Research Tinne Dilles

Abstract

In hospital, healthcare providers usually manage medication for patients although patients are expected to self-manage their medication after discharge. A lack of self-management competencies is found to be associated with low adherence levels and medication errors harming patients' health. Approximately 50% of patients afflicted by chronic conditions do not adhere to prescribed medication regimens. When self-management is allowed during hospitalization, it rarely is provided using a structured, evidence based format. Medication self-management is considered to be a promising strategy to optimize adherence rates. To date, however, empirical data demonstrating the effect of medication self-management on patient adherence is lacking. The proposed PhD project will: 1) develop and evaluate an evidence-based guideline for healthcare providers supporting patients with medication self-management problems; 2) explore medication-related shared decision making as a supportive measure in medication self-management; 3) assess the feasibility and applicability of a combined set of tools measuring medication adherence to polypharmacy from a longitudinal perspective; 4) evaluate the effect of structured medication self-management (i.e., SelfMED) on medication adherence after discharge. Using a stepped wedge trial design, the effect of the SelfMED-intervention will be compared to usual care in hospitalized patients with polypharmacy.

Researcher(s)

• Promoter: Goossens Eva
• Co-promoter: Dilles Tinne
• Fellow: Mortelmans Laura

Research team(s)

• Centre for Research and Innovation in Care (CRIC)

Project type(s)

• Research Project

Abstract

The "Arega Chair" focuses on the following: The quality of care and quality of life of patients with polypharmacy and complex pharmacotherapy, with patient involvement and support as primary concerns. The prevalence of polypharmacy is very high, especially in the elderly and in patients with chronic diseases. Taking medication can be very important to maintain or improve health as much as possible, and thus increase the quality of life. On the other hand, taking these drugs can also be quite challenging for the patient, interfere with daily life, cause side effects and have a negative impact on quality of life. From research into the way polypharmacy and complex pharmacotherapy interfere with the quality of life, the aim is to develop opportunities to improve care delivery for this population. The social context of the patients will be taken into account. Potential opportunities for improvement will be tailored to the needs, and can be diverse, from strengthening patient participation to technological innovations. We use Hepler and Strand's definition of pharmaceutical care, in which interprofessional, and in consultation with the patient, the aim is, through the provision of pharmacotherapy in a responsible manner, to achieve results that improve the patient's quality of life.

Researcher(s)

• Promoter: Dilles Tinne

Research team(s)

• Centre for Research and Innovation in Care (CRIC)

Project type(s)

• Research Project

Abstract

Generally, nursing home (NH) residents use many medications. Medications are beneficial and needed to treat symptoms and diseases, but some medications have questionable benefits at the end of life. These medications with questionable benefits are suitable for deprescribing. Deprescribing means stopping or tapering a medication. Up to now, we do not know the effects of changes in medication use (e.g. deprescribing medications with questionable benefits and initiating beneficial medications) at the end of life. In this study, we will evaluate these effects on the quality of life of NH residents with limited life-expectancy, as well as on their susceptibility to disease and risk of dying, using innovative data techniques. We will use data on quality of life and physical and psychosocial health of NH residents with limited life-expectancy collected in an ongoing data implementation project (BelRAI 2.0). These data are linked to administrative databases ("Big Data") including reimbursed treatment and medication data of the whole Belgian population. Using these data we can approximate an RCT and measure effects of changes in medication use on quality of life, susceptibility to disease and mortality by comparing people for whom use of a specific medication has changed (exposure group) to people for whom use of this medication has not changed (control group), without putting them at actual risks of e.g. dying sooner by actually stopping a medication in real-life.

Researcher(s)

• Promoter: Dilles Tinne

Research team(s)

• Centre for Research and Innovation in Care (CRIC)

Project type(s)

• Research Project

Abstract

Nursing homes residents often take many medications. Some medications can be potentially inappropriate, leading to side-effects such and increased risks for falls, hospitalisations or mortality. To reduce the number of potentially inappropriate medications, we present the OptiMEDs tool: a combined intervention of an electronic decision support tool for the identification of potentially inappropriate medications, anticholinergic medications, or medications that can be deprescribed, with focussed nurse-observations supporting a multidisciplinary medication review. The Ageing of the population will lead to more older adults. For Belgium; around 18% of the population is 65 years or older, but this number is to rise significantly to 23% by 2030 (equalling more than 100.000 extra adults of 65 years and older). These older adults will develop an increasing number of diseases (multimorbidity), affecting their social life, activities of daily living, and quality of life. As a result, they will be prescribed more medications, but this again can induce problems. Older adults are more sensitive to the effects and side-effects of medications than younger adults. DRPs potentially affect quality of life and are also an important risk factor for hospital admissions or increased risks for mortality. All prescribers face a more complex medication choice process in poly-medicated patients with a higher level of multimorbidity. All face the problem of lack of specific evidence in this particular age group so support complex drug choice processes with regard to efficacy and safety of medications. Medications can affect the quality of life of patients, could induce severe medication side-effects, and could increase the costs for the Belgian government. For Belgium, the findings of the PHEBE project indicate that nursing home residents have a high chronic intake of medications (mean of 7.1 chronic medications), costing up to 140€ each month. An analysis of the quality of prescribing showed that 82% of the nursing home residents had potentially inappropriate medications, showing the potential for optimising the pharmacotherapy. Currently, medication reviews are seldom performed, or are not structured. Nurses reported different barriers (a lack of pharmacotherapeutic knowledge, a lack of communication possibilities), believing that observation of Drug Related Problems (DRPs) is not part of their job. Pharmacists mostly restrict their role in nursing homes to the delivery of medications. With our intervention, we propose a method that could investigate the medication use on a deeper level, in order to support the decision of GPs regarding the pharmacotherapy of older adults. We want to aid and involve different actors (nurses and clinical pharmacists) in the medication review by offering them tools to strengthen their role (enhanced knowledge, focussed observation). The study objectives are to examine whetherThe OptiMEDs intervention, the combination of an electronic decision support tool (for the appraisal of potentially inappropriate medication use, anticholinergic use, or medications that can be deprescribed in the medication chart of nursing home residents) with focussed nurse observations (derived from the Pharmanurse component in the OptiMEDs software, where potential medication symptoms are listed based on the medication chart of nursing home residents), that will serve as the basis during a medication review between GPs and nurses (where additional feedback from clinical pharmacists is provided) can lead to a more appropriate, safer, and more cost-effective pharmacotherapy in nursing home residents (e.g. less medication-related symptoms, less inappropriate prescribing, a better quality of life, less hospitalisations, health care usage, or mortality).

Researcher(s)

• Promoter: Dilles Tinne

Research team(s)

• Centre for Research and Innovation in Care (CRIC)

Project type(s)

• Research Project

Abstract

Introduction: Improving the speed and quality of empirical evidence's implementation into real world settings is a top priority for health care systems. Indeed, suboptimal implementation not only adds increases research waste, it both keeps cutting-edge treatments and interventions from the patients who need them and, in the worst cases, leaves those patients exposed to ineffective or even harmful ones. To date, the most effective bridge between lab results and clinical outcomes is implementation science. Defined as "the scientific study of methods to promote the integration of research findings and evidence-based interventions into healthcare policy and practice", implementation science "seeks to understand the behaviour of healthcare professionals and support staff, healthcare organizations, healthcare consumers, and policymakers in context as key variables in the sustainable uptake, adoption, and implementation of evidence-based interventions". Accordingly, over the past decade, implementation science's success at translating researchers' results into meaningful actions across the full range of health care stakeholders has made it a leading methodology for proposals submitted to the EU's Horizon 2020 programme. Goal of the course: This course's overall goal is to advance course participants' knowledge and skills in view of implementation science, with a particular focus on implementation research designs, implementation science outcomes, contextual analyses, implementation strategies, patient and public involvement in research, and reporting of implementation science results. Target group: This implementation science course is relevant to all health care disciplines. It applies to a variety of health care settings for a broad set of interventions. Course participants will need a solid basis in clinical research methods (e.g., conceptual thinking, quantitative and qualitative methodology, statistical analysis).

Researcher(s)

• Promoter: Dilles Tinne

Research team(s)

• Centre for Research and Innovation in Care (CRIC)

Project type(s)

• Research Project

Abstract

Summary Background Nurses' role in interdisciplinary pharmaceutical care is not transparent and varies between European countries. Similarly, in nurse education, a clear description of specific learning outcomes on pharmaceutical care is lacking and curricula in pharmaceutical care vary a lot. Furthermore, the match with the needs of the labour market and society is insufficient. The lack of transparency and recognition, together with the variation between countries, in nursing practice and nurse education, has a major impact. It hinders collaboration on different levels: interdisciplinary collaboration in clinical practice; transnational collaboration in research, education and innovation in Europe; labour mobility of nurses. As a result patient safety is threatened, development and innovation are slowed down, and healthcare budgets are not used in the most efficient way. Preliminary analysis of EUPRON data of 3300 European nurses, doctors and pharmacists, in preparation of DeMoPhaC, shows nearly all participants are convinced of the positive impact on quality of care of increased nurse involvement in pharmaceutical care. Interprofessional communication in pharmaceutical care scored 5,2/10, an alarming score given the link between patient safety and interprofessional communication. DeMoPhaC objectives and related outputs: 1. to develop a model for nurses' role in interprofessional pharmaceutical care, a framework for collaboration in pharmaceutical care on the different levels aforementioned, based on the needs and context of the labour market and society, in a qualitative interview study → A scientific report on the results of the EUPRON study → A scientific report on the qualitative study results → A validated model for nurses' role in interprofessional pharmaceutical care in Europe 2. to specify and validate learning outcomes for nurse education in pharmaceutical care, which meet the learning needs of students, matched to the labour market and societal needs, in a Delphi study → Validated learning outcomes for nurse education in Europe on pharmaceutical care, framed in the European Qualification Framework 3. to develop an assessment to evaluate competences in pharmaceutical care, as a guidance to evaluate nurse education, as a tool for nurse educators, for benchmarking, and nurse labour mobility → An assessment to evaluate nurse competences in pharmaceutical care 4. to strengthen an international network for pharmaceutical care in nursing, to collaborate on nurse education, research, practice and policy → A sustainable European network on nurse and pharmaceutical care, NuPhaC 5. A strong involvement of students in the projects, connecting research, education and policy in Europe → About 80 European nurse students trained in and contribute to nurse research, education and policy in Europe 6. to describe nurses' role, nurse education and student nurses' competences in interdisciplinary pharmaceutical care in the European partner countries, necessary to reach objectives 1-3, and allowing benchmarking, a clarification of differences and similarities, essential for international collaboration, in 3 large-scale international cross-sectional studies → 3 scientific reports + benchmarking in Europe on: 1) nurses' role in in interprofessional pharmaceutical care; 2) nurse educational programs in pharmaceutical care; 3) nurse students' competences in pharmaceutical care. ​ https://ec.europa.eu/programmes/erasmus-plus/projects/eplus-project-details/#project/2018-1-BE02-KA203-046861

Researcher(s)

• Promoter: Dilles Tinne

Research team(s)

• Centre for Research and Innovation in Care (CRIC)

Project website

Project type(s)

• Education Project
• Research Project

Abstract

Researcher(s)

• Promoter: Elseviers Monique
• Fellow: Dilles Tinne

Research team(s)

• Centre for Research and Innovation in Care (CRIC)

Project type(s)

• Research Project