Comprehensive medication reviews by ward‐based pharmacists in Swedish hospitals: What does the patient have to say?

Abstract

Rationale, aims, and objectives: Inappropriate medication prescribing and use amongst older patients is a major patient safety and health care problem. To promote appropriate medication prescribing and use, comprehensive medication reviews (CMRs) by ward-based pharmacists, including follow-up telephone calls after hospital discharge, have been conducted in older patients in the context of a randomized controlled trial (RCT). One of the key actors in a CMR is the patient. To support the understanding of the effects of CMRs on patients' health outcomes and improve clinical practice, knowledge about the patient perspective is needed. We therefore aimed to explore older patients' experiences with, and views on, hospital-initiated CMRs and follow-up telephone calls by ward-based clinical pharmacists within an RCT. Methods:We conducted in-depth semi-structured interviews with 15 patients (66-94 years) and carers from four hospitals in Sweden. Discussion topics included communication, information, decision-making, and effects on the patient. Interviews took place after discharge, were audio-recorded, transcribed verbatim, and thematically analysed using a framework approach. Results: In general, patients' experiences and views were positive. Seven key themes were identified: (a) feeling of being taken care of and heterogenous health effects; (b) the pharmacist is competent; (c) despite the unclear role of pharmacists, their involvement is appreciated; (d) patients rely on health care professionals for decision-making; (e) importance of being informed, but receiving and retaining information is problematic; (f) time, location, and other factors influencing the effectiveness of CMRs; and (g) generic substitution is a problem. Conclusions: Older patients generally have positive experiences with and views on CMRs and follow-up telephone calls. However, some factors, like the unclear role of the ward-based pharmacist and problems with receiving and retaining information, may negatively impact the effectiveness of these interventions. Future initiatives on hospital-initiated CMRs by clinical pharmacists should address these negative factors and utilize the positive views. KEYWORDS clinical pharmacists, health services for the aged, interdisciplinary health team, patient involvement, qualitative research, review, drug utilization

Facilitators and barriers for performing comprehensive medication reviews and follow-up by multiprofessional teams in older hospitalised patients

“…Having pharmacists structurally participate in medical ward rounds may facilitate collaboration. These findings also corroborate our previous research on patient experience with and views on the interventions in the MedBridge trial [25]. Patients valued physicianpharmacist collaboration and the pharmacists' knowledge and competence, but a lack of understanding about the CMR process and role of the pharmacist may decrease the interventions' effectiveness.…”

“…However, it was questioned whether hospital is the most suitable setting to conduct CMRs. Patients may be too ill and not willing to be involved in the CMR process during hospitalisation [25]. Our findings also show that specialist physicians at internal medicine wards may not consider CMRs their responsibility and refer to primary care.…”

“…We previously explored older patients' experiences with, and views on, hospital-initiated CMRs and follow-up calls by ward-based pharmacists, as part of a process evaluation of the MedBridge trial [25]. Older patients generally had positive experiences and views.…”

Intervention fidelity and process outcomes of medication reviews including post‐discharge follow‐up in older hospitalized patients: Process evaluation of the MedBridge trial

“…10 Two qualitative studies using interviews with patients and carers 11 and healthcare professionals 12 negatively impact effectiveness of the trial's interventions. 11,12 Assessing intervention fidelity, that is the consistency of the performed interventions with the planned interventions, 10 and intermediate process outcomes, like identified discrepancies and DRPs within a CMR, 13 can provide complementary knowledge. This study therefore aimed to assess the intervention fidelity and process outcomes of CMRs including post-discharge follow-up, as part of a process evaluation of the MedBridge trial.…”

“…12 Patient interviews indicated little patient involvement during hospital stay. 11 Failure to involve patients at discharge and ensure appropriate follow-up on treatment changes may lead to the introduction of new DRPs. 15,16 Pharmacists mentioned not being used to send referrals and preferred to add their recommendations to a referral sent by the ward physician to the GP.…”