The Influence Of Interactive Medication Literacy Intervention On Medication Safety In Patients With Coronary Heart Disease

ObjectiveTo investigate the influences of interactive medication literacy intervention on knowledge literacy,drug skill literacy,self-efficacy of rational drug use,participation in medication safety behavior,medication error,blood lipids,severity of angina pectoris and rehospitalization rate in the patients with coronary heart disease;and to provide the scientific and effective assessments for promoting participation in medication safety in the patients with coronary heart disease and beneficial reference for the promotion of participation in medication safety in chronic disease patients.MethodsFrom December 2019 to May 2020,70 patients with coronary heart disease,who were hospitalized in the Department of Cardiovascular Medicine of a tertiary hospital in a prefecture-level city,Hunan Province,were randomly and evenly divided into experimental group（n=35）and control group（n=35）.However,the effective cases in the experimental group and the control group were eventually 31 and 29,respectively,owing to voluntary exit and disease deterioration.All patients with coronary heart disease were given routine nursing and discharge follow-up.Meanwhile,the patients in the experimental group additionally adopted an online and offline platform of multidisciplinary guidance,and implemented the interactive drug literacy intervention from hospital continuation to home for 12 weeks,which included knowledge lectures,skill training,group discussion,discharge follow-up and intensive training,practical interaction,individualized supervision and other intervention items.The data questionnaire,coronary heart disease-related knowledge literacy assessment form,Self-efficacy for Appropriate Medication Use scale,patient participation in drug safety scale and medication error questionnaire were used to assess the patients’knowledge literacy,drug skill literacy,attitude literacy,behavioral literacy and medication errors before intervention,at discharge,at the end of intervention,and the 4^th weekend after intervention.Descriptive analysis,independent sample t-test,chi-square test and repeated measures analysis of variance of the data were performed in the framework of statistics using SPSS 24.0 software.Results（1）Before the intervention,no significant differences were shown by comparing scores between two groups in the general data,coronary heart disease related knowledge literacy,drug skill literacy,Self-efficacy for Appropriate Medication Use,patient participation in drug safety and medication error,blood lipid levels,compliance rate of lipid-lowering therapy and severity of angina pectoris（P>0.05）.（2）At discharge,at the end of intervention and at the 4^th weekend after intervention,the total points of coronary heart disease-related knowledge literacy in the experimental group were（35.19±1.56）,（39.46±1.75）,and（40.02±1.73）,respectively,which were significantly higher than that before intervention（24.78±7.55）and the control group[（33.36±2.29）,（33.81±2.45）,and（33.70±2.33）]（P<0.05）.The repeated measures analysis of variance between two groups showed that the time effects of the total score of knowledge literacy and the scores of each dimension,the group effects of the total score of knowledge literacy and the scores of dimensions including risk factors,clinical manifestations,treatment,medication knowledge and secondary prevention knowledge,and the interaction effects of the total score of knowledge literacy and the scores of dimensions including risk factors,predisposing factors,examination,treatment and medication knowledge were statistically significantly different（P<0.05）.（3）At discharge,the total score of drug skill literacy in the experimental group was（4.94±0.85）,which was not statistically higher than that in the control group（4.48±0.95）（P>0.05）.At the end of the intervention and at the 4^th weekend after the intervention,the total scores of drug skill literacy in the experimental group were（5.81±0.75）and（5.81±0.87）,respectively,which were significantly higher than that before intervention（3.77±2.14）and the control group[（4.31±1.07）,（4.21±1.11）]（P<0.001）.Compared the time effect,group effect and interaction effect of the total score of drug skill literacy between two groups by the repeated measures analysis of variance,there were statistically significant differences（P<0.001）.（4）At discharge,at the end of intervention and at the 4^th weekend after intervention,the total scores of self-efficacy of appropriate medication in the intervention group were（24.81±1.38）,（29.58±2.14）,and（29.97±2.48）,respectively,which were statistically higher than that before intervention（21.26±2.90）and the control group[（22.79±2.37）,（22.28±3.21）,（21.52±3.31）]（P<0.01）.The repeated measures analysis of variance showed that the time effects,group effects and interaction effects of the total score of rational drug use self-efficacy and its dimension scores between two groups were statistically significant differences（P<0.001）.（5）At discharge,at the end of intervention and at the 4^th weekend after intervention,the mean scores of participating in medication safety behavior in the experimental group were（3.56±0.26）,（3.99±0.28）,and（3.98±0.27）,respectively,which were significantly higher than that before intervention（2.92±0.55）and the control group[（3.11±0.52）,（3.05±0.52）,（3.00±0.47）]（P<0.001）.The repeated measures analysis of variance showed that the time effects,group effects and interaction effects of the average score of participating in medication safety behavior and scores of 3 dimensions were statistically significant differences between two groups（P<0.05）.（6）At the end of intervention and at the 4^th weekend after intervention,the total scores of the medication error questionnaire in the experimental group were（34.00±2.34）and（34.10±2.33）,respectively,which were significantly higher than that before intervention（23.23±3.69）and the control group[（23.07±4.17）,（22.93±3.59）]（P<0.001）.The repeated measures analysis of variance revealed that the time effects,group effects and interaction effects of the total score of medication error questionnaire and the scores including unconcern on prescription errors,omission errors,timing errors,dosage errors,unauthorized errors,medication compliance errors and monitoring compliance errors were statistically significant differences between two groups（P<0.05）.And the time effect of score of storage errors was statistically significant difference between two groups（P<0.05）.（7）At the 4^th week after intervention,the levels of triglyceride,total cholesterol and low-density lipoprotein in the experimental group were（1.17±0.97）mmol/L,（3.58±1.04）mmol/L,（1.65±0.66）mmol/L,respectively,which were significantly lower than that in the control group[（1.69±0.90）mmol/L,（4.29±1.37）mmol/L,（2.14±0.92）mmol/L]and in the experimental group before intervention[（2.36±1.69）mmol/L,（4.61±1.08）mmol/L and（2.62±0.80）mmol/L]（P<0.05）.Compared with the experimental group before intervention and the control group,the high-density lipoprotein level of the experimental group was not significantly different（P>0.05）.The standard rate of lipid-lowering therapy of the experimental group was 67.74%,which was significantly higher than that of 16.13%before intervention and 37.93%of the control group（P<0.05）.The severity of angina pectoris in the experimental group was significantly more than that of the control group（P<0.05）.The rehospitalization rate of the experimental group was 9.7%,which was not significantly lower than 17.2%of the control group（P>0.05）.Conclusions（1）Interactive medication literacy intervention can improve the knowledge literacy,drug skills literacy,rational drug use self-efficacy and participation in medication safety behavior of the patients with coronary heart disease.（2）Interactive medication literacy intervention can reduce medication errors of patients with coronary heart disease.（3）Interactive medication literacy intervention can also lower blood lipids,improve the standard rate of lipid-lowering therapy and alleviate the severity of angina pectoris of the patients with coronary heart disease.