Taking Your Medicines Safely:

A Community Senior Center

Education Program

Monique A. Sheppard, PhD

Cecelia B. Snowden, PhD

Paul R. Jones, PhD

Amy Owens

Lori Roche, MA

STIPDA 2009

February 25, 2009

Poisoning in Older AdultsPoisoning in Older Adults

�� Substances involvedSubstances involved–– Prescription medicinesPrescription medicines

––OverOver--thethe--counter medicinescounter medicines

–– VitaminsVitamins

–– HerbalsHerbals

�� Education ProgramsEducation Programs–– ResearchedResearched--based programs showing based programs showing the importance of the poison center are the importance of the poison center are neededneeded

Taking Your Medicines SafelyTaking Your Medicines Safely PilotPilot

�� Purpose:Purpose:

–– Prevent older adults from being poisoned due Prevent older adults from being poisoned due

to accidental misuse and interactions with to accidental misuse and interactions with

medicinesmedicines

�� Population:Population:

–– Ages 65+Ages 65+

–– EnglishEnglish--speakingspeaking

�� Program:Program:

–– PowerPower--point presentationpoint presentation

–– Tic Tac Toe game & incentivesTic Tac Toe game & incentives

–– Short questionnaires before and afterShort questionnaires before and after

–– FollowFollow--up phone callsup phone calls

�� Poison Prevention Education ProgramPoison Prevention Education Program

�� Developed by American Association of Developed by American Association of

Poison Control Center EducatorsPoison Control Center Educators

�� Funded by Health Resources and Services Funded by Health Resources and Services

AdministrationAdministration

�� Original pilot studyOriginal pilot study

–– Enrollment of 145 seniors in 2 areasEnrollment of 145 seniors in 2 areas�� West Virginia (Charleston)West Virginia (Charleston)

�� Missouri (St. Louis)Missouri (St. Louis)

–– 139 of 145 participants completed participant 139 of 145 participants completed participant

assessmentassessment�� 95 of 139 (68%) completed 4 week follow95 of 139 (68%) completed 4 week follow--upup

Taking Your Medicines SafelyTaking Your Medicines Safely PilotPilot

Taking Your Medicines SafelyTaking Your Medicines Safely PilotPilot

�� ParticipantsParticipants

–– Enjoyed programEnjoyed program

–– Increased medicine safety knowledgeIncreased medicine safety knowledge

–– Improved attitudesImproved attitudes

–– Changed behaviorsChanged behaviors

��Health EducatorsHealth Educators

–– Program worthwhileProgram worthwhile

–– Program adaptable to other settingsProgram adaptable to other settings

TYMSTYMS in Senior Centersin Senior Centers

��Original program alteredOriginal program altered

––Delivery by senior center personnel not Delivery by senior center personnel not

health educatorshealth educators

–– Improved assessment to better measure Improved assessment to better measure

attitudes and beliefsattitudes and beliefs

–– Addition of poison center moduleAddition of poison center module

–– FollowFollow--up phone calls are now mailup phone calls are now mail--in in

surveysurvey

–– Translated into SpanishTranslated into Spanish

–– Provides limited trainingProvides limited training

�� Increases access to informationIncreases access to information

TYMSTYMS by Senior Center Staffby Senior Center Staff

�� 7 groups (N=~125 seniors)7 groups (N=~125 seniors)

–– 1 trial group (n=12)1 trial group (n=12)

–– 4 groups by senior center staff (n=88)4 groups by senior center staff (n=88)

–– 2 self2 self--administered groups (n~25)administered groups (n~25)

Phases of the medicine safety programPhases of the medicine safety program

TicTic--TacTac--Toe GameToe Game

��Give an example of an interaction Give an example of an interaction

that we discussed todaythat we discussed today

�� State one of six questions that State one of six questions that

should be discussed with your doctor should be discussed with your doctor

or pharmacist when starting a new or pharmacist when starting a new

medicinemedicine

��Name one way to keep track of your Name one way to keep track of your

medicinemedicine

Phases Phases -- poison information programpoison information program

Findings Findings –– TYMS in Senior CentersTYMS in Senior Centers

�� The percentage increase in The percentage increase in

knowledge varied from 15.2% to knowledge varied from 15.2% to

119.4%. 119.4%.

�� 23.1% (12/51) changed behavior at 23.1% (12/51) changed behavior at

44--week followweek follow--upup–– Track medicines (10/12)Track medicines (10/12)

–– Use Poison Center (1/12)Use Poison Center (1/12)

Findings Findings –– TYMS in Senior CentersTYMS in Senior Centers

�� ““I am aware of circumstances that may I am aware of circumstances that may cause a medicine interaction, but I have cause a medicine interaction, but I have not had a problem recentlynot had a problem recently””

–– 60% at 460% at 4--week followweek follow--upup

�� Since programSince program

–– 33% spoke with doctor33% spoke with doctor

–– 13% spoke with pharmacist13% spoke with pharmacist

–– 60% are tracking medicines60% are tracking medicines

��2/3 use pill minder2/3 use pill minder

–– 81% know correct 181% know correct 1--800# (compared to 800# (compared to 56% at pre56% at pre--test)test)

�� 65.4% (34/51) did NOT change 65.4% (34/51) did NOT change

medicine routine becausemedicine routine because……

–– Already had medicine system in placeAlready had medicine system in place

–– Following doctorFollowing doctor’’s orderss orders

–– I posted or memorized the poison I posted or memorized the poison

center numbercenter number

–– I have greater awarenessI have greater awareness

Findings Findings –– TYMS Senior CentersTYMS Senior Centers

Findings Findings –– TYMS Control GroupsTYMS Control Groups

��Control and study groups were Control and study groups were

similar in gender, age and educationsimilar in gender, age and education

––Differed in race & ethnicity (study group Differed in race & ethnicity (study group

was more likely to be white and was more likely to be white and

Hispanic)Hispanic)

�� 84% of control group read all or 84% of control group read all or

some of take home materialssome of take home materials

�� Less likely to retain knowledge or Less likely to retain knowledge or

change behavior at 4change behavior at 4--week followweek follow--upup

Overall ResultsOverall Results

� Health belief perceived barriers, and self-

efficacy all in the “safety” direction

– Sure to very sure “able to use pill reminder

correctly”

– Not too busy to “keep track of [their]

medicines”

– Agree with “short and long term effects of

incorrectly mixing medicine”

Findings from senior center staffFindings from senior center staff

�� TYMSTYMS can be delivered effectively by can be delivered effectively by senior center personnel senior center personnel –– seniors seniors have gains in knowledge.have gains in knowledge.

��Majority of program leaders found Majority of program leaders found the educational program beneficial the educational program beneficial for their respective centersfor their respective centers

��Overall program requires Overall program requires improvementsimprovements

––Diversity / Cultural IssuesDiversity / Cultural Issues

–– Education LevelEducation Level

–– Program Length Program Length

RecommendationsRecommendations

�� Modify program to address diversity in Modify program to address diversity in education leveleducation level–– Do less reading to seniors; if they cannot read, Do less reading to seniors; if they cannot read, have assistants help themhave assistants help them

�� Increase print size of all program Increase print size of all program materialsmaterials

�� Overall program should be shortened Overall program should be shortened –– Note: without evaluation program is 24Note: without evaluation program is 24--30 30 minutesminutes

–– Game component should be lengthened Game component should be lengthened

�� Develop program in languages other than Develop program in languages other than EnglishEnglish–– Note: program is also in SpanishNote: program is also in Spanish

ConclusionsConclusions�� Taking Your Medicines Safely: A Taking Your Medicines Safely: A Community Senior Center Education Community Senior Center Education ProgramProgram will be a valuable asset to those will be a valuable asset to those charged with improving the health and charged with improving the health and wellwell--being of seniorsbeing of seniors–– Increases medicine safety practicesIncreases medicine safety practices

–– Increases knowledge of poison centersIncreases knowledge of poison centers

�� Senior center personnel can conduct Senior center personnel can conduct effective theoryeffective theory--driven health education driven health education programsprograms–– Prevent unintentional medicine misusePrevent unintentional medicine misuse

–– Prevent complications from medicine Prevent complications from medicine interactions interactions

Next stepsNext steps

��Work with AoA on behalf of HRSA to Work with AoA on behalf of HRSA to establish what senior center establish what senior center personnel will need to implement personnel will need to implement program in their Centersprogram in their Centers

��Work with Poison Center Educators Work with Poison Center Educators to encourage use of programto encourage use of program

��Disseminate program Disseminate program results viaresults via

–– PoisonHelp.hrsa.govPoisonHelp.hrsa.gov

AcknowledgementsAcknowledgements

Funded by Funded by

Health Resources and Services Health Resources and Services

AdministrationAdministration

Poison Control Program Poison Control Program