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Hospital inpatient self-administration of medicine programmes: a critical literature review

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Abstract

Aim

The Department of Health, pharmaceutical and nursing bodies have advocated the benefits of self-administration programmes (SAPs), but their implementation within UK hospitals has been limited. Perceived barriers are: anticipated increased workload, insufficient resources and patient safety concerns. This review aims to discover if benefits of SAPs are supported in the literature in relation to risk and resource implications.

Method

Electronic databases were searched up to March 2004. Published English language articles that described and evaluated implementation of an SAP were included. Outcomes reported were: compliance measures, errors, knowledge, patient satisfaction, and nursing and pharmacy time.

Results

Most of the 51 papers reviewed had methodological flaws. SAPs varied widely in content and structure. Twelve studies (10 controlled) measured compliance by tablet counts. Of 7 studies subjected to statistical analysis, four demonstrated a significant difference in compliance between SAP and controls. Eight studies (5 controlled) measured errors as an outcome. Of the two evaluated statistically, only one demonstrated significantly fewer medication errors in the SAP group than in controls. Seventeen papers (11 controlled) studied the effect of SAPs on patients’ medication knowledge. Ten of the 11 statistically analysed studies showed that SAP participants knew significantly more about some aspects of their medication than did controls. Seventeen studies (5 controlled), measured patient satisfaction. Two studies were statistically analysed and these studies suggested that patients were satisfied and preferred SAP. Seven papers studied pharmacy time, three studied nursing time but results were not compared to controls.

Conclusions

The paucity of well-designed studies, flawed methodology and inadequate reporting in many papers make conclusions hard to draw. Conclusive evidence that SAPs improve compliance was not provided. Although patients participating in SAPs make errors, small numbers of patients are often responsible for a large number of errors. Whilst most studies suggest that SAPs increase patient’s knowledge in part, it is difficult to separate out the effect of the educational component of many SAPs. Most patients who participated in SAPs were satisfied with their care and many would choose to take part in a SAP in the future. No studies measured the total resource requirement of implementing and maintaining a SAP.

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Acknowledgements

The authors thank Dr. David Brown Portsmouth University for his valuable help in drafting this manuscript.

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Authors and Affiliations

  1. Pharmacy Department, Southampton University Hospitals NHS Trust, Tremona Road, Southampton, Hants, SO16 6YD, UK

    Julia Wright

  2. Medicines Information Pharmacist-Research and Training, Wessex Regional Drug and Medicines Information Centre, Southampton University Hospitals NHS Trust, Southampton, UK

    Angela Emerson

  3. Clinical Support Directorate, Southampton University Hospitals NHS Trust, Southampton, UK

    Martin Stephens

  4. Southampton Cancer Centre, Southampton University Hospitals NHS Trust, Southampton, UK

    Elaine Lennan

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  1. Julia Wright
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Correspondence to Julia Wright.

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Wright, J., Emerson, A., Stephens, M. et al. Hospital inpatient self-administration of medicine programmes: a critical literature review. Pharm World Sci 28, 140–151 (2006). https://doi.org/10.1007/s11096-006-9014-x

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