital, Toronto, Ontario