การพัฒนาเอกสารให้คำแนะนำแบบรูปภาพสำหรับยาที่ต้องระมัดระวังสูงกลุ่มเมทิลแซนทีน

Abstract

This study aimed to develop drug information pictograms for informing patient about the side-effects of high alert drugs in Methylxantine group, to evaluate the effectiveness of pictograms by assesing knowledge of medicine information and to reporting the the roles of interdisciplinary healthcare team in managing high alert drugs (HADs) by having patients as a team member Methods: The study consisted of two phases. In Phase I, a focus group discussion among interdisciplinary healthcare team members at Sansai Hospital, Chiang Mai, was conducted in order to revisit the roles and responsibilities of each member in managing HAD. A think-aloud interview was used with 30 out-patients at Sansai Hospital to develop a pictograms. Results showed that, although the interdisciplinary healthcare team members knew their roles and responsibilities on HADs, they did not strictly follow the practice guidelines. They reported that the pharmacists’ roles were unclear and the HADs handbook was impractical. Moreover healthcare team members were confused due to a large list of HADs. They agreed that providing patients and their relatives with knowledge about HADs symptoms would help monitoring the HADs toxic effects. Starting with the drugs in Methylxantine group, the pictograms would inform the patients about the symptoms of nausea-vomiting, loss of appetite, sleepless, headache, thirsty and palpitation. After trying out the pictograms with the patient for three rounds, the pictures with at least 90% correct responses were nausea-vomiting, loss of appetite and headache.

In Phase II, the experimental research was used to evaluate the effectiveness of pictograms in knowledge of medicine information and patients report on the Methylxantine toxicity. Sample were 123 in-patients who had been prescribed medicine with Methylxanthine group or their relatives. They were enrolled and were allocated by purposive sampling in to 3 groups, 41 persons in each group. Group 1 ,a control group, they recived only verbal consultation by a pharmacist. In group 2, samples recived verbal consultation with a text-only information sheet. In group 3, samples recived verbal consultation with a pictogram developed in phase I. The outcomes were examined at a discharge counseling or at day 4 after admission. Participant knowledge about medicine was investigated by asking a series of question. Results shown that medicine knowledge was significantly higher in the group 3, comparing with other groups (p < 0.001). The median knowledge score were 1.0 (Q1, Q3 = 1.0, 2.0), 2(Q1, Q3 = 2.0, 3.0) and 3.0 (Q1, Q3 = 2.0, 4.0) in group 1, 2 and 3 respectively. Sample in group 3 reported that seeing symptom pictures helped remind them and make it easy to remember. They were 5 patients (4.2%) reported to physicians that they had experience the palpitation and nausea. The physicians readjusted the medicine doses according to there report. Cooperation between interdisciplinary healthcare team, patients and their relative caregivers are necessary for effective HADs management. It took several rounds to develop clear and reliable pictograms. The pictogram can help communicate clearly, and increase patient knowledge.