Medication Self-Management in Hospitalised Patients with Schizophrenia or Bipolar Disorder: The Perceptions of Patients and Healthcare Providers
2. Materials and Methods
2.1. Research Team and Auhor Reflexivity
2.4. Data Collection
2.5. Data Analysis Process
2.6. Ethical Considerations
3.1.1. Theme 1: Monitoring and Shared Decision-Making
“Especially in the beginning, I think eh… eh… especially with people who have never done that. Do regular sampling to see if the medication has been taken. Regular monitoring is very important.”(Patient 8, bipolar disorder)
“You have to do some checking every day. You still have to go in the room or everyone’s medication tray in the evening… and look in the bin… are they not in the bin? Have they not been flushed down the toilet?…“(Nurse, 16)
“That supervision and guidance from the nurse is important but you should not last longer than necessary.”(Patient 4, schizophrenia)
“I think that’s also an important part of ‘How do you as a patient see this? Would you like to take it?… ‘Are there any problems? How did it go in the past? How do you feel about taking the medication?’ That this is important, otherwise we will interpret it in the place of the patient.”(Nurse 6)
3.1.2. Available Tools
“I would perhaps like there to be a kind of community group, where the patients who are almost discharged can go and practice to do their own medication self-management. Uh… a group with stable people with whom we work towards home that we… who have their own living space or something, so that we really are a separate target group actually… in which you can work very intensively with their medication.”(Nurse 2)
“I tell you, with me one of the tools is also setting my alarm clock…there are also those boxes or those things, shall I say, that remind you of that or something…, those little machines…. ”(Patient 9, bipolar disorder)
3.1.3. Theme 2: Relationship Based on Trust
3.1.4. Patient Readiness
“I think one of the risks is that people will think ‘He can’t do that’ and so, we don’t do it. That is a risk, that from themselves, there is… It’s very difficult to assess the extent to which people can do things. Sometimes people are chronically overestimated, sometimes they are underestimated.”(Psychiatrist)
“And… yes, maybe from the social aspect, peer pressure, swapping medication, theft… that kind of thing.”(Psychiatrist)
“The threat for the patient is also thinking about it yourself, taking it yourself, yes… and forgetting to take it out of unwillingness, that you forget. It may be that you really forget, it may be that you don’t want to…”(Patient 17, bipolar disorder)
3.1.6. Theme 3: Patient Satisfaction and Rehabilitation
“I think that also gives the patient a feeling of, yes… perhaps also of ‘I can do this myself’… ‘I can…’. They also say to me that I can take responsibility for this’, so I think that’s something the patient can be proud of.”(Hospital pharmacist 1)
“By the time, when you come home, you will know how to do it. Yes, then you learn it by the time you get back home.”(Patient schizophrenia, 13)
“The opportunities are that he is more aware of what he is taking, that he has more of a routine, of ‘ah, I have to take my medication’ in the morning and that that would certainly be a good idea in function of going back home after discharge.”(Nurse 4)
“I also think if… he prepares it himself that, he might become more aware of the need for his medication.”(Psychiatrist)
“You would like to do medication self-management. You also see the opportunity of… to be able to do that yourself in preparation to go home, you also say… one week is not enough, it would be better to be able to practice here for three or four weeks in order to be able to go home… to make it your own and build a routine into it… And you believe that this will also benefit the medication adherence.”(Patient 17, bipolar disorder)
4.1. Main Findings
4.2. Strengths and Limitations
4.3. Implications for Practice
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
- How do you manage your medication at home? How does this work?
- What difficulties do you experience?
- Have you ever tried or performed medication self-management during hospitalization?
- Would you like to self-manage your medication during your hospitalisation?
- Why not?
- What advantages do you think this would have for…:
- The patients?
- The healthcare providers: doctors, nurses, hospital pharmacist?
- What disadvantages do you think there are for the self-management of medication during hospitalisation?
- The patients?
- The health care providers?
- What opportunities do you think self-management of medication offers for:
- The healthcare providers?
- The organisation?
- What threats do you consider self-management of medication during hospitalisation to be for:
- The patients?
- The healthcare providers?
- The organisation?
- What should be present to allow self-management of medication during hospitalisation? What prerequisites?
- Patient related prerequisites?
- Prerequisites related to the medication or treatment?
- Prerequisites related to the hospital?
- Other prerequisites?
- World Health Organization. The Global Economic Burden of Non-Communicable Diseases; World Economic Forum: Geneva, Switzerland, 2011; Available online: https://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf (accessed on 11 April 2022).
- Pitanupong, J.; Ratanaapiromyakij, P.; Teetharatkul, T. Factors Associated with Low Relapse Rates of Schizophrenia in Southern Thailand: A University Hospital-Based Study; Research Square: Durham, NC, UAS, 2021. [Google Scholar] [CrossRef]
- Rzewuska, M. Drug maintenance treatment compliance and its correlation with the clinical picture and course of schizophrenia. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 2002, 26, 811–814. [Google Scholar] [CrossRef]
- Zhang, H.; Mi, W.; Li, L.; Shi, Y.; Xiao, J. High relapse rate and poor medication adherence in the Chinese population with schizophrenia: Results from an observational survey in the People’s Republic of China. Neuropsychiatr. Dis. Treat. 2015, 11, 1161–1170. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Fenton, W.S. Determinants of medicationcompliance in schizophrenia: Empirical and clinical findings. Schizophr. Bull. 1997, 23, 637–651. [Google Scholar] [CrossRef]
- Valenstein, M.; Kavanagh, J.; Lee, T.; Reilly, P.; Dalack, G.W.; Grabowski, J.; Smelson, D.; Ronis, D.L.; Ganoczy, D.; Woltmann, E.; et al. Using a pharmacy-based intervention to improve antipsychotic adherence among patients with serious mental illness. Schizophr. Bull. 2011, 37, 727–736. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Velligan, D.; Mintz, J.; Maples, N.; Xueying, L.; Gajewski, S.; Carr, H.; Sierra, C. A randomized trial comparing in person and electronic interventions for improving adherence to oral medications in schizophrenia. Schizophr. Bull. 2013, 39, 999–1007. [Google Scholar] [CrossRef]
- Guo, X.; Zhai, J.; Liu, Z.; Fang, M.; Wang, B.; Wang, C.; Hu, B.; Sun, X.; Lv, L.; Lu, Z.; et al. Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: A randomized, 1-year study. Arch. Gen. Psychiatry 2010, 67, 895–904. [Google Scholar] [CrossRef]
- Pakpour, A.H.; Modabbernia, A.; Lin, C.-Y.; Saffari, M.; Asl, M.A.; Webb, T.L. Promoting medication adherence among patients with bipolar disorder: A multicenter randomized controlled trial of a multifaceted intervention. Psychol. Med. 2017, 47, 2528–2539. [Google Scholar] [CrossRef]
- Sajatovic, M.; Tatsuoka, C.; Cassidy, K.A.; Klein, P.J.; Fuentes-Casiano, E.; Cage, J.; Aebi, M.E.; Ramirez, L.F.; Blixen, C.; Perzynski, A.T.; et al. A 6- Month, Prospective, Randomized Controlled Trial of Customized Adherence Enhancement Versus Bipolar-Specific Educational Control in Poorly Adherent Individuals With Bipolar Disorder. J. Clin. Psychiatry 2018, 79, 3997. [Google Scholar] [CrossRef]
- Bodenheimer, T.; Lorig, K.; Holman, H.; Grumbach, K. Patient self-management of chronic disease in primary care. JAMA 2002, 288, 2469–2475. [Google Scholar] [CrossRef]
- Holman, H. Patients as partners in managing chronic disease. Partnership is a prerequisite for effective and efficient health care. BMJ 2000, 320, 526–527. [Google Scholar] [CrossRef]
- Clark, N.M.; Becker, M.H.; Janz, N.K.; Lorig, K.; Rakowski, W.; Anderson, L. Self-management of chronic disease by older adults: A review and questions for research. J. Aging Health 1991, 3, 3–27. [Google Scholar] [CrossRef][Green Version]
- Wagner, E.H.; Austin, B.T.; Davis, C.; Hindmarsh, M.; Schaefer, J.; Bonomi, A. Improving chronic illness care: Translating evidence into action. Health Aff. 2001, 20, 64–78. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Barlow, J.H.; Sturt, J.; Hearnshaw, H. Self-management interventions for people with chronic conditions in primary care: Examples from arthritis, asthma and diabetes. Health Educ. J. 2002, 61, 365–378. [Google Scholar] [CrossRef]
- Bailey, S.C.; Oramasionwu, C.U.; Wolf, M.S. Rethinking Adherence: A Health Literacy–Informed Model of Medication Self-Management. J. Health Commun. 2013, 18, 20–30. [Google Scholar] [CrossRef][Green Version]
- Parnell, M.A. Medicines at the bedside. Am. J. Nurs. 1959, 59, 1417–1418. [Google Scholar]
- Richardson, S.J.; Brooks, H.L.; Bramley, G.; Coleman, J.J. Evaluating the effectiveness of self-administration of medication (SAM) schemes in the hospital setting: A systematic review of the literature. PLoS ONE 2014, 9, e113912. [Google Scholar] [CrossRef][Green Version]
- Wright, J.; Emerson, A.; Stephens, M.; Lennan, E. Hospital inpatient self- administration of medicine programmes: A critical literature review. Pharm. World Sci. 2006, 28, 140–151. [Google Scholar] [CrossRef]
- Vanwesemael, T.; Van Rompaey, B.; Petrovic, M.; Boussery, K.; Dilles, T. SelfMED: Self- Administration of Medication in Hospital: A Prevalence Study in Flanders, Belgium. Nurs. Scholarsh. 2017, 49, 277–285. [Google Scholar] [CrossRef]
- Zorginspectie, F.; (Brussels, Belgium). Care inspection of the Flemish division of wellbeing. Public Health and Family. Personal communication, 2015. [Google Scholar]
- Vanwesemael, T.; Boussery, K.; Bemt, P.V.D.; Dilles, T. The willingness and attitude of patients towards self-administration of medication in hospital. Ther. Adv. Drug Saf. 2018, 9, 309–321. [Google Scholar] [CrossRef][Green Version]
- Grady, P.A.; Gough, L.L. Self-Management: A Comprehensive Approach to Management of Chronic Conditions. Am. J. Public Health 2014, 104, e25–e31. [Google Scholar] [CrossRef] [PubMed]
- Hall, R.; Rutledge, J.; Colón-Emeric, C.; Fish, L.J. Unmet Needs of Older Adults Receiving In-Center Hemodialysis: A Qualitative Needs Assessment. Kidney Med. 2020, 2, 543–551. [Google Scholar] [CrossRef] [PubMed]
- Vaismoradi, M.; Turunen, H.; Bondas, T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs. Health Sci. 2013, 15, 398–405. [Google Scholar] [CrossRef]
- Tracy, S. Qualitative Quality: Eight “Big-Tent” Criteria for Excellent Qualitative Research. Qual. Inq. 2010, 16, 837–851. [Google Scholar] [CrossRef][Green Version]
- Manias, E.; Beanland, C.; Riley, R.; Baker, L. Self-administration of medication in hospital: Patients’ perspectives. J. Adv. Nurs. 2004, 46, 194–203. [Google Scholar] [CrossRef] [PubMed]
- Vanwesemael, T.; Boussery, K.; Manias, E.; Petrovic, M.; Fraeyman, J.; Dilles, T. Self-management of medication during hospitalisation: Healthcare providers’ and patients’ perspectives. J. Clin. Nurs. 2018, 27, 753–768. [Google Scholar] [CrossRef]
- Williams, A.; Low, J.K.; Manias, E.; Crawford, K. The transplant team’s support of kidney transplant recipients to take their prescribed medications: A collective responsibility. J. Clin. Nurs. 2016, 25, 2251–2261. [Google Scholar] [CrossRef]
- Brady, T.J.; Sacks, J.J.; Terrillion, A.J.; Colligan, E.M. Operationalizing Surveillance of Chronic Disease Self-Management and Self-Management Support. Prev. Chronic Dis. 2018, 15, E39. [Google Scholar] [CrossRef]
- Beentjes, T.A.A.; van Gaal, B.G.I.; van Achterberg, T.; Goossens, P.J.J. Self-Management Support Needs From the Perspectives of Persons With Severe Mental Illness: A Systematic Review and Thematic Synthesis of Qualitative Research. J. Am. Psychiatr. Nurses Assoc. 2020, 26, 464–482. [Google Scholar] [CrossRef]
- Zou, H.; Li, Z.; Nolan, M.; Wang, H.; Hu, L. Self-management among Chinese people with schizophrenia and their caregivers: A qualitative study. Arch. Psychiatr. Nurs. 2013, 27, 42–53. [Google Scholar] [CrossRef]
- Costa, E.; Giardini, A.; Savin, M.; Menditto, E.; Lehane, E.; Laosa, O.; Pecorelli, S.; Monaco, A.; Marengoni, A. Interventional tools to improve medication adherence: Review of literature. Patient Prefer. Adherence 2015, 9, 1303–1314. [Google Scholar] [CrossRef] [PubMed][Green Version]
|Characteristics (n = 49)||Psychiatric Hospital 1||Psychiatric|
|Type of hospital||University psychiatric|
|Regional psychiatric hospital||Public|
|Private psychiatric hospital|
|Number of hospital beds||601||747||263||313||1924|
|Codes interviewed groups *|
|Age patients (years)||Mean (sd)||Median (min–max)|
|44 (11.6)||43 (26–62)|
|Years working||Mean (sd)||Median (min–max)|
|Psychiatrists||14 (12.5)||13 (2–27)|
|Nurses||13 (9.4)||10 (1–27)|
|Hospital pharmacists||3.5 (0.7)||3.5 (3–4)|
|Duration of the interviews|
|Mean (sd)||Median (min–max)|
|Patients||40.3 (12.2)||37 (21–60)|
|Psychiatrists||27.5 (4.6)||27 (23–32)|
|Nurses||44.6 (9.9)||42.9 (27–60)|
|Hospital pharmacists||53 (4.8)||53 (50–56)|
|1. Monitoring and shared decision-making||Available tools|
|2. Relationship based on trust||Patient readiness|
|3. Patient satisfaction and rehabilitation||Safety|
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Loots, E.; Leys, J.; Proost, S.; Morrens, M.; Glazemakers, I.; Dilles, T.; Van Rompaey, B. Medication Self-Management in Hospitalised Patients with Schizophrenia or Bipolar Disorder: The Perceptions of Patients and Healthcare Providers. Int. J. Environ. Res. Public Health 2022, 19, 4835. https://doi.org/10.3390/ijerph19084835
Loots E, Leys J, Proost S, Morrens M, Glazemakers I, Dilles T, Van Rompaey B. Medication Self-Management in Hospitalised Patients with Schizophrenia or Bipolar Disorder: The Perceptions of Patients and Healthcare Providers. International Journal of Environmental Research and Public Health. 2022; 19(8):4835. https://doi.org/10.3390/ijerph19084835Chicago/Turabian Style
Loots, Elke, Josée Leys, Shara Proost, Manuel Morrens, Inge Glazemakers, Tinne Dilles, and Bart Van Rompaey. 2022. "Medication Self-Management in Hospitalised Patients with Schizophrenia or Bipolar Disorder: The Perceptions of Patients and Healthcare Providers" International Journal of Environmental Research and Public Health 19, no. 8: 4835. https://doi.org/10.3390/ijerph19084835