Health Education Programme targeting the Elderly on the ...€¦ · Foster self-care and empowerment. Promote communication between the elderly and health professionals. Strengthen

Health Education Programme

targeting the Elderly on the

Correct Use of Medicines (PESGG)

1. Introduction

2. Programme goals

3. Organisation and methodology

i. Teaching material

ii. Programme stages

4. Programme assessment: 2015 edition

i. Survey structure

ii. Specifications

iii. Main results

a. The correct use of medicines

b. The importance of treatment compliance

c. What you should know about hypertension

5. Conclusions

6. What is next? 2016 edition

Contents

The Health Education Programme for the Elderly on the proper use of medicines (PESGG) is a project consisting of talks given by community pharmacists to foster proper use of medicines by the elderly.

The project was started in 2006 and currently it is implemented in all of Catalonia.

The programme’s design created during 2014 was extended to the 2015 edition; that is, assessing its impact through the acquisition of knowledge about medicines among the assistants.

The programme is provided by the Catalan Health Service (CatSalut) with the cooperation of the Catalan Council of Pharmacists' Associations (CCFC).

The PESGG is integrated in CatSalut's overall strategy and is included in the Health Plan 2011-2015.

Further information is provided at the web page http://medicaments.gencat.cat/ca/ciutadania/formacio/xerrades-per-a-gent-gran/

Introduction

http://medicaments.gencat.cat/ca/ciutadania/formacio/xerrades-per-a-gent-gran/
















Programme goals

Enhance and increase elderly people's knowledge about the proper use of medicines.

Improve treatment compliance.

Educate in the rational, responsible and sustainable use of medicines.

Foster self-care and empowerment.

Promote communication between the elderly and health professionals.

Strengthen the role of the community pharmacist as a key part of the system.

Elderly people are a population group among whom polypharmacy is common and, therefore, are a priority group for promoting the correct use of medicines.

Strategic

goal

Organisation and methodology

Create a task force composed of representatives from CatSalut and the Catalan Council of Pharmacists' Associations.

Applicants: local councils and social entities working with elderly people that have asked the Pharmacists' Associations to give the course, in strict order of submission of the application.

Course givers: community pharmacists who have volunteered and received training from the respective provincial Pharmacists' Association.

Workshops lasting for about 45 minutes.

Attendance is voluntary, without any cost for the participants.

Content: decided jointly by the members of the task force.

Teaching material

The material is adapted to elderly people; the content is presented in simple terms and supported with images and videos.

In 2015 edition, three sessions were offered. Nevertheless, in each edition new topics are added to broaden the range of topics, now putting the focus on the most frequent diseases and conditions among the elderly:

The correct use of medicines

The importance of treatment compliance

What you should know about hypertension

What you should know about diabetes

What you should know about hypercholesterolemia

New 2016 edition

Programme stages in 2015

Teaching material

Agreement on the educational material that will be provided in the 2015 PESGG programme

Drafting and approval of content

Presentation layout

Assessment methodology

Review of the 2014 surveys’ design and adjustment

Survey design for the hypertension topic

Sessions

implementation

Dissemination to local councils and social organisations

Recruitment of community pharmacists interested in becoming course givers

Finalisation of the number of sessions to be given

Training of the community pharmacists

Giving of the sessions

Central management of surveys and data exploitation by CatSalut

Programme assessment

The main goal is to evaluate the programme’s efficacy by measuring the acquisition of knowledge about medicines among the population group that has received this training.

The assessment methodology is based on a survey administered to the people attending the workshops.

Preparation of a different survey for each session, evaluating the main contents taught on workshops and summarizing the take-home messages.

The data obtained are processed with SPSS Statistics using the chi-squared test. The strength of the association is measured using Cramer's V, with values ranging from 0 to 1 (the higher, the stronger).

Survey structure

Block Scale

Session data (date and location)

--

Participant data (age, gender, level of education)

---

Knowledge about the proper use of medicines

3 items

Habits related with the correct use of medicines

3 items

Block Scale

Satisfaction degree 5 items


3 items

To be answered before the session To be completed after the session

Side A Side B

Surveys are divided into two sides and structured in blocks.

The blocks of knowledge about the proper use of medicines are repeated before and after the session in order to determine the degree of knowledge assimilation by the people attending.

Each session questionnaire has its own set of questions, focusing on the main points taught.

Specifications

Universe

People aged 65 and over living in Catalonia and their carers who have attended the first health education talk given by each Pharmacists' Association in Catalonia

Territorial scope Catalonia

Information collection method

Self-administered, on-site survey

Duration of the questionnaire

30-45 minutes (population group with visual acuity and comprehension problems, which lengthens the process)

Sample size The total group has consisted of 5.600 participants

Sampling procedure Answering the survey was voluntary, approximately 20% of the assistants refused to answer the questionnaire

Level of confidence 95%

Significance level p< 0,05

Expected proportion 0.5

Sample error +/- 1.2%

Analysis period June 2015 – February 2016

Main results: Overall activity

Workshops

conducted Assistants

Collected

surveys

The correct use of

medicines 83 1.736 1.162

The importance of

treatment compliance 72 1.100 945

What you should know about hypertension

160 2.782 2.443

TOTAL 315 5.618 4.550

2014 EDITION 272 5.234 3.596

Compared to the last edition, activity has increased (272 to 315), reaching municipalities that did not take part in 2014 edition.

Surveys seem to be more accepted by the assistants, since in 2015 only 19,0% of the participants decline to answer, compared to 31,3% in 2014.

Results refer to 65 talks implemented and 850 surveys answered.

Demographic data N %

Age (years)

<60 63 8,5%

60-69 173 23,2%

70-79 280 37,6%

≥80 229 30,7%

Average age 73,07 ± 11,06

Gender

Female 219 27,3%

Male 582 72,7%

Level of education

No formal education 52 6,7%

Primary education 417 53,8%

Secondary education 231 29,8%

Higher education 75 9,7%


Almost never or rarely

Sometimes Almost always

N % N % N %

If the medication makes me feel unwell, I tell the doctor or pharmacist

47 5,8% 146 18,0% 618 76,2%

I look at the Medication Plan when I have doubts about how to take the medication

90 11,3% 203 25,4% 507 63,4%

I take the medication I no longer use to the drop-off box

76 9,5% 181 22,5% 547 68,0%

I know what all the medicines I take are supposed to do

44 5,5% 180 22,4% 579 72,1%

I ask friends and relatives to recommend the medicine that is most effective

627 78,0% 142 17,7% 35 4,4%

The correct use of medicines. Main results (I)

Q- It is important to know whether I must take my medication before, during or after meals.


N =850 p< 0,001 Cramer’s V = 0,210

Q- Generic medicines are just as good as branded medicines.

N =850 p< 0,001 Cramer’s V = 0,328

Satisfaction degree Poor Fair Good Very good Perfect Average rating

(values 1 to 5) N % N % N % N % N %

Overall rating of the talk 0 0,0% 4 0,5% 75 9,0% 335 40,4% 416 50,1% 4,49 ± 0,90

Rating of how interesting the subject was 0 0,0% 5 0,6% 99 11,9% 382 46,0% 345 41,5% 4,38 ± 0,96

Clarity of the explanations 1 0,1% 4 0,5% 77 9,3% 318 38,5% 425 51,5% 4,53 ± 0,98

Rating of the facilities 2 0,2% 23 2,8% 184 22,7% 314 38,8% 286 35,4% 4,30 ± 1,33

Rating of the times allocated for the talk 2 0,2% 22 2,7% 219 26,6% 284 34,5% 295 35,9% 4,20 ± 1,23

Rating of the person giving the talk 2 0,2% 4 0,5% 61 7,4% 307 37,2% 452 54,7% 4,58 ± 0,99

40

157

625

28 26 93

711

20

0100200300400500600700800

Totally disagree Rather agree Fully agree DK/No opinion

before after

252 281 251

66

150

260

414

26

0

100

200

300

400

500


before after

The correct use of medicines. Main results (II)

Q- If I don’t take my medication correctly, my disease may worsen or I may become ill.

N =850 p< 0,001 Cramer’s V = 0,241

Q- Some traditional remedies, herbal teas or medicinal plants may affect how medicines work.

N =850 p< 0,001 Cramer’s V = 0,261

Q- Expensive medicines are better.

N =850 p< 0,001 Cramer’s V = 0,281

40

171

573

66 45

143

629

33

0

100

200

300

400

500

600

700


before after

240 300

235

75 117

275

406

52

0

100

200

300

400

500


before after

525

177

95 53

580

139 104

27

0

100

200

300

400

500

600


before after

The correct use of medicines. Main results (III)

The importance of treatment

compliance. Main results (I)

Results refer to 65 talks implemented and 735 surveys answered.


Age (years)

<60 35 5,3%

60-69 152 22,9%

70-79 262 39,5%

≥80 214 32,3%


Gender

Female 542 75,6%

Male 175 24,4%

Level of education








N % N % N %

When I have doubts about medicines, I ask my doctor or pharmacist about them

19 2,6% 166 23,0% 536 74,3%

When I am given a pack I don’t recognise in the pharmacy, I ask what it is

28 3,9% 114 15,8% 580 80,3%

When I use an inhaler and am not sure I did it properly, I inhale again just in case

385 61,4% 179 28,5% 63 10,0%

Q- When taking medicines, their effect depends on how I follow the instructions given by the doctor or pharmacist.


N =735 P= 0,253 Cramer’s V = 0,072

Q- It doesn’t matter if I double the dose of a medicine because I missed the previous intake.

N =735 P= 0,008 Cramer’s V = 0,101


(values 1 to 5) N % N % N % N % N %

Overall rating of the talk 0 0,0% 3 0,4% 57 7,9% 291 40,2% 372 51,5% 4,49 ± 0,80

Rating of how interesting the subject was 0 0,0% 6 0,8% 103 14,2% 321 44,3% 295 40,7% 4,30 ± 0,86

Clarity of the explanations 0 0,0% 2 0,3% 82 11,4% 286 39,7% 351 48,7% 4,45 ± 0,90



Rating of the person giving the talk 0 0,0% 0 0,0% 56 7,7% 253 34,9% 416 57,4% 4,55 ± 0,79

19

184

522

10 21 81

616

17

0100200300400500600700


before after

560

86 67 22

609

46 61 19

0100200300400500600700


before after


compliance. Main results (II)

Q- It is important to know for how long I can use the eye drops once opened.

N =735 P= 0,284 Cramer’s V = 0,070

Q- Writing down on the pack how to take the medicine, for how long or what it is for is a good technique to prevent doing mistakes.

N =735 P= 0,007 Cramer’s V = 0,102

87 119

493

36 86 78

556

15

0

100

200

300

400

500

600


before after

40 124

551

20 22 86

620

7 0

100

200

300

400

500

600

700


before after


compliance. Main results (III)

What you should know about

hypertension. Main results (I)

Results refer to 154 talks implemented and 2.167 surveys answered.


Age (years)

<60 173 8,9%

60-69 550 28,3%

70-79 743 38,2%

≥80 478 24,6%


Gender

Female 1.558 73,5%

Male 560 26,4%

Level of education








N % N % N %

I measure my blood pressure at home or at the pharmacy

254 12,1% 1.167 55,4% 685 32,5%

I check that the food or supplements that I take won't worsen my high blood pressure

437 21,2% 790 38,3% 837 40,6%

I take my high blood pressure medications at the same time and in the same way

181 9,6% 246 13,1% 1.454 77,3%

Q- To quit smoking is recommendable to prevent heart disease and others.


N =2.167 P< 0,001 Cramer’s V = 0,236

Q- Once I reach my blood pressure goal, I can stop taking the medication.

N = 2.167 P< 0,001 Cramer’s V = 0,184


(values 1 to 5) N % N % N % N % N %

Overall rating of the talk 0 0,0% 4 0,2% 160 7,5% 860 40,5% 1.100 51,8% 4,52 ± 0,86

Rating of how interesting the subject was 0 0,0% 8 0,4% 241 11,4% 1.000 47,1% 873 41,1% 4,38 ± 0,91

Clarity of the explanations 0 0,0% 4 0,2% 219 10,4% 839 39,8% 1.045 49,6% 4,51 ± 0,97



Rating of the person giving the talk 0 0,0% 1 0,0% 170 8,0% 778 36,8% 1.166 55,1% 4,57 ± 0,92


hypertension. Main results (II)

78 120

1.930

39 52 94

2.000

21 0

200400600800

1.0001.2001.4001.6001.8002.000


before after

1.541 342

205 79

1.806

137 166 58 0

200400600800

1.0001.2001.4001.6001.8002.000


before after

Q- If I take my high blood pressure medications properly, it's ok not to have a healthy diet.

N =2.167 P< 0,001 Cramer’s V = 0,227

Q- Walking regularly can help lower my blood pressure.

N =2.167 P< 0,001 Cramer’s V = 0,152


hypertension. Main results (III)

1.502

337 246

82

1.693

184 234 56

0

200

400

600

800

1.000

1.200

1.400

1.600

1.800


before after

72 262

1.775

58 70 149

1.931

17 0

200400600800

1.0001.2001.4001.6001.8002.000


before after

Conclusions

The 2015 edition has consolidated what was accomplished during the last edition: unifying teaching materials and the Programme’s assessment. New municipalities have been reached in comparison with last year.

However, community pharmacists still refer many problems regarding the difficulties the assistants face when answering the survey.

To summarize the main results:

1. The PESGG programme talks were rated very positively by the participants (4,5 out of 5). The higher results were given to the overall talk and to the course givers (4,6 out of 5).

2. The assistants’ profile was as follows: the average age was 72-73 years, 73-76% were women and 48-54% received primary education.

3. Results reflect proper habits and adequate level of knowledge prior to workshops.

Programme’s efficacy results:

1. The change of the knowledge degree has had statistical significance within all the items assessed in the talks The correct use of medicines and What you should know about hypertension. Generally speaking, elderly people have satisfactorily assimilated the concepts related to the proper use of medicines.

2. Nevertheless, the talk The importance of treatment compliance did not show statistical significance.

What is next? 2016 edition

The Health Education Programme targeting the Elderly on the Correct Use of Medicines (PESGG) has shown its value in offering talks to the elderly that are both well perceived and deliver useful information allowing the assistants to have a better knowledge of their condition or disease and medication and how they can improve their self-care.

In this sense, the new talks offered in the 2016 edition focus on highly prevalent conditions and diseases among the elderly (diabetes and hypercholesterolemia).

Due to the difficulties in answering the survey, as well as the load of work that involves, the assessment methodology is being reviewed.

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Health Education Programme targeting the Elderly on the ...€¦ · Foster self-care and empowerment. Promote communication between the elderly and health professionals. Strengthen

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