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Additional file 1.

Supplemental material, Appendix_2_questions for Self-administration of medication: a pragmatic randomized controlled trial of the impact on dispensing errors, perceptions, and satisfaction by Charlotte Arp Sørensen, Marianne Lisby, Charlotte Olesen, Ulrika Enemark, Signe Bredsgaard Sørensen and Annette de Thurah in Therapeutic Advances in Drug Safety

Additional file 2:. Questions at follow-up.

Additional file 1:. CONSORT pilot feasibility checklist.

FormålAt undersøge, om selvadministration af medicin (SAM) under indlæggelse påvirker antallet af dispenseringsfejl, opfattelse af medicin og deltagernes tilfredshed sammenlignet med medicin dispensering ved sygeplejerske.MetoderEt pragmatisk randomiseret kontrolleret forsøg blev udført i en dansk kardiologi-enhed. Patienter ≥18 år, der var i stand til at selvadministrere medicin, var berettigede til inklusion. Patienter blev udelukket, hvis de ikke selv administrerede deres medicin derhjemme, ikke blev ordineret medicin egnet til selvadministrering eller ikke talte dansk.Deltagere i interventionsgruppen administrerede selv deres medicin. I kontrolgruppen blev medicin dispenseret og administreret af sygeplejersker.Det primære resultat var andelen af ​​dispenseringsfejl indsamlet gennem modificeret skjult observation af deltagere og sygeplejersker. Dispenseringsfejl blev opdelt i kliniske og procedurefejl.Sekundære resultater blev undersøgt gennem telefonopkald for at bestemme deltagernes opfattelse af medicin og tilfredshed og endelig afvigelser i deres medicinliste 14 dage efter udskrivelse.ResultaterDer blev observeret markant færre dispenseringsfejl i interventionsgruppen med 100 fejl / 1033 fejlmuligheder (9,7%) sammenlignet med 132 fejl / 1028 fejlmuligheder (12,8%) i kontrolgruppen. Antallet af kliniske fejl blev signifikant reduceret, hvorimod der ikke blev observeret nogen forskel i procedurefejl. Ved opfølgningen havde de, der selv administrerende deres medicin, færre bekymringer med hensyn til deres medicin, fandt at medicin var mindre skadelig, var mere tilfredse, foretrak denne mulighed i fremtiden og havde færre afvigelser i deres medicinliste efter udskrivelse sammenlignet med kontrolgruppe.KonklusionDet reducerede antal dispenseringsfejl i interventionsgruppen indikerer, at SAM er sikkert. Derudover havde SAM en positiv indflydelse på i) opfattelse af medicin, hvilket antydede øget lægemiddeladherence, ii) afvigelser i medicinlisten efter udskrivning, og iii) deltagernes tilfredshed relateret til medicinhåndtering på hospitalet. Background: Our aim was to investigate whether self-administration of medication (SAM)during hospitalization affects the number of dispensing errors, perceptions regarding medication, and participant satisfaction when compared with nurse-led medication dispensing.Methods: A pragmatic randomized controlled trial was performed in a Danish cardiology unit. Patients aged ⩾ 18 years capable of SAM were eligible for inclusion. Patients were excluded if they did not self-administer medication at home, were not prescribed medication suitable for self-administration, or did not speak Danish.Intervention group participants self-administered their medication. In the control group, medication was dispensed and administered by nurses.The primary outcome was the proportion of dispensing errors collected through modified disguised observation of participants and nurses. Dispensing errors were divided into clinical and procedural errors.Secondary outcomes were explored through telephone calls to determine participant perceptions regarding medication and satisfaction, and finally, deviations in their medication list two weeks after discharge.Results: Significantly fewer dispensing errors were observed in the intervention group, with 100 errors/1033 opportunities for error (9.7%), compared with 132 errors/1028 opportunities for error (12.8%) in the control group. The number of clinical errors was significantly reduced, whereas no difference in procedural errors was observed. At follow up, those who were selfadministering medication had fewer concerns regarding their medication, found medication to be less harmful, were more satisfied, preferred this opportunity in the future, and had fewer deviations in their medication list after discharge compared with the control group.Conclusion: In conclusion, the reduced number of dispensing errors in the intervention group, indicate that SAM is safe. In addition, SAM had a positive impact on (a) perceptions regarding medication, thus suggesting increased medication adherence, (b) deviations in medication list after discharge, and (c) participant satisfaction related to medication management at the hospital.

Objectives: The objective of this study was to evaluate the costs and consequences of introducing "self-administration of medication" (SAM) during hospitalization as compared with nurse-led dispensing and administration of medication.Methods: This pragmatic randomized controlled trial was performed in a Danish Cardiology Unit. Patients ⩾18 years old capable of self-administering medication were eligible. In the intervention group, patients self-administered their medication. In the control group, medication was dispensed and administered by nurses. The implementation of SAM was used to evaluate the cost–consequences. The micro-costing analysis used the hospital perspective and a short-term incremental costing approach. The costs for medication, materials, and nursing time were included. Consequences included the dispensing error proportion, patients’ perceptions regarding medication, satisfaction, and deviations in the medication list at followup. In addition, the number of readmissions and general practitioner (GP) contacts within 30 days after discharge was included.Results: The total cost (TC) per patient in the intervention group was 49.9€ (95% CI: 46.6–53.2) compared with 52.6€ (95% CI: 46.6–58.6) in the control group. The difference between the groups was not statistically significant (p = 0.09). Sensitivity analysis consistently showed TCs favoring the intervention. The dispensing error proportion was 9.7% (95% CI: 7.9–11.6) in the intervention group compared with 12.8% (95% CI: 10.9–15.6) in the control group. The difference was statistically significant (p = 0.02). The analysis also found changes in the perceptions regarding medication (indicating higher medication adherence), increased satisfaction, and fewer patients with deviations in the medication list at follow-up. No statistically significant differences between the groups in relation to readmissions and GP contacts within 30 days were observed.Conclusions: SAM seems to cost less although the cost difference was small and not statistically significant. As SAM had positive effects on patient outcomes, the results indicate that SAM may be cost-effective.

Supplemental material, CHEERS-Checklist_CCA_revised for Cost–consequence analysis of self-administration of medication during hospitalization: a pragmatic randomized controlled trial in a Danish hospital setting by Charlotte Arp Sørensen, Annette de Thurah, Marianne Lisby, Charlotte Olesen, Signe Bredsgaard Sørensen and Ulrika Enemark in Therapeutic Advances in Drug Safety

Supplemental material, Appendix_TAW for Cost–consequence analysis of self-administration of medication during hospitalization: a pragmatic randomized controlled trial in a Danish hospital setting by Charlotte Arp Sørensen, Annette de Thurah, Marianne Lisby, Charlotte Olesen, Signe Bredsgaard Sørensen and Ulrika Enemark in Therapeutic Advances in Drug Safety

AIMS: Remote ischaemic conditioning seems to improve long-term clinical outcomes in patients undergoing primary percutaneous coronary intervention. Remote ischaemic conditioning can be applied with cycles of alternating inflation and deflation of a blood-pressure cuff. We evaluated the cost-effectiveness of remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction from the perspective of the Danish healthcare system.METHODS AND RESULTS: Between February 2007 and November 2008, 251 patients with ST-elevation myocardial infarction were randomly assigned to remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention (n=126) or to primary percutaneous coronary intervention alone (n=125). During a 4-year follow-up period, we used data from Danish medical registries and medical records to estimate within-trial cardiovascular medical care costs and major adverse cardiac and cerebrovascular event-free survival. After 4 years of follow-up, mean cumulative cardiovascular medical care costs were €2763 (95% confidence interval 207-5318, P=0.034) lower in the remote ischaemic conditioning group than in the control group (€12,065 vs. €14,828), while mean major adverse cardiac and cerebrovascular event-free survival time was 0.30 years (95% confidence interval 0.03-0.57, P=0.032) higher in the remote ischaemic conditioning group than in the control group (3.51 vs. 3.21 years). In the cost-effectiveness plane, remote ischaemic conditioning therapy was economically dominant (less costly and more effective) in 97.26% of 10,000 bootstrap replications.CONCLUSION: Remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention appears to be a cost-effective treatment strategy in patients with ST-elevation myocardial infarction.

Objective Although depression among older people is an important public health problem worldwide, systematic studies evaluating its prevalence and determinants in low and middle income countries (LMICs) are sparse. Biopsychosocial model of depression and prevailing socioeconomic hardships for older people in LMICs have provided the impetus to determine the prevalence of geriatric depression, to study its associations with health, social, and economic variables, and to investigate socioeconomic inequalities in depression prevalence in LMICs. Methods We accessed World Health Organisation-Study on global AGEing and adult health (WHO-SAGE) wave-1 data that studied nationally representative samples from six large LMICs (N=14,877). A computerised algorithm derived depression diagnoses. We assessed hypothesised associations using survey multivariate logistic regression models for each LMIC, and pooled their risk estimates by meta-analyses. We investigated related socioeconomic inequalities using concentration indices. ResultsCross-national prevalence of geriatric depression was 4.7% (95% CI 1.9-11.9%). Women, illiteracy, poverty, indebtedness, past informal-sector occupation, bereavement, angina, and stroke had significant positive associations, while pension support and health insurance showed significant negative associations with geriatric depression. We documented pro-poor inequality of geriatric depression in five LMICs. Conclusions Socioeconomic factors and related inequalities may predispose, precipitate, or perpetuate depression among older people in LMICs. Relative absence of health safety net places socioeconomically disadvantaged older people in LMICs at risk. The need for population-based public health interventions and policies to prevent and to manage geriatric depression effectively in LMICs cannot be overemphasised.