- 23 June 2021
Congratulations on this great work! I really enjoyed the video and thought it outlined the components of the project really nicely. Can you tell us a bit more about what the root cause analysis revealed and how the findings align with the development of the website? Consider whether the graphs should have two medians, one calculated with the baseline data and one calculated with the post intervention data once an adequate number of data points is achieved. By initially extending the baseline median (often displayed with a dotted line), you could use SPC to determine whether you have special cause variation. Your future plans sound great. Now that the pandemic is (hopefully) waning, the team can continue with future PDSA plans.
- 25 June 2021
The video was excellent at explaining the project. I agree Marie- how does the website specifically address what you found in the root cause analysis for why adherence is low? The website seems to be focused on education about the medications, how and why to take them- but is adherence low to these medications because of a lack of education? Also agree that it would be good to look for special cause variation- was it the website that worked or the fact that healthcare provider took extra time to explain the importance of the medications when they provided patients with the website information? Overall looks like a great project with lots of potential!
- 17 August 2021
Thank you both very much for your time in watching the video and interest in this project! My apologies for the late response. Our root cause analysis was a survey of both patients and practitioners who commonly prescribe TXA and oral iron for women with HMB. For TXA, we found that common themes for low adherence included 1) need to take a minimum of two large tablets three times per day during bleeding, 2) premature cessation of TXA due to the perception that it is interfering with “normal” blood loss, 3) high cost of oral TXA, 4) misunderstanding or lack of mastery with dose and frequency titration to produce optimal effects, 5) common side effects such as nausea, diarrhea, and headache, 6) patient concern regarding the potential thromboembolic risk of TXA, and 7) concern regarding potential synergistic thromboembolic risk with TXA and estrogen based therapies. For oral iron, common themes included 1) difficulty managing gastrointestinal side effects, 2) not taking iron on an empty stomach or with an acidic food/beverage, 3) cessation of therapy once energy is improved despite still having low iron stores, 4) forgetting to take oral iron pills, and 5) high cost of polysaccharide and heme-based oral iron supplements. Thus lack of education on how to properly take the medications and manage side effects was certainly a barrier. Cost and bill burden was another issue and we attempted to at least provide cost transparency in our website so that patients would have that information readily available. Otherwise, yes, the main focus was on patient education to provide clarification on themes that arose from the root cause analysis. Thank you both also for the suggestions to use separate baseline and post-intervention medians and also look for special cause variation - those are fantastic ideas that we would love to incorporate!!