Browsing by Author "Chang, Feng"

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An Evaluation of the Effect of Primary Care Pharmacist Interventions on Patients with Chronic Pain
(University of Waterloo, 2017-01-20) Chen, Mo; Chang, Feng; Patel, Tejal
Background: Chronic pain is a common condition that has significant impact on patients’ physical and psychological well-being. Pharmacotherapeutic management of chronic pain differs on the basis of the cause pain. Pharmacists’ expertise of pharmacological knowledge and patient care make them key players in managing chronic pain. Methods: A three-month prospective pilot study was carried out at primary care settings including community pharmacies and family health teams. Patients were seen by pharmacists at the initial visit, 2-week follow-up, and 3-month follow-up visit. Pharmacists’ interventions consisted of patient assessments, medication reviews, care plan recommendations, and patient education. Pain, quality of life, and medication adherence were measured with Brief Pain Inventory (BPI), Short Form-36, and Morisky Medication Adherence Scales-8, respectively. Results: Thirteen patients were enrolled, one withdrew. There was no significant improvement in pain or quality of life at 3-month follow-up. However, trends toward improvement were found. Conclusions: This study showed that interventions of primary care pharmacists had no significant effect on pain or quality of life of patients with chronic pain. However, positive trends towards reducing pain intensity and pain interference with patients’ general activity, mood, normal work, and sleep were found. The reason for this could be due to small sample size, low implementation rate of pharmacist recommendations by physicians, low patient adherence, or extended study period.
Incorporating sex, gender and vulnerable populations in a large multisite health research programme: The Ontario Pharmacy Evidence Network as a case study
(BioMed Central, 2017-03-20) Cooke, Martin; Waite, Nancy; Cook, Katie; Milne, Emily; Chang, Feng; McCarthy, Lisa; Sproule, Beth
Background: Funders now frequently require that sex and gender be considered in research programmes, but provide little guidance about how this can be accomplished, especially in large research programmes. The purpose of this study is to present and evaluate a model for promoting sex-and gender-based analysis (SGBA) in a large health service research programme, the Ontario Pharmacy Evidence Network (OPEN). Methods: A mixed method study incorporating (1) team members' critical reflection, (2) surveys (n = 37) and interviews (n = 23) at programme midpoint, and (3) an end-of-study survey in 2016 with OPEN research project teams (n = 6). Results: Incorporating gender and vulnerable populations (GVP) as a cross-cutting theme, with a dedicated team and resources to promote GVP research across the programme, was effective and well received. Team members felt their knowledge was improved, and the programme produced several sex-and gender-related research outputs. Not all resources were well used, however, and better communication of the purposes and roles of the team could increase effectiveness. Conclusions: The experience of OPEN suggests that dedicating resources for sex and gender research can be effective in promoting SGBA research, but that research programmes should also focus on communicating the importance of SGBA to their members.
Pharmacist experience with providing care for patients with chronic pain in the community setting: A qualitative study
(University of Waterloo, 2017-01-20) Tabeefar, Hamed; Chang, Feng; Patel, Tejal
Objectives: Chronic pain is a condition pharmacists frequently encounter in practice; however, the pharmacist’s role in the management of chronic pain is under-investigated. This study examines pharmacist perceptions and experiences in providing care to patients with chronic pain in the community setting. Methods: Practicing primary care pharmacists in Ontario were recruited and interviewed using a semi-structured guide. Interviews were analyzed using modified grounded theory. Sample recruitment continued until saturation was achieved. Results: Twelve pharmacists responded to the email invitation. Two did not meet eligibility criteria and one withdrew. The sample consisted of 6 female and 3 male pharmacists with a mean age of 47 years (range: 27 – 63) and mean of 20 years (range: 2 – 40) of practice. Five themes emerged from the content analysis: (1) perception of chronic pain (2) concern about opioid use (3) lack of support for patients, (4) communication with prescribers, and (5) knowledge gaps. Participants were comfortable with their knowledge of chronic pain and were empathetic of their patients’ suffering. They also felt their role is limited within the current healthcare system. Participants reported that misuse of opioids is the most challenging; issues included high potential for misuse, inadequate monitoring and under-use of other medications and resources for the treatment of chronic pain. Additionally, participants believed that patients suffer from lack of support by their family, employers and the health care system. Furthermore, trust was identified as the most important parameter in building a collaborative relationship with physicians. Finally, participants felt more training on legal issues related to opioids is required. Conclusion: Pharmacists were empathetic towards patients with chronic pain; however, they felt their role is limited in current climate. Deficiencies in the current system of managing chronic pain were identified including opioid use as the most challenging. Future research should investigate expansion of pharmacist roles to optimize chronic pain management.
A Picture is Worth a Thousand Words: A Randomized Controlled Trial to Assess the Impact of a Computerized Pictorial Medication Calendar Medication Taking Behaviour
(University of Waterloo, 2017-08-11) Maximos, Mira; Chang, Feng
OBJECTIVES The primary was to determine if a pictorial medication calendar would improve patient adherence to supportive medication regimens for adult patients receiving chemotherapy treatment. The secondary objectives were to: a) assess if the pictorial medication calendar would improve concordance with prescribed supportive care medication regimens, b) assess patient satisfaction associated with using the calendar and c) determine whether this tool affects participants' quality of life. METHODS Prospective, open-label, RCT with participants randomly assigned 1:1 to receive either routine care or routine care plus the intervention. Adherence was measured using pill count and diary. Concordance was measured by assessment of symptoms of nausea and vomiting in relation to PRN antiemetic use. Medication use and self-efficacy was evaluated using the MUSE scale. Participant satisfaction was evaluated using surveys created by the research team. A correlation analysis was performed between pills dispensed and taken as per the different adherence tools and a line of best fit was plotted where possible. A mean score difference was performed for the MUSE Scale results from baseline to end of study. A regression analysis was performed to determine if the symptoms of nausea and vomiting could predict the number of PRN anti-emetics taken. Data on participant satisfaction was analyzed graphically. RESULTS The correlation between scheduled pills dispensed and taken as per pill count was p<0.001, r=0.96. The correlation between scheduled pills dispensed and taken as per the diary was p=0.015 and r=0.71. The correlation between the PRN number of pills taken as per the pill count and average symptoms recorded in the diary was r=0.65 and p=0.06. The correlation between the number of PRN pills taken as per the diary and the average symptom score was p=0.47, r= 0.28 and between the PRN pills taken as per the diary and the number as per the pill count was p=0.19 and r=0.49. For the regression analysis model that assesses whether symptoms can predict PRN medication use in the intervention arm, F (2,3)=7.24, r2=0.8284, adjusted r2=0.7141, p=0.035. Due to the low number of participant data in the control arm, a regression analysis was not possible. The line of best fit for the intervention arm was y=-0.09x+3.06, R² = 0.05 and for the control arm, y=1.11x+0.16, R² = 0.92. For the intervention arm, the mean of score difference for the MUSE scale was 0.7, std. dev. = 4.40. For the control group arm the mean of the score difference of the MUSE scale was 1.86, std. dev.= 4.99. The alternative hypothesis, Ha: diff>0, where Pr (T>t)= 0.67, t (15)= -0.46 was chosen. Of the 17 participants for which results were available for the survey, 8 of the intervention group participants and 3 of the control group participants completely disagreed that the medication regimen was complicated, 1 participant in the intervention group and 2 in the control group moderately disagreed, none of the participants neither agreed nor disagreed, 1 in the intervention arm and 2 in the control arm moderately agreed and no participants completely agreed. Participants that received the calendar found it useful for medication taking behaviours. Approximately 80% of participants either moderately or completely agreed that the diary helped keep track of medications, with which medications to take, when to take them and how many times per day. DISCUSSION There appeared to be a correlation between scheduled pills taken as per the pill count and as per the diary, however the correlation was not statistically significant. Participants in both arms tended to take the majority of all prescribed medications according to both pill count and diary. There appeared to be a trend towards predictability of PRN anti-emetic use with increased symptoms, however this trend was only visible with pill count and not with the ORN anti-emetic pills taken as per diary recording. The MUSE scale results between the intervention and control arm did not appear to be significantly different. Of the intervention arm participants who answered the questions related to the calendar, the majority either moderately or completely agreed that it was a useful tool. Therefore, at this point it cannot be assumed that medication use and self-efficacy is improved with the use of the calendar. Participants in the control arm found the treatment regimen less complicated overall. The pictorial medication calendar tool may have played a factor in this response as those in the intervention arm would have not only been given routine care, but also would have received further information from the pictorial medication calendar. CONCLUSION Therefore, it appeared that the calendar was a useful tool, subjectively to participants involved in the study for ease of medication use. Furthermore, it also appears that participants who received the diary felt that their regimen was less complex. However, at this point it cannot be stated that the tool significantly affects adherence in a statistically significant manner as further data collection is required.
Serious Games on the Lived Experience of Dementia as Learning Tools in Pharmacy Education
(University of Waterloo, 2023-10-23) Eskandari, Yasaman; Chang, Feng
Dementia is a stigmatized and often ‘invisible’ condition which requires clinicians to have a nuanced understanding of the lived experience to build trust and provide better quality of care. Pharmacists are at the frontline of care for patients who may have dementia and there is a need for effective and engaging learning opportunities to prepare them for caring for patients living with dementia. Serious games have gained popularity for their potential in facilitating safe and engaging learning opportunities. However, there are limited applications of serious games in clinical education on the topic of dementia and little transparency on the development process. The thesis work outlined in this project intends to explore how serious games can best facilitate a learning experience for senior pharmacy students to better their understanding of the lived experience of dementia. The primary objective was to develop a serious game with multi-stakeholder input. The secondary objective was to provide game design recommendations for development of serious games on this topic based on end-user play-testing experiences. During both the development and user-testing, qualitative methods were used to gather thorough feedback and understand individual play experiences, namely semi-structured interviews and the think-aloud protocol. To develop a serious game, the game design framework for medical education was adapted in this project, which involved three stages: preparation and design, development, and formative evaluation. In the first stage, a clinician and a systems design expert were consulted to develop the first prototype. In the development stage, the prototype was reviewed by stakeholders including clinicians, people with lived experiences of dementia or care partners, and serious game researchers through semi-structured interviews, resulting in iterative improvements. Stakeholder feedback culminated in the development of a serious game with the goal of helping pharmacy students better understand the lived experience of dementia, in a digital, non-linear story format. During the final formative evaluation stage of game design, 11 senior pharmacy students, a pharmacy educator, and a social worker with expertise in dementia care tested the game. Their learning and play experiences were gauged through the semi-structured interview and think-aloud protocols. The qualitative data was analyzed using the framework method of analysis. Three factors were necessary for creating an engaging learning experience about dementia for senior pharmacy students. The first was facilitating understanding of dementia through an experiential approach using a realistic environment and authentic storytelling. The second was providing a problem-oriented experience by providing meaningful player interaction opportunities and creative freedom. Finally, novelty in the game format was necessary for an engaging experience. Future directions include recruiting more stakeholders and student participants with experiences relating to dementia, and utilizing these recommendations to improve on the game and assessing its impact on student empathy and confidence in caring for patients who have dementia.
Using a collaborative research approach to develop an interdisciplinary research agenda for the study of mobile health interventions for older adults.
(JMIR Mhealth Uhealth., 2015-02-10) Grindrod, Kelly; Baskerville, Neill; Giangregorio, Lora M.; Tomasson Goodwin, Jill; Sadat Rezai, Leila; Mercer, Kathryn; Burns, Catherine; Chang, Feng
Background: Seniors with chronic diseases are often called on to self-manage their conditions. Mobile health (mHealth) tools may be a useful strategy to help seniors access health information at the point of decision-making, receive real-time feedback and coaching, and monitor health conditions. However, developing successful mHealth interventions for seniors presents many challenges. One of the key challenges is to ensure the scope of possible research questions includes the diverse views of seniors, experts and the stakeholder groups who support seniors as they manage chronic disease. Objective: Our primary objective was to present a case-study of a collaborative research approach to the development of an interdisciplinary research agenda. Our secondary objectives were to report on the results of a nominal group technique (NGT) approach used generate research questions and to assess the success of including non-academic researchers to enrich the scope, priority, and total number of possible research questions. Methods: We invited researchers and stakeholders to participate in a full day meeting that included rapid-style presentations by researchers, health care professionals, technology experts, patients and community groups followed by group discussions. An NGT was used to establish group consensus on the following question: In your opinion, what research needs to be done to better understand the effectiveness, usability and design of mobile health apps and devices for older adults? Results: Overall, the collaborative approach was a very successful strategy to bring together a diverse group of participants with the same end goal. The 32 participants generated 119 items in total. The top three research questions that emerged from the NGT were related to adoption, the need for high quality tools and the digital divide. Strong sub-themes included privacy and security, engagement and design. The NGT also helped us include the perspectives information from non-academic researchers that would not have been captured if the process had been limited to the research team. Conclusions: Developing ways for patients and other stakeholders to have a voice when it comes to developing patient awareness as related to mHealth may guide future research into engagement, ownership, usability and design. It is our intention that our paper be used and adapted by other researchers to engage small or vulnerable populations often excluded from mHealth research and design.