1. Med Ed : Making sense of medication

2. A reflective exercise… In your practice, do you: Work with youth who take medications? Feel that youth have enough information about their medications? Find information about medications for your clients? Feel that this information is readily available and accessible?

3. Todays presentation Background and context Resource development Description Using Med Ed © Training Evaluation Next steps

4. Background and context Youth taking psychotropic medications often do not know enough about these medications Youth-oriented materials are very hard to find Most resources dont work to promote dialogue between youth, caregivers, and health providers

5. The team Developers 2 pharmacists (Drs. Andrea Murphy and David Gardner) 1 psychiatrist (Dr. Stan Kutcher) Partners The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO (Drs. Ian Manion and Simon Davidson)

6. Other key people Youth with mental illnesses Clinicians Graphic designer Plain language consultant Expert review panel (Ontario) Legal consultation Stakeholder feedback Basic booklet template

7. Why are information sources about medications needed? To enhance the clients ability to make informed decisions about medication To support collaborative treatment planning To improve treatment-related outcomes

8. Considerations in developing information resources What do clients want to know? What is the best way of getting this information to clients? Who should be involved in the conversation? Source: Zwaenepoel L, et al. (2005), Pharm World 27:47-53

9. Ways to provide medication information Verbal Written Video Internet Media

10. Concerns with the Internet Consumers frequently default to the Internet to find health and medication information Clients rarely share or discuss information that they have found on the Internet with their health providers Information found on the Internet is often inaccurate or misleading Source: Diaz JA, et al. J Gen Intern Med. 2002;17:180-185; Sciamanna CN, et al. Int J Med Inform. 2003;72:1-8; Hansen DL, et al. J Med Internet Res. 2003;5:e25.

11. Concerns with the media 1999 survey: 84% of Canadian doctors reported that they believed media reports influenced the kind of treatments their clients requested 1997 US National Health Council: 58% of people surveyed said they were prompted to modify some aspect of their behaviour by a health-related story reported in the media Source: Gregg A, Kelly C, Sullivan M, Woolstencroft T. A report on the attitudes of Canadian physicians regarding media coverage of health issues. Toronto: The Strategic Counsel, Inc.; 1999; Americans talk about science and medical news: the National Health Council Report. New York: Roper Starch Worldwide; 1997.

12. Concerns with written materials Documents are too long Information is common knowledge Print is too small Difficult to understand/language barriers Information is worrisome Information is confusing Information is not useful Source: Nathan JP, et al. Ann Pharmacother 2007; 41:777-82.

13. Despite this, the literature says that… Clients still prefer to receive medication information verbally or through printed materials Health care providers tend to prefer face-to- face interactions and paper-based resources Multiple approaches work best Source: Raynor DK, et al. Health Technol Assess. 2007;11:iii, 1-160; Bennett NL, et al. BMC Med Inform Decis Mak. 2005;5:9; Bennett NL, et al., J Contin Educ Health Prof. 2006;26:120-127; Murphy AL, et al. BMC Nurs. 2006; 5:5.

14. The purpose of Med Ed © Information and knowledge exchange Collaborative decision-making Client participation

15. Med Ed © is not intended to… Substitute or replace information and discussions that occur with a clients health providers Serve as a stand alone resource to answer all of a clients or caregivers questions about medications

16. Target users 1.Youth aged 12 to 24 either currently using or considering psychotropic medication as a part of treatment for a mental illness 2.Parents/caregivers and family members 3.Health providers such as physicians, pharmacists, nurses, psychologists, occupational therapists, and social workers

17. The resource

18. Developing the content 1.Order of information 2.Style (font, size, graphics) 3.Medicaleze 4.Illustrations 5.Written at a grade 6 level 6.Concise, bulleted format 7.Consistent design and information

19. The booklet Content rich Three main sections: Frequently asked questions (FAQs) Tools and checklists Glossary

20. The passport Portable, concealable Full of tools A companion to the booklet Abbreviated sections FAQs Checklists

21. Med Ed © Content

22. Contact information

23. General information and disclaimers

24. Legal rights regarding meds in Ontario Q: What information should be provided to me about my treatment? Q: I consented to treatment, but now Ive changed my mind. What should I do?

25. FAQs Q: How long do I need to take this medication? Q: Will taking this medication affect my relationship with my boyfriend/girlfriend? Q: Everyone keeps talking about side effects – what are they?

26. Med Ed © information boxes

27. Table of medications Classes of drugs Anti-anxiety and sleep medications Common group names Benzodiazapines Antihistamines Antidepressants Common examples Generic name Trade name

28. Side effects

29. Med Ed © Tools

30. Checklists Designed to support communication between clients and care providers Lists questions to ask prescriber and pharmacist Includes space to make notes

31. Checklist Doc What is this medication for? Should I avoid any foods or alcohol? What are my other treatment options? What should I do if I have an emergency?

32. Trackers

33. Also includes… Medication list Appointments Notes page Glossary

34. Med Ed © Passport Includes: FAQs Tools Trackers Medication list Appointments

35. Med Ed © training Train-the-trainer model 38 trained champions from across the province in a range of roles (mental health counselling, residential care, psychiatry, psychology, nursing, pharmacy) Champions are currently providing training within their organizations Ongoing support is provided to champions via web portal and regular teleconferences

36. Med Ed © evaluation Focus Effectiveness of training, utility of tool for end- users Sources Champions, trained service providers, end-users (youth and caregivers) Methods Questionnaires, telephone interviews

37. Preliminary findings related to training NMean (/6) The Med-Ed © tool is easy to learn745.55 It is easy to use745.45 It is useful for decision-making for children and youth on psychotropic medications 725.33 I can find the time to disseminate the Med-Ed © tools 734.90 It is too much trouble to apply742.26 It is consistent with other initiatives in our organization 714.70

38. Preliminary findings related to the tool A good resource to help clients take ownership of their treatment… Just a great way to engage kids in their health care… This is a great idea and instrument with many possibilities… …very informative for my every day administering of meds…(helps me to) recognize my need to do more reviews on clients' meds…

39. Evaluation next steps Continue to analyze data from new round of champions and the service providers they train Conduct and analyze semi-structured interviews with service providers, parents/caregivers, and youth

40. Med Ed © in your practice setting Just because Med Ed © is available doesnt mean it will be used A number of variables influence whether or not health care innovations are adopted

41. Small group exercise What factors may influence the uptake of Med Ed © in your practice setting? What are the barriers? What are the facilitators? What strategies can be used to overcome barriers and capitalize on facilitators?

42. Next steps… Continued evaluation Ongoing supports for trained champions Planning for future dissemination

43. Purnima Sundar, PhD Research and Knowledge Exchange Consultant 613.737.7600 ext. 3485 psundar@cheo.on.ca www.onthepoint.ca www.onthepoint.ca For more information: