Develop Strategies for Managing Medications During Sick Days

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Strategies for intervention design focused on opportunities for both patients and providers by way of medication labeling, specific prescription instructions, prescribing prompts, and educational services.

Sick day medication guidance (SDMG) is a concept that revolves around management of medications during times of acute illness (e.g., vomiting, fever, anorexia) to prevent adverse effects, particularly in patients with renal or cardiovascular disease. The National Kidney Foundation provided consensus recommendations in 2023 identifying various strategies endorsed by patients and health care providers (HCPs) to aid in the development of future trial design.¹ The following year, researchers from the Universities of Alberta and Calgary sought to identify:²

Barriers and enablers to behavior related to SDMG by both patients and HCPs
Strategies to advise SDMG intervention design
Perspectives on an electronic health tool for this service.

Sick, coronavirus or covid-19, illness asian young woman, girl with blanket have a fever, flu or sore throat and sneezing until chest pain while rest at home. Health care with disease, pandemic

Image credit: KMPZZZ | stock.adobe.com

The Canadian Journal of Diabetes published this qualitative descriptive study in early 2024. From January 2021 to April 2022, researchers conducted interviews and focus groups with patients and HCPs.² Participants included patients, pharmacists, family physicians and nurse practitioners. Interventions were simulated to address barriers and enablers for use of an electronic health tool. Patients could be included if they were taking 2 medications from the following classes: renin-angiotensin-aldosterone system antagonists, diuretics, nonsteroidal anti-inflammatory drugs, sodium-glucose transport protein-2 inhibitors, insulin, sulfonylureas, and meglitinides.

Community providers wrote prescriptions, pharmacists added labels to at-risk medications, and the information technology team built prompts into prescribing and dispensing software. Feedback from participants indicated generalized consensus that pharmacists are the ideal provider for ongoing care and communication.

Identified barriers related to SDMG revolved heavily around holes in communication and procedures, which led to patient and provider ignorance and lack of continuum of care. Increased clinician responsibility and subsequent liability and workload were additional barriers. The findings suggested a need for standardized protocols and procedures within practices to ensure timely assessment and response to patients requiring SDMG.

Additional strategies for intervention design focused on opportunities for both patients and providers by way of medication labeling, specific prescription instructions, prescribing prompts, and educational services such as workshops, seminars, and infographics. Both patients and HCPs perceived the eHealth tool as practical, although they raised concerns regarding credibility, patient privacy, and equitable access.

The findings of this study will hopefully guide the design of future interventions for SDMG and bring further awareness to the importance of close medication management during acutely ill conditions.

References

1. Watson KE, Dhaliwal K, Robertshaw S, et al. Consensus recommendations for Sick Day Medication Guidance for people with diabetes, kidney, or cardiovascular disease: A modified Delphi Process. Am J Kidney Dis. 2023;81(5):564-574. doi:10.1053/j.ajkd.2022.10.012

2. Watson KE, Dhaliwal K, Benterud E, et al. Managing medications during “Sick days” in patients with diabetes, kidney, and cardiovascular conditions: A theory-informed approach to intervention design and implementation. Can J Diabetes. Published online February 2024. doi:10.1016/j.jcjd.2024.02.003