Managing complex medication regimens: perspectives of consumers with osteoarthritis and healthcare professionals

BACKGROUND: Managing medications is complex, particularly for consumers with multiple coexisting conditions for whom benefits and adverse effects are unpredictable and health priorities may be variable.

OBJECTIVE: To investigate perceptions of and experiences with managing drug regimens from the perspectives of consumers with osteoarthritis and coexisting chronic conditions and of healthcare professionals from diverse backgrounds.

METHODS: Using an exploratory research design, focus groups were formed with 34 consumers and 19 healthcare professionals. Individual interviews were undertaken with 3 community medical practitioners.

RESULTS: Consumers' management of medications was explored in terms of 3 themes: administration of medications, provision of information, and the perceived role of healthcare professionals. In general, consumers lacked understanding regarding the reason that they were prescribed certain medications. Since all consumer participants had at least 2 chronic conditions, they were taking many drugs to relieve undesirable symptoms. Some consumers were unable to achieve improved pain relief and were reluctant to take analgesics prescribed on an as - needed basis. Healthcare professionals discussed the importance of using non-pharmacologic measures to improve symptoms; however, consumers stated that physicians encourage them to continue using medications, often for prolonged periods, even when these agents are not helpful.

CONCLUSIONS: Consumers were dissatisfied about the complexity of their medication regimens and also lacked understanding as to how to take their drugs effectively. Dedicated time should be devoted during medical consultations to facilitate verbal exchange of information about medications. Pharmacists must communicate regularly with physicians about consumers' medication needs to help preempt any problems that may arise. Instructions need to be revised through collaboration between physicians and pharmacists so that "as needed" directions provide more explicit advice about when and how to use such drugs. Future research, using large, generalizable samples, should examine trends related to consumers' experiences of symptomatic relief from chronic conditions and their understandings about medications.

Healthcare professionals’ use of mobile phones and the internet in clinical practice

Background: Over the last few years mobile phone applications have been designed for healthcare professionals. However, little is known in regards to healthcare professionals’ use of and attitudes towards using smartphones (and applications) within clinical practice. Thus the aims of the present study were to enumerate the number of healthcare professionals that use mobile phones within clinical practice and their attitudes towards using them. Furthermore, given that the internet preceded smartphones, we also established healthcare professionals’ attitudes towards internet use in clinical practice as a comparison.

Method: Forty-three healthcare professionals from a range of disciplines and specialities who were predominantly working in Australia completed an anonymous online survey. 

Affective commitment and turnover intentions among healthcare professionals: the role of emotional exhaustion and disengagement

This paper utilises the conservation of resources theory to examine the mediating role played by disengagement in the relationships between emotional exhaustion, affective commitment and turnover intentions among healthcare professionals. Structural equation modelling was conducted on data obtained from 302 healthcare professionals in a major Australian cancer hospital. Our findings demonstrate that disengagement fully mediates the relationships between emotional exhaustion and both affective commitment and turnover intentions. Recommendations for future research are suggested and practical implications discussed. © 2013 Taylor & Francis.

A gendered view of computer professionals: preliminary results of a survey

The under-representation of women in the computing profession in many parts the western world has received our attention through numerous publications, the noticeable low representation of women at computer science conferences and in the lecture halls. Over the past two decades, the situation had become worse. Please refer to the other articles in this special issue for detailed statistics, a discussion of factors that contribute to the low participation rate by women, and for suggestions on how to reverse the current trend.This paper seeks to add to the dialogue by presenting preliminary findings from a research project conducted in four countries. The aim of this research was to gain an insight into the perceptions future computer professionals hold on the category of employment loosely defined under the term of "a computer professional." One goal was to get insight into whether or not there is a difference between female and male students regarding their view of computer professionals. Other goals were to determine if there was any difference between female and male students in different parts of the world, as well as who or what most influences the students to undertake their courses in computing.The team of researchers gave an extensive questionnaire to undergraduate students enrolled in a variety of computing degree programs. The students enrolled in these programs at Victoria University of Technology in Melbourne, the University of East London, the Chinese University of Hong Kong, and Ithaca College located in Ithaca, New York. This article reports on the analysis of the results from the questionnaire. It discusses the gender differences in the responses from the students in these countries to try to get a worldwide perspective. At this time, it does not yet report on the similarities and differences between the groups of participants from each of the four countries. Instead, it investigates whether there are gendered differences in the views of this rather broad sample of student population of future computer professionals.

What's wrong with me? Concerns about online medical self-diagnosis

Self-service technologies (SSTs) are becoming increasingly commonplace in healthcare. However, research on the customer (patient) experience in this context is rare. This paper focuses on online medical self-diagnosis, a type of e-health service. This SST can provide customers with benefits such as greater convenience and control, yet we argue that this form of do-it-yourself doctoring also raises concerns for customers. This paper contributes to the service domain by presenting research propositions on the potential negative implications for customers, and their antecedents, of online medical self-diagnosis. We propose that this form of self-diagnosis is related to harms, such as customer anxiety, customer willingness to bypass healthcare professionals, and self-medication. Future research opportunities are discussed, along with implications for policy and practice.

Investigating the efficacy of an intelligent operation planning and support tool for acute healthcare contexts

Nurses are the largest group of healthcare professionals in hospitals providing 24-hour care to patients. Hence, nurses are pivotal in coordinating and communicating patient care information in the complex network of healthcare professionals, services and other care processes. Yet, despite nurses' central role in health care delivery, intelligent systems have historically rarely been designed around nurses' operational needs. This could explain the poor integration of technologies into nursing work processes and consequent rejection by nursing professionals. The complex nature of acute care delivery in hospitals and the frequently interrupted patterns of nursing work suggest that nurses require flexible intelligent systems that can support and adapt to their variable workflow patterns. This study is designed to explore nurses' initial reactions to a new intelligent operational planning and support tool (IOPST) for acute healthcare. The following reports on the first stage of a longitudinal project to use an innovative approach involving nurses in the development of the IOPST; from conceptualization to implementation.

Snowballing obesity: Australians will get run over if they just sit there.

* Overweight and obesity are very common in Australian adults (56%) and children (27%). * Rates of overweight and obesity are snowballing and will place greater burdens on health services for the treatment and care of chronic diseases. * Prevention is urgently required from health, social and economic perspectives, but the response to date has been inadequate.
* A long-term, sustained action plan starting with a focus on young people is needed. This should particularly address the “obesogenic” environments causing the epidemic. * Although whole-of-government action is required, support from and involvement by parents, carers, community leaders, healthcare professionals, teachers, childcare workers, urban planners, recreation managers, food manufacturers, employers, advertisers, and communicators is essential. *  The health sector should take the lead, but success will only come from concerted and integrated action across the whole of society. * There are now signs of political commitment to addressing overweight and obesity. Doctors should get behind this and help mobilise community support.

Retirement planning and expectations of Australian babyboomers

The "babyboomer" generation, those who were born between 1946 and 1965, account for over 30% of the population in Australia, and it is no surprise that the government is concerned about the financial implications for future healthcare costs. While many babyboomers are more financially secure than previous generations have been on account of compulsory superannuation contributions made over the past 15 years, there are still some who are financially vulnerable and expect to rely on government pensions and welfare assistance. Changes to family structures and job security also mean that those who are less financially secure will need social support. Using an ecological framework model , we explored the retirement expectations and experiences of some Australian babyboomers through focus groups and individual interviews to identify key issues and their plans to address these issues. Four main themes are reported in this paper: retirement attitudes and expectations, finances, health, and food. The results suggested that for many persons retirement equated freedom. Little future planning was undertaken for retirement other than contributing to superannuation schemes, and expectations were reported in general terms, such as wanting to remain independent and healthy and to have time to socialize and travel.

The politics of resistance to workplace cultural diversity education for health service providers : an Australian study

This qualitative study has as its focus an exploration of health service providers' perceptions and experiences of the processes and implications of delivering workplace cultural diversity education for staff. Data were obtained from conducting in-depth individual and focus group interviews with a purposeful sample of 137 healthcare professionals, recruited from over 17 different organizational sites. Participants included cultural diversity educators, ethnic liaison officers, health service managers, nurses, health interpreters, allied health professionals, and community-based ethnic welfare organization personnel working in or with select metropolitan health services in Victoria, Australia. Analysis of the data revealed that workplace cultural diversity education in healthcare is a significant site of resistance and struggle. 'Resistance' was expressed in several forms including: the problematization of resources and staff availability to attend cultural diversity education forums; indifferent failure to recognize cultural imperatives in healthcare; deliberate refusal to recognize cultural imperatives in healthcare; selective recognition of cultural imperatives in healthcare ('facts sheets' only); and the angry rejection of cultural imperatives in healthcare. 'Struggle', in turn, largely involved cultural diversity educators having to constantly 'cajole and convince' (and even manipulate) staff to attend cultural diversity education forums and using a 'velvet glove and iron fist' approach to teaching staff who remained resolute in their resistance when participating in educational forums. An important implication of this study is that the politics of workplace cultural diversity education - and the 'politics of resistance' to such programs - need to be better recognized and understood if the status quo is to be successfully challenged and changed. The need for critical debate and further comparative research on the subject are also highlighted.

Selecting the right integration of research into practice strategy

Healthcare professionals need to be cognizant of integration of research into practice literature to advance clinical practice. This article describes the strengths and limitations associated with 10 currently used integration of research into practice strategies and the issues that need to be considered when selecting an appropriate strategy. Selecting the right strategy that ensures the uptake of best available evidence is an essential component of developing evidence-based practice and ultimately improving patient care.