Title: Brian J Quilliam, Roberta E. Goldman, Anne L Hume, Charles Eaton and Kate L Lapane.
1USE OF MIXED-METHOD DESIGNS TO INFORM
PATIENT-CENTERED TOOLS TO IMPROVE MEDICATION
MANAGEMENT
- Brian J Quilliam, Roberta E. Goldman, Anne L
Hume, Charles Eaton and Kate L Lapane. -
2Overview
- Background
- Introduction to Tailored DVD Project
- Highlight the Mixed Methods Approach
- Our Application of Mixed Methods Approach
- Preliminary Results
- Next Steps
3Importance of improving medication management in
ambulatory settings
- 62 of all outpatient office visits result in
prescribing of at least one medication - (Cherry et al. Adv Data 20033371-4)
- Incidence of adverse drug events in community
dwelling adults 27.4 - (Gandhi TK et al. NEJM 20033481556-64)
- At least 887 million spent on preventable
adverse drug events among Medicare beneficiaries
in outpatient settings - (Field TS et al. Medical Care 2005
43(12)1171-76.)
4Specific AimsTailored DVDs for Patients
- Identify medical management issues for minority
and low-income geriatric patients - Develop personalized materials in English and
Spanish to improve adherence - To pre-test these materials by conducting a
feasibility study in 4 clinics and 100 patients
5The Mixed Methods Approach
- Quantitative data can reveal generalizable
information for a large group of people - These data often fail to provide specific
answers, reasons, explanations or examples - Qualitative research provides data about meaning
and context regarding the people and environments
of study - Findings are often not generalizable because of
the small numbers narrow range of participants - Both methods have strengths and weaknesses
- When used together, these methods can be
complimentary
6Why the Mixed Methods Approach
- Study populations are increasingly alert to how
they are being approached by interventionists,
and how they are represented in research - With increasing diversity in the US, community
research is becoming more complex and
multi-faceted.
7The Qualitative Perspective
- I want to understand the world from your point
of view. I want to know what you know in the way
you know it. I want to understand the meaning of
your experience, to walk in your shoes, to feel
things as you feel them, to explain things as you
explain them. Will you become my teacher and
help me understand? - James P. Spradley (1979). The ethonographic
interview. New York, NY Holt, Rinehart and
Winston.
8Nature of Qualitative Research
- Attempts to make sense of the social world in
terms of the meanings people bring to it - To uncover ideas, insights, or ways of thinking
of and explaining phenomena about which little is
known - To gain novel and fresh perspectives on things
about which quite a bit is already known
9Perspectives
- We are all natives insiders to some groups and
outsiders to others even as we aspire also to
be scientists and transcend the tribal. - Howard Stein, 1992
10Qualitative vs. Quantitative
- Qualitative
- Looking for a range of phenomena
- Rarely use statistical analyses
- Not representative of the population
- Quantitative
- Focused search, limited factors
- Formal statistical analyses are common
- Sampling may be done to maximize generalizability
11Qualitative vs. Quantitative
- Participant observation
- Individual interviews
- Focus groups
- Visual (i.e. video or still image)
- Surveys
- Observational Study Designs
- Experimental Study Designs
12Focus Groups
- Ideal number participants 8
- Select participants carefully
- Ensure there is no status conflict among the
participants - Private space for discussion
- Audio record or video record (use 2 audio
recorders consider going digital and upgrading
your mic!) - Refreshments
- Develop discussion guide and use it loosely
13Uses for Qualitative Research in Developing
Patient Centered Materials
- Obtain data that are useful on their own
- Detailed, contextually-based data on subtle
meanings associated with attitudes, beliefs, and
behaviors - What, how, and why people conceptualize issues
differently in different contextual circumstances - Generate indigenous terms and categories
- Generate new avenues for study
14Uses for Qualitative Research in Developing
Patient Centered Materials
- Obtain data that serve as building blocks or can
be triangulated with other data - Information that enhances intervention design
- Information that informs survey design and
implementation - Understand the range of relevant survey questions
and responses - Test surveys and intervention elements
- Information that complements and/or explains
other results
15Our Mixed Methods Approach
DVD/Print Material Development
Feasibility Study
16Results Focus Groups
- From Exploratory Focus Group
- How do you decide whether you want to take this
medicine?"
Morning
MWF
Random
17Results Patients Survey
18Results Patients Survey
19Results Focus Groups
- From Exploratory Focus Group
- When you have questions about your medications,
who do you ask? Why? - I really trust the pharmacist
- Pharmacists are very more up to date with the
medications - Besides all the doctors Ive talked about, I run
it by the pharmacist - he has a very poor habit of going to the
doctors, whether they are specialists or whatever
hes going to go to the doctor with, and he never
asks any questions - RG you didnt ask the pharmacist,
- PT no, they know
20Results Patients Survey
21What We Learned Utilizing the Mixed Methods
Approach
- Patients sometimes take their medications at
random or rationalize their medication taking
behavior - Point of intervention
- Patients utilize both physicians and pharmacists
for medication information - Incorporated into design of video
- Terminology is important
- Medicine verses Medication
22Next Steps
- Continue Analysis of Focus Group and Patient
Survey Results - Triangulation of data
- Stratification of patient survey results
- Development of video segments
- General tips segment in progress
- Conduct Confirmatory Focus Groups
- Pre-test developed materials