Drugs, distrust and dialogue –a focus group study with Swedish GPs on discharge summary use in primary care

Caleres, Gabriella; Strandberg, Eva Lena; Bondesson, Åsa Åb; Midlöv, Patrik; Modig, Sara

doi:10.1186/s12875-018-0804-8

Cited by 18 publications

(19 citation statements)

References 24 publications

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“…Our findings have been consistent with existing literature, particularly in terms of the key role of discharge communication in patient safety 4,8-10 and coordination of healthcare services 45,46 , underlining the need for improvement in terms of quality and consistency 6,13,29,47 . Further to this, a more holistic understanding of a typical NHS discharge communication system has been uncovered and drawn together, contributing clarity to the challenge of how discharge communication might be improved.…”

Section: Comparison With Existing Literaturesupporting

confidence: 90%

How can communication to GPs at hospital discharge be improved? A systems approach

et al. 2021

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BackgroundPoor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries commonly written by the most junior doctors. Previous quality improvement efforts have largely focused on adherence to standardised templates, with limited success. A lack of understanding has been identified as a cause of the issue’s resistance to decades of improvement work.AimTo understand the system of communication to GPs at hospital discharge, with a view to identifying potential routes to improvement.Design, SettingA qualitative exploration of the secondary-to-primary care communication system surrounding a UK tertiary hospital.MethodA ‘systems approach’, recently defined for the healthcare domain, was used to structure and thematically analyse interviews (n=18) of clinical and administrative staff from both sides of the primary-secondary care interface and a subsequent focus group.ResultsThe largely one-way communication system structure and the low level of hospital stakeholder insight into recipient GP needs emerged as consistent hindrances to system performance. More open lines of communication and shared records might enable greater collaboration to share feedback and resolve informational deficits. Teaching sessions and assessments for medical students and junior doctors led by GPs could help to instil the importance of detail and nuance when using standardised communication templates.ConclusionFacilitating the sharing of performance insights between stakeholder groups emerged as the key theme of how communication might be improved. The empirical measures proposed have the potential to mitigate the safety risks of key barriers to performance, such as patient complexity.

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Section: Comparison With Existing Literaturesupporting

confidence: 90%

How can communication to GPs at hospital discharge be improved? A systems approach

et al. 2021

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“…The importance of an adequate discharge summary medication list may be disputed for these patients because drug changes also should be carried out in the electronic MDD system. However, in a previous study by our research group, general practitioners stressed the lack of such changes being performed during hospitalisation [17]. Accordingly, these patients are at risk of having no accurate medication information, as are the general practitioners in primary care.…”

Section: Discussionmentioning

confidence: 85%

“…Preventing medication errors is heavily dependent on the discharge summary, which is commonly the only medication information a primary care patient receives after hospital discharge. Accordingly, its accuracy is crucial to enable smooth care transitions, but is often deficient according to primary care clinicians and previous studies [16,17]. However, many studies include only a small sample of patients and have not focused solely on the elderly who are at a particular risk of re-admission and adverse outcomes after hospital discharge [18,19].…”

Section: Methodsmentioning

confidence: 99%

Medication Discrepancies in Discharge Summaries and Associated Risk Factors for Elderly Patients with Many Drugs

Caleres

Modig

Midlöv

et al. 2019

Drugs - Real World Outcomes

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Background and Objective Elderly patients are at high risk for medication errors in care transitions. The discharge summary aims to counteract drug-related problems due to insufficient information transfer in care transitions, hence the accuracy of its medication information is of utmost importance. The purpose of this study was to describe the medication discrepancy rate and associated risk factors in discharge summaries for elderly patients. Methods Pharmacists collected random samples of discharge summaries from ten hospitals in southern Sweden. Medication discrepancies, organisational, and patient-and care-specific factors were noted. Patients aged ≥ 75 years with five or more drugs were further included. Descriptive and logistic regression analyses were performed. Results Discharge summaries for a total of 933 patients were included. Average age was 83.1 years, and 515 patients (55%) were women. Medication discrepancies were noted for 353 patients (38%) (mean 0.87 discrepancies per discharged patient, 95% confidence interval 0.76-0.98). Unintentional addition of a drug was the most common discrepancy type. Central nervous system drugs/analgesics were most commonly affected. Major risk factors for the presence of discrepancies were multi-dose drug dispensing (adjusted odds ratio 3.42, 95% confidence interval 2.48-4.74), an increasing number of drugs in the discharge summary (adjusted odds ratio 1.09, 95% confidence interval 1.05-1.13) and discharge from departments of surgery (adjusted odds ratio 2.96, 95% confidence interval 1.55-5.66). By contrast, an increasing number of drug changes reduced the odds of a discrepancy (adjusted odds ratio 0.93, 95% confidence interval 0.88-0.99). Conclusions Medication discrepancies were common. In addition, we identified certain circumstances in which greater vigilance may be of considerable value for increased medication safety for elderly patients in care transitions.

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“…Previous studies do, however, show that discharge summaries are often lacking in content and quality [49,50] as is the transfer of these to the next caregiver [50]. Even though the discharge summary, medication report and medications list are considered to be helpful to the GPs, their use of the information provided is often lacking due to the uneven quality as well as the discrepancies found in the medications lists included [49][50][51]. These deficits lead to risks of medication errors and ADEs for older patients in transitions of care [49,52] and could be part of the reason as to why older adults living in the community with home care have increased odds of readmission as compared to those living in nursing homes.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for hospital readmission in older adults within 30 days of discharge – a comparative retrospective study

Glans

Ekstam²,

Jakobsson

et al. 2020

BMC Geriatr

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Background The area of hospital readmission in older adults within 30 days of discharge is extensively researched but few studies look at the whole process. In this study we investigated risk factors related, not only to patient characteristics prior to and events during initial hospitalisation, but also to the processes of discharge, transition of care and follow-up. We aimed to identify patients at most risk of being readmitted as well as processes in greatest need of improvement, the goal being to find tools to help reduce early readmissions in this population. Methods This comparative retrospective study included 720 patients in total. Medical records were reviewed and variables concerning patient characteristics prior to and events during initial hospital stay, as well as those related to the processes of discharge, transition of care and follow-up, were collected in a standardised manner. Either a Student’s t-test, χ2-test or Fishers’ exact test was used for comparisons between groups. A multiple logistic regression analysis was conducted to identify variables associated with readmission. Results The final model showed increased odds of readmission in patients with a higher Charlson Co-morbidity Index (OR 1.12, p-value 0.002), excessive polypharmacy (OR 1.66, p-value 0.007) and living in the community with home care (OR 1.61, p-value 0.025). The odds of being readmitted within 30 days increased if the length of stay was 5 days or longer (OR 1.72, p-value 0.005) as well as if being discharged on a Friday (OR 1.88, p-value 0.003) or from a surgical unit (OR 2.09, p-value 0.001). Conclusion Patients of poor health, using 10 medications or more regularly and living in the community with home care, are at greater risk of being readmitted to hospital within 30 days of discharge. Readmissions occur more often after being discharged on a Friday or from a surgical unit. Our findings indicate patients at most risk of being readmitted as well as discharging routines in most need of improvement thus laying the ground for further studies as well as targeted actions to take in order to reduce hospital readmissions within 30 days in this population.

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Drugs, distrust and dialogue –a focus group study with Swedish GPs on discharge summary use in primary care

Cited by 18 publications

References 24 publications

How can communication to GPs at hospital discharge be improved? A systems approach

How can communication to GPs at hospital discharge be improved? A systems approach

Medication Discrepancies in Discharge Summaries and Associated Risk Factors for Elderly Patients with Many Drugs

Risk factors for hospital readmission in older adults within 30 days of discharge – a comparative retrospective study

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