Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda

ABSTRACT: BACKGROUND: Chronic diseases are rapidly increasing and are currently the major cause of death and disability worldwide. Patients with chronic diseases experience many challenges including medicine-related problems. However, there is limited information about the home management of medicines among these patients. This study therefore was to determine home medication management practices and associated factors among patients with chronic diseases seeking care in a community pharmacy in Uganda. METHODS: A cross-sectional study was conducted in a community pharmacy in Kampala from June to July 2010. A total of 207 consenting chronic disease patients or caregivers of children with chronic disease were consecutively sampled. The patients were visited at home to evaluate their drug management practices and to check their medical forms for disease types and drugs prescribed. An interviewer-administered questionnaire and an observation checklist were used to collect the data. RESULTS: Overall home medication management was inappropriate for 70% (n = 145) of the participants (95% CI = 63.3-76.2) and was associated with perceived severity of disease (not severe OR =0.40, moderately severe OR = 0.35), duration of disease >5 years (OR = 2.15), and health worker not assessing for response to treatment (OR = 2.53). About 52% (n = 107) had inappropriate storage which was associated with inadequate information about the disease (OR = 2.39) and distance to the health facility >5 kilometres (OR = 2.82). Fifteen percent (n = 31) had no drug administration schedule and this was associated with increasing age (OR = 0.97), inadequate information about the disease (OR = 2.96), and missing last appointment for medical review (OR = 6.55). About 9% (n = 18) had actual medication duplication; 1.4% (n = 3) had expired medicines; while 18.4% (n = 38) had drug hoarding associated with increasing number of prescribers (OR = 1.34) and duration of disease (OR = 2.06). About 51% (n = 105) had multiple prescribers associated with perceiving the disease to be non severe (OR = 0.27), and having more than one chronic disease (OR = 2.37). CONCLUSIONS: Patients with chronic disease have poor home management of medicines. In order to limit the occurrence of poor outcomes of treatment or drug toxicity, health providers need to strengthen the education of patients with chronic disease on how to handle their medicines at home.

Recording Memories from Political Violence: a Filmmaker's Journey

Based on the work the author has carried out with survivors groups in Northern Ireland and South Africa, this book describes and analyses the use of documentary filmmaking in recording experiences of political conflict. A variety of issues relevant to the genre are addressed at length, including the importance of ethics in the collaboration between the filmmaker and the participant and the effect of location on the accounts of participants.

Further Information:
This monograph reflects on and analyses the work of the author/director over the past decade. His documentary films have been produced in the context of how to address storytelling in post conflict societies by drawing on the disciplines of oral history, ethnography, memory studies and documentary film. All the documentary films under discussion have been produced collaboratively with NGOs, including the Victims and Survivors Trust and WAVE Trauma Centre (both Belfast) and the Human Rights Media Centre, Cape Town. Investigating the influence of location in memory stimulation and the role of collaboration on authorship during trauma recovery, the author offers insights into the process of collaboratively production, which attends to both ethical and aesthetic considerations. While most emphasis is placed on the research, production and post-production phases, thought is also given to the reception of these films and the impact they have on the participants, wider communities, and on policy decisions.

A Contextual Analysis of the Council of Europe's Convention on Preventing and Combating Violence against Women

This article examines the Council of Europe’s recent Convention on Preventing and Combating Violence against Women. The focus of this paper is on the specific issue of domestic violence. The article seeks to place the Convention in the context of other developments as regards the analysis of domestic violence as a human rights issue.

Moral distress experienced by health care professionals who provide home-based palliative care

Health care providers regularly encounter situations of moral conflict and distress in their practice. Moral distress may result in unfavorable outcomes for both health care providers and those in their care. The purpose of this study was to examine the experience of moral distress from a broad range of health care occupations that provide home-based palliative care as the initial step of addressing the issue. A critical incident approach was used in qualitative interviews to elicit the experiences on moral distress from 18 health care providers drawn from five home visiting organizations in south central Ontario, Canada. Most participants described at least two critical incidents in their interview generating a total of 47 critical incidents. Analyses of the critical incidents revealed 11 issues that triggered moral distress which clustered into three themes, (a) the role of informal caregivers, b) challenging clinical situations and (c) service delivery issues. The findings suggest that the training and practice environments for health care providers need to be designed to recognize the moral challenges related to day-to-day practice.