Pixel International Conferences

People over 75, who have comorbidities in 80% of cases, have to take numerous medications throughout the day (ISTAT, 2019). The self-management model considers the dynamic and complex phenomenon of polytherapy linked to three dimensions: context, process and outcome. In particular, contextual factors are those that influence the involvement of individuals and families in their outcomes. The process of self-management refers, however, to the use of self-regulation skills to manage chronic disease conditions or risks associated with them. These processes include activities and goals, self-monitoring, reflective thinking, decision making, planning, and engaging in specific self-evaluative behaviours of several dimensions, including affective-emotional and cognitive, important for behaviour change.

Furthermore, self-management can contribute to increasing the activation of the patient and caregiver in the dimension of contextual adaptation to prescriptions in terms of mnemonic strategies, drug conservation and self-care. They demonstrate, with photographic material, the methods of taking medicines at home implemented by the over 65s in polypharmacy.

Methods and materials

The real-world pragmatic research with mixed methods was conducted in collaboration with ASLTO4-Regione Piemonte and University of Turin.

The study made it possible to interview 23 patients and caregivers followed by the Home Care of the Chivasso District, ASLTO4, in collaboration with some general practitioners, in order to understand the habits of using the therapy.

Furthermore, a literature review was conducted to identify the most effective educational narrative interventions aimed at improving adherence to therapy in patients over 65 with polypharmacy and comorbidities.

Numerous photographs have been collected of how people adopt mnemonic, classification and drug storage strategies.

Results

23 patients and caregivers were interviewed. Each of them was administered a questionnaire on drug consumption habits, educational preferences and digital skills. Dozens of photographs have been collected of how people handle therapy at home.

From a first analysis it is possible to divide the methods of classification and conservation of medicines into three methods:

• transcription of the therapy on paper sheets by the patient himself;
• using tablet boxes
• division of medicines based on times (medicines stored, for example, in separate drawers and/or in bags).

The mnemonic strategies adopted by the interviewees consist of transcribing the information on intake (time, between meals) directly on the package. Some patients also report the indications for which that drug was prescribed. One patient, however, reports that he writes down the therapy every day so as to "remember" what and when he has to take the drugs.

DISCUSSIONS

According to the World Health Organization (2003), therapeutic adherence can be defined as "the degree of effective coincidence between the patient's individual behaviours and the therapeutic prescriptions received from the treating healthcare personnel". It is divided into the stages of initiation, persistence, implementation, cessation or interruption. With respect to persistence, understood as "maintenance of a drug therapy over time", it is important to know the ways in which people determine their own self-care. The photographic testimonies highlight the abilities of the elderly to remember, separate and classify medicines at home, in order to minimize the risks of forgetting and incorrect storage.