Quality Use Of Medicines: A Case Study Of Mrs. Martha Vella, An Essay.

Mrs. Martha Vella is a 55-year-old public servant of Maltese background with a past medical history of generalised anxiety disorder, hypertension, and osteoarthritis. Her medications include: Efexor-XR (venlafaxine, 75 mg controlled release, once daily), Zestril (lisinopril, 10 mg, once daily), Panadol Osteo (paracetamol, 665 mg controlled release, two tablets BD), and Nurofen (ibuprofen, 200 mg, TDS when required). Martha is overweight (BMI = 28) and has a history of smoking one pack of cigarettes per day for 25 years (31 pack years).

She had elevated blood sugar and cholesterol levels 12 months ago but did not follow up with a clinical diagnostic work-up. Until recently, Martha has felt fine. Today, she presents to the general practitioner (GP), Dr. Hosu, complaining that her left foot has been weak and numb for nearly two weeks, and that the foot is difficult to flex. Furthermore, she reports that she has been very thirsty lately and gets up more often at night to urinate.

Martha’s physical examination including random plasma glucose level revealed the following: blood pressure of 165/100 mmHg, pulse rate of 96 bpm, and random plasma glucose of 13.1 mmol/L. Dr. Hosu suspects type 2-diabetes, and orders additional tests that need to be done after an overnight fast. Some of Martha’s results of additional tests are presented in the table below.

Blood test results	Urinalysis
BGL: 8.3 mmol/L	Ketones: negative
HbA1c = 7.5	Protein: negative
Total cholesterol: 6.9 mmol/L	Glucose: positive
HDL: 1.2 mmol/L	Microscopy: negative for microbes, red blood cells and white blood cells
LDL: 4.7 mmol/L

Dr. Hosu initiates pharmacological therapy consisting of  :  Caduet (amlodipine 10 mg and atorvastatin 20mg, once daily),   metformin (500 mg controlled release, once daily) and cessation of lisinopril. Martha is now referred for education in relation to her medication management.

The assignment assesses the ability of the student to critically analyse the patient scenario presented, and apply the principles of the Quality use of Medicines to develop an education session that covers medication management plan for the patient. You are expected to integrate evidence from a variety of information sources including the peer reviewed literature, clinical practice guidelines and the Australian Quality Use of Medicines Framework.

Previous Medical History of Mrs. Martha Vella

In this assignment, case study of Mrs. Martha Vella, from Maltase background is discussed. In this course, this assignment emphasizes on the Quality use of medicines, patient educations along with medication management procedure. Nowadays, it is very crucial for a patient like Mrs. Vella to go through all of these three stages. As this patient has a previous medical history along with anxiety related disorders . From blood test results, it is found to be present that, she has a high level of blood sugar and cholesterol also. Another bad habit of patient, excessive level smoking makes the patient more crucial. In this assignment, quality use of medicines will be a discussion according to the case study to make this patient aware of utilization of her medicines along with side effects of drugs. Patient education is effective for her because such education makes all patients cautious patients to take medicines at a particular time schedule (Thakral et al., 2017). Above all, through medical management procedure of QUM will also discussed I relation with Mrs. Martha Vella to get effective results of all medicines. The entire discussion on every points is provides in the following part of the assignment. It will help patients like Mrs. Martha Vella to take medicines at a regular manner ad get its effective results. According to the medicine framework of QUM, the judicial nature is maintained where it is always followed to utilised medicines under medical supervisions. Medical alternatives should be used only when it is needed (Fayanju et al., 2017).

Appropriateness is the another thing which should be included in the patient education session about quality use of medicines. It will helps patients to select proper medicine as selection of medicine is a crucial factor which are always changing in nature according to the clinical conditions, potential risks, benefits of the patiets along with time and cost-effectiveness of the treatment situation.

According to this case study, Mrs. Marth Vella has a high blood pressure, sugar and cholesterol level but she was one followed up by any medication system. She has come to Dr. Hosu, a general medical prescriptioner due to her problems in legs which are now disabled to flexed and Mrs. Vella has felt weakness along with numbness in her legs.MMrs. Vella has another problem of thirstiess at night along with heavy urination trouble. Due to this urination problem, she had to wake up at night many times. To control,  high hypertension, osteoarthritis and anxiety related disorders, Mrs. Vella was prescribed previously to take Efexor-XR, Zestril, Panadol Osteo, and Nurofen.  All of these drugs, their utilization and side effects are as follows. In this case study based critical analysis it will be discussed that, how medicines of Mrs. Vella works along with their interaction procure and side effects. In this aspect, new medicines are also provided by Dr. Hosu. Discussion is also provided that, why Dr. Hosu has changed the medicines. It also covers the reasons that, new medicines has enough interaction power to mitigate all the medical complexities of Mrs. Vella.

Physical Examination and Additional Tests

This drug belongs to anxiolytic medication system. It continues its activities as a serotonin and nor-epinephrine hormone reuptake related inhibitors (SNRIs). This drug is very effective to control activities of Central Nervous system (CNS) (Chua et al., 2017) This drug is very significant for Mrs. Vella to control all her depression, anxiety related disorders and mood fluctuations. Recommended dose of this Venlafaxine group drug is 75 mg controlled release to control depression level

This drug is an effective one to reduce depression level though such drug can create a lot of side effects also, such as blurred vision, sudden feelings of urination, mood fluctuation problems, serotonin syndromes, liver damage problems, along with sevel lower abdominal pains. For Mrs. Vella none of these side effects are reported till now. But, if happens treatment is highly needed

Medical prescriptioner has prescribed Zestril 10 mg to Mrs. Vella to control her high bood pressure level. This medicine acts as the Angiotesin Convertig Enzyme Inhibitor (ACE). As this patient has high blood pressure and cholesterol, so she is highly prone to heart attack or other heart related issues. This medicine is also used to protect a patient from all kinds of heart diseases.  This drug is prescribed every patient after getting assured that the patient is neither pregnant nor allergic to this medicine. After consumption of this medicine, smoking and drinking are very dangerous for patients (Corkindale et al., 2017). It may lead to the heart failure. Zestril 10 mg, Lisinopril group drug has some side effects of dizziness, nausea, light headedness and weakness. It can be assumed that, due to intake of this drug, Mrs. Vella is now feeling a chronic weakness in her leg.

As Mrs. Vella is a chronic patient of Arthritis, for that reason medical practitioner has prescribed her Panadol Osteo (Samdani et al., 2017). It is a two-layered capsule with an immediate and a sustained release of parasetamol.  This drug is very effective to provide relief from externsive pain of Arthritis. It is basically a pai releaf based schedule drug. It has no effect on breastfeeding women also, however due to presence of Acitaminophen, one of the active components of Pannadol Osteo, this medicine shows some unwanted side effects also. These side effects are sudden appearance of skin rashes, hives, sore throat, reduction in urination amount, along with unusual weakness or tiredness. Medical prescriptioner has provided Nurofen  665 mg controlled release,  2 tablets BD to Mrs.Vella. It will redue her arthritis related pains. The side effect is also found to be present in Mrs. Vella. Most commonly informed side effects of this drug are vomiting, nausea along with constipation.

Pharmacological Therapy and Medication Management Plan

In all of these medicine based system, Dr. Hosu has found some side effects in Mrs. Vella and for that reason he provided a new medication system.

Nurofen is the ibuprofen group drug, mainly prescribed as an anti-inflammatory one.  It is called Non-steroidal Ati-inflammatory drug (NSAID).  In context of Mrs. Vella, this drug may be fatal because of her smoking habit. This drug has limitless side effects for patients with high blood pressure, suger, or with habit of smoking. This drug has some side effects also, like Marfan syndrome, Sjogren’s syndrome, asthma and many others. According to the case study, this drug is prescribed to Mrs. Vella to reduce her pain of Arthritis. It is not prescribed to her as a routine drug, bt medical prescriptioer has prescribed the drug Nurofen, 200 mg, for using it when Mrs. Vella will feel any pain.

Till now the discussion spins around side effects and dosage of medication of rs. Vella. From her Blood test results it is found to be present that, she is a chroic patient with high blood pressure, sger and cholesterol. From her urinalysis resuls, it is found to be present that, she has  positive glucose level along with negative ketone and protein level. From entire report, it can be implicated that, she is a hypoglysemia patient aong with glycosuria. But, from microscopic analysis, it is found that, in both red and white blood cells with absence of microbes that, she has no himaturia or urinal infection related issues (Schmidt et al., 2017). Blood pressure of Mrs. Vella, 165/ 100 hg is a high blood pressure because 120/80 is the normal blood pressure range. Pulse rate is also high as it is normally 72 bpm along with radom plasma  glucose level of 13.1 mmol/L. After analyzing her health conditions, blood reports and urinalysis based reports, Dr. Hosu, assume the disease as Diabetes Type 2. In this blood report, the High Density lipoprotein amount is very low for Mrs. Vella , but low density lipoprotein is presented in a high amount. It is also very degerous heath condition (Psotka et al., 2018).

After discussion all of these issues, it is crucial to provide a quality medicine management system to MRs. Vella. Above all, she belongs to Maltese background also.  Mrs. Vella belongs to ethic group which is indigenus to Malta island, in the mmiddle of Mediterriniean sea. All of these people speaks in the language of Malta. These Maltese group peoples are included in the Gozitan group of people, ihabiiting in the sister island of Malta, named Gozo.

Quality Use of Medicines Framework

Smoking habit of patient, Mrs. Vella is very injurious to her health. Due to this habit, along with takig some drugs like Zestre, ad others may create a great physiological complexities also. From the case study, it is found to be present that the patient has the habit of smoking, a packet per day. It will also create a dangerous blood cell destruction also (Valdersnes et al., 2017). Smoking also has a rucial role in creation of depression among people. For that reason, it will be a prudet activities of  Dr. Hosu to stop her from smoking like destructive habilts. 31 packet cigarette consumption may lead the latient towards cancer also.

To continue the discussion about quality use of medicines, patiend educations and medication management a research is conducted by researchers during this assignment. This research is discussed below (Boardman & Westman, 2018).

During this assignment, qualitative and quantitative study are processed on a population of people whose age is more than 60. Among all the population participants, 50% are grouped as controlled with quality medicine use and under medicine management programming. Remaining participants belong to enormous complexities like Mrs. Vella. Some of them have arthritis, blood suger, high cholesterol level and above all they belong to the group where there is no system of medicine management, patient education session and others (McLeod et al., 2017).

Validity and reliability of this qualitative and quantitative study will be possible after going through a lot of researches, literatures and textbooks. In these perspectives, sometimes trials are conducted over twice or thrice time to get a proper result also (Smith et al., 2018). The researcher cannot stake claims on the reliability of the data collected and analysed due to the inability of conducting multiple forms of the test, as the research is academic, the said research has been conducted with limited resources (Thompson et al., 2017).

Qualitative research methodologies are utilised during the research to comprehend the behaviour and recognition of the contributors towards the global accounting standards. Although there are various methods to analyse data, this research enables the researcher to obtain a critical understanding of the subject and draw inferences which can be very easy once obtained.

For this assignment, the researcher has utilised the survey methodology for data collection for further assessment, refining and strategically derive at a conclusion(Kinniburgh et al., 2017). The survey method is utilised to obtain a genuine insight of data obtained from many people (Powers  et al., 2017)A web-based online questionnaire has been utilised for this research as it can reach out to countless people, at this moment enabling the researcher to accumulate ample data towards assessment.

Patient Education on Medication Management

The method of sampling utilised for this research is known as convenience sampling. It is one of the non-probability sampling techniques wherein the researcher can select the participants at their convenience (Butcher et al., 2017).

The Quantitative research methodology has been selected to focus upon the numerical data for obtaining a conclusion. On the contrary of the qualitative research which does not provide any conclusion, the quantitative research methods help in obtaining a definitive result with the help of manipulating statistical data with the utilisation of computational techniques

Data collection methods adopted for conducting of quantitative research for the study included a collection of data using a questionnaire and interviews.

The Questionnaires utilised for conducting the said research includes a list of questions with checkboxes and a rating scales pertaining the participant’s experience. This method enables the research to understand the respondent's behaviours and attitudes which are simplified and quantified using a checklist consisting of various parameters such as behaviours, options and attributes the researcher might be looking for.

In quantitative research, structured interviews are employed for data collection wherein the researcher will ask a series of questions from an interview questionnaire to the respondents, who in turn provide answered based on their knowledge, experience, perceptions and feelings. The researcher notes or records down these answer. The research may even ask some personal questions during the interview process. These interviews can take place at a place and time convenient both to the researcher and the respondent (Gonzalo et al., 2017).

The research results cannot be generalized as the samples size for this research was relatively small and also due to the subjective nature of the subject matter. Research on such subjects are required to be conducted carefully and the participation of different people on different days, in such research, results to the derivation of a different result on a different day at this moment making the research findings unreliable (Flick, 2014).

Every quantitative research is plagued with its limitations as such forms of research do not examine the individual participant’s perception. Also, the correspondents are provided with only limited logical choices to answer wherein they might not be able to describe their individual experiences. Quantitative research does not always explore asking the questions regarding “how or why”. Such researches might provide the researcher with flawed results while applying its outcomes in another application.

The following is an estimated timeline with the overview of the tasks.

Tasks	May	Jun	Jul	Aug	Sep	Oct
Research Proposal	10-May
Finding answers to research question
Interview Scheduling
Interviewing and data analysing.
Survey
Data analysing and reporting
Final Submission						20-Oct

Medication and Side Effects: Analysis of Mrs. Martha Vella

Figure : Research plan

Source: Shafi et al., 2017

According to the medicine framework of QUM, the judicial nature is maintained where it is always followed to utilised medicines under medical supervisions. Medical alternatives should be used only when it is needed (Fayanju et al., 2017).

Appropriateness is the thing which should be included in the patient education session about quality use of medicines. It will helps patients to select proper medicine as selection of medicine is a crucial factor which are always changing in nature according to the clinical conditions, potential risks, benefits of the patients along with time and cost-effectiveness of the treatment situation.

Patient education session has to be most effective through providing the education about making patients cautious about the misuse, over dosage, and underuse along with their bad effects on the health. Medicine can provide an effective outcome only when it is used through safety ad within an effective medicine freame work. In the initial part it is also discussed that, how the drugs can effect adversely on Mrs. Vella due to lack of medical based knowledge  (Boelen, 2018).

In this asect, QUM has provided has a great patient education session to Mrs. Vella. In this medication system, medical service providers have provided a medicine based chart to Mrs. Vella. In this medicine chart, all of her medicines are instructed at different time. At a time, during afternoon, this medical institute has started a new session of patient education where Mrs. Vella and all other patients are educated about how and when to take a particular medicine. It is also emphasized there that, what are the side effects, of over dosage and under dosage of a medicine. Sometimes Mrs. Vela and patients are not aware of these. Such information will definitely help them to be cautious of al of the medicines and take the entire medicines inn a proper time.

Quality use of medicine is a great strength of Australian medicinal policy.  It includes selection of management options in a prudent manner, selection of required medicines only and utilisation of required medicines in such a way which will mitigate the  health complexities only without making any side effects.

Figure:

Source:

In this quality use of medicine system, medical institutes provide education session to both of their clients and servants. Through this QUM system, Mrs. Vella will come to know about quality utilization of medicines.

New Medication System for Mrs. Martha Vella

It is found to be preset from enormous secondary researches that, in Australia, QUM has saved 1.5 million peoples only through providing education about Quality medicine system. Mrs. Vella is also provided  some patient education session which wil help her to mitigate her complexities.

Mrs. Vella is provided with Timely Enhanced Access to Medication Management (TEAMM) which will help her to take medicines in time to get recovered soon.

Technological improvement is highly needed in this sector for making patients cautious about the patient education sessions (McLeod et al., 2017). Nowadays, scial media is a great platform to inform all the patients. There are face book, titter, Whatsapp and many other social media platform. QUM and many other medical organizations have to access those platforms along with highly developed IoT, Internet of things.

Through these materials, patients and medical organizations can be connected through telecommunication system. In this system, patients will be able to contact with their medical service providers whenever they need it. There are the systems of reminder providing. In this system, nurses and medical practitioners can provide medical services to the rural areas also. It will open a new horizon in the medical system also (Boardman & Westman, 2018).

Conclusion:

It can be concluded from the entire discussion, drugs, and medicines are beneficial in all aspects, but it should be consumed according to their dosage. In this aspect, the side effects of some drugs are also discussed here. It will help people to be cautious about that. This assignment also provides the knowledge about adverse effects of smoking. Sometimes, the habit of smoking creates a significant problem to through making side effects. People should maintain this medicine framework and live a life without any disease.

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