Optimization of Medication Management for Community-Dwelling Persons with Spinal Cord Injury

While polypharmacy and multimorbidity are major global public health concerns in the general population, overall there is very minimal research specific to the spinal cord injury (SCI) population. Moreover, the lack of research on optimal medication management for SCI is startling given that most individuals with SCI experience significant complications directly and indirectly related to their injuries. Ideal medication management can be defined as 'patient-centred care to optimize safe, effective and appropriate drug therapy' such that care is provided in collaboration with the patient and care team members. Importantly, poorly managed conditions (e.g., pain, fatigue, depression) may have substantial impact on clinical and psychosocial outcomes, health care utilization, re-integration into the workplace, and overall health, well-being and quality of life of persons with a SCI. The proposed pilot research will build on the previous quantitative work, by using a two phased multi-method exploratory research design. PHASE I will use linked administrative health data to identify rates of polypharmacy by persons with SCI by type of injury. Potential risk factors for polypharmacy at the individual and provider level will be examined using statistical models. PHASE II will build on findings from the administrative data phase by using qualitative semi-structured interviews to explore the experiences with medications from the perspective of persons with a SCI (n=10-12 for traumatic SCI; n=10-12 for non-traumatic SCI), as well as perspectives from those who care or provide support (informal caregivers n=10-12, physicians, nurses and pharmacists directly involved in medication management n=10-12). Barriers and facilitators for medication self-management and care management will be explored. Importantly, this work will contribute to the research, clinical and broader community by expanding our understanding of the medication management for SCI. This novel information will inform future interventions to improve the quality of care, self-management, and overall quality of life for the SCI population. Findings from this work will identify certain sub-groups who might be most at risk for poor medication management. Therefore, the long-term goal of this innovative work is to develop, implement and evaluate targeted complex interventions to optimize medication management for persons with SCI. Our work will be valuable to persons living with a SCI, clinicians, informal caregivers, decision-makers and policy-makers. (CHN: PSR chn:wdg)