Medication discussion between nurse prescribers and people with diabetes: An analysis of content and participation using MEDICODE

Aim: This paper is a report of astudy to identify the content of, and participation in, medicine discussionbetween nurse prescribers and people with diabetes in England.

 

Background: Diabetes affects 246million people worldwide and effective management of medicines is an essentialcomponent of successful disease control. There are now over 20,000 nurseindependent prescribers in the UK, many of whom frequently prescribe for peoplewith diabetes. With this responsibility comes a challenge to effectivelycommunicate with patients about medicines. National guidelines on medicinescommunication have recently been issued, but the extent to which nurseprescribers are facilitating effective medicine-taking in diabetes remainsunknown.

 

Methods: A purposive sample of 20 nurseprescribers working with diabetes patients audio-recorded 59 of their routineconsultations and a descriptive analysis was conducted using a validated codingtool: MEDICODE. Recordings were collected between January and July 2008. Theunit of analysis was the medicine.

 

Results: A total of 260 instancesof medicine discussion identified in the audio-recordings were analysed. Themost frequently raised themes were ‘medication named’ (raised in 88·8% ofmedicines), ‘usage of medication’ (65·4%) and ‘instructions for takingmedication’ (48·5%). ‘Reasons for medication’ (8·5%) and ‘concerns aboutmedication’ were infrequently discussed (2·7%). Measures of consultationparticipation suggest largely dyadic medicine discussion initiated by nurseprescribers.

 

Conclusion: MEDICODE discussionthemes linked to principles of recent guidelines for effective medicine-takingwere infrequently raised. Medicine discussion was characterized by a onestatement-one response style of communication led by nurses. Professionaldevelopment is required to support theoretically informed approaches toeffective medicines management.