Background

Adults aged 65+ (older adults) disproportionately consume 30% of over-the-counter (OTC) medications and are largely responsible for making OTC treatment decisions because providers lack awareness of their consumption. These treatment decisions are complex: older adults must navigate age-related body/cognitive changes, developed comorbidities, and complex medication regimens when selecting the right OTC. Yet little is known about how older adults make such decisions.

Objectives

This study characterizes older adults' cognitive decision-making process when seeking to self-medicate with OTCs from their community pharmacy, and demonstrates how hierarchical task analysis (HTA) can be used to evaluate a pharmacy intervention's impact on their decision-making.

Methods

A pre-/post-implementation approach, using a think-aloud interview process, was conducted with older adults within a community pharmacy setting as they completed a hypothetical scenario to treat either pain, sleep, or cough/cold/allergy symptoms. HTA developed a conceptualization of older adult decision-making regarding OTC selection and use before/after Senior Section implementation.

Results

An HTA constructed from 12 purposefully-selected interviews (pre-n = 9/post-n = 3), consisting of 8 goals/15 sub-goals. While selecting an OTC, older adults considered quantity, cost, form, regimen, safety, strength, appropriateness of OTC safety, generic/name-brand, past experiences, and ingredients. The intervention reduced by half the number of factors considered.

Implications

Older adult decision-making is more complex than just selecting OTC medication from a pharmacy shelf. HTA-informed decision profiles can provide pharmacists critical insights into safety issues that older adults may not be considering (e.g., factors related to safety, strength, or appropriateness of OTC for symptoms) so that pharmacists can support their decision-making.

中文翻译：

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利用认知工程方法进行分层任务分析，以了解在非处方药选择过程中复杂的老年人决策

背景

65 岁以上的成年人（老年人）不成比例地消耗了 30% 的非处方 (OTC) 药物，并且在很大程度上负责做出 OTC 治疗决定，因为提供者缺乏对他们消费的认识。这些治疗决策很复杂：在选择正确的非处方药时，老年人必须应对与年龄相关的身体/认知变化、合并症和复杂的药物治疗方案。然而，人们对老年人如何做出此类决定知之甚少。

目标

本研究描述了老年人在寻求使用社区药房的非处方药进行自我治疗时的认知决策过程，并展示了如何使用分层任务分析 (HTA) 来评估药房干预对其决策的影响。

方法

实施前/实施后方法，使用有声思考的访谈过程，在社区药房环境中对老年人进行，因为他们完成了治疗疼痛、睡眠或咳嗽/感冒/过敏症状的假设情景。HTA 在高级部门实施之前/之后开发了关于 OTC 选择和使用的老年人决策的概念化。

结果

由 12 个有目的地选择的访谈（pre-n = 9/post-n = 3）构成的 HTA，包含 8 个目标/15 个子目标。在选择 OTC 时，老年人考虑了数量、成本、形式、方案、安全性、强度、OTC 安全性的适当性、通用/名牌、过去的经验和成分。干预将考虑的因素数量减少了一半。

启示

老年人的决策比仅仅从药房货架上选择非处方药要复杂得多。HTA 知情决策概况可以为药剂师提供对老年人可能没有考虑的安全问题的重要见解（例如，与安全性、强度或 OTC 对症状的适当性相关的因素），以便药剂师可以支持他们的决策。