title: The impact of an intervention for nurse prescribers on consultations to promote patient medicine-taking in diabetes: a mixed methods study.
abstract: BACKGROUND
  Nurse prescribers are in a key position to promote medicine-taking in diabetes. Although patients' beliefs about medicines are important predictors of medicine-taking, evidence suggests nurses do not routinely explore these.
  
  
  OBJECTIVE
  To evaluate a theory-based intervention designed to increase nurse prescribers' exploration of medicines' beliefs with people with diabetes.
  
  
  METHODS
  Mixed methods concurrent triangulation design.
  
  
  METHODS
  Nurse prescribers were recruited from 7 Trusts in England.
  
  
  METHODS
  A purposive sample of 14 nurse prescribers attended four 1 day workshops.
  
  
  METHODS
  Audio-recordings of each nurse prescribers' consultations with diabetes patients were collected at baseline, 1 week, 3 months and 6 months after the intervention. Nurse prescribers were interviewed at 1 month and 6 months post-intervention. Changes in medicines' discussion and participation in consultations were analysed using MEDICODE. Interview data were analysed using Framework Analysis.
  
  
  RESULTS
  MEDICODE themes of 'attitudes towards medication' showed a significant rise at 1 week (p<0.01) and 3 months (p<0.05). 'Asks patient opinion about medication' significantly increased at 1 week (p<0.01). Discussion on 'concerns about medication' rose significantly at 1 week (p<0.001) and 6 months (p<0.01). Discussion on 'expected effects of medication', 'action of medication' and 'reasons for medication' showed no change. There were no significant changes in Dialogue Ratio. However, the Preponderance of Initiative moved towards more patient initiative at 1 week (p<0.0001), 3 months (p<0.0001), and 6 months (p<0.0001). In interviews, nurses reported increased attention to patients' medication beliefs and adoption of patient-centred skills. Contextual factors that positively influenced ability to explore medicines beliefs in practice settings were: support of colleagues and practicing new skills. Inhibiting factors included: patients' perceived lack of receptivity, time constraints, and concerns about opening a 'can of worms'. Six months interviews revealed using skills in practice enhanced nurses' confidence and sustainability of skills requires a nurse-patient relationship. Method triangulation illuminated how the intervention was implemented in practice contexts.
  
  
  CONCLUSIONS
  The intervention was effective at changing some key dimensions of prescribing consultations. The use of a self-efficacy framework in the intervention, to promote nurses' confidence in working in a different way, may have been instrumental in effecting the changes found. Contextual factors influencing beliefs exploration in medicine-taking consultations were identified.
authors.affiliation: School of Health Sciences, University of Southampton, Highfield, Southampton, UK. sml@soton.ac.uk
authors.forename: Sue
authors.initials: S
authors.lastname: Latter
authors.forename: Andrew
authors.initials: A
authors.lastname: Sibley
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Skinner
authors.forename: Sue
authors.initials: S
authors.lastname: Cradock
authors.forename: Katarzyna M
authors.initials: KM
authors.lastname: Zinken
authors.forename: Marie-Therese
authors.initials: MT
authors.lastname: Lussier
authors.forename: Claude
authors.initials: C
authors.lastname: Richard
authors.forename: Denis
authors.initials: D
authors.lastname: Roberge
mesh_terms: D003920:Diabetes Mellitus / Q000188:drug therapy*; D011307:Drug Prescriptions; D004739:England; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D009726:Nurses; D010349:Patient Compliance
chemical_list: D007004:Hypoglycemic Agents