More than a fleeting conversation: managing medication communication across transitions of care

Manias, Elizabeth; Hughes, Carmel; Woodward‐Kron, Robyn; Jorm, Christine; Ozavci, Guncag; Bucknall, Tracey

doi:10.5694/mja2.51651

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…Previous research suggests that conversations with patients with complex medications tended to be brisk, one-way and controlled by healthcare professionals. 27 This can be due to traditional cultures of healthcare professionals leading care. 28 Researchers suggest that another reason that pharmacist interactions tended to be rushed was due to the high flow of patients being discharged, and doctors and nurses had limited discharge medication communication with patients due to time constraints and multitasking.…”

Section: Discussionmentioning

confidence: 99%

“…We found healthcare professionals were taking the initiative to start topics when patients were at high risk of medication-related problems; however, these conversations were largely monologues. Previous research suggests that conversations with patients with complex medications tended to be brisk, one-way and controlled by healthcare professionals 27. This can be due to traditional cultures of healthcare professionals leading care 28.…”

Section: Discussionmentioning

confidence: 99%

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Older patient participation in discharge medication communication: an observational study

et al. 2023

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ObjectiveTo describe the extent to which older patients participate in discharge medication communication, and identify factors that predict patient participation in discharge medication communication.DesignObservational study.SettingAn Australian metropolitan tertiary hospital.Participants173 older patients were observed undertaking one medication communication encounter prior to hospital discharge.OutcomePatient participation measured with MEDICODE, a valid and reliable coding framework used to analyse medication communication. MEDICODE provides two measures for patient participation: (1) Preponderance of Initiative and (2) Dialogue Ratio.ResultsThe median for Preponderance of Initiative was 0.7 (IQR=0.5–1.0) and Dialogue Ratio was 0.3 (IQR=0.2–0.4), indicating healthcare professionals took more initiative and medication encounters were mostly monologue rather than a dialogue or dyad. Logistic regression revealed that patients had 30% less chance of having dialogue or dyads with every increase in one medication discussed (OR 0.7, 95% CI 0.5 to 0.9, p=0.01). Additionally, the higher the patient’s risk of a medication-related problem, the more initiative the healthcare professionals took in the conversation (OR 1.5, 95% CI 1.0 to 2.1, p=0.04).ConclusionOlder patients are passive during hospital discharge medication conversations. Discussing less medications over several medication conversations spread throughout patient hospitalisation and targeting patients at high risk of medication-related problems may promote more active patient participation, and in turn medication safety outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Older patient participation in discharge medication communication: an observational study

et al. 2023

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“…Health literacy can be defned as individuals having the necessary skills, knowledge and motivation to access, and understand and apply health information when making decisions about their (or their family member's) care [45]. In addition, discussions among health care professionals, residents, and family members about medications, particularly during transitions of care, e.g., admission to an RACF, are an important mechanism to support residents and family members in having the necessary information to make informed medication management decisions [46].…”

Section: Discussionmentioning

confidence: 99%

Exploration of an On-Site Pharmacist Intervention within Australian Residential Aged Care Facilities Using Normalisation Process Theory: A Mixed-Methods Study

Batten,

Kosari,

Lewis

et al. 2023

Health & Social Care in the Community

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Residents living in residential aged care facilities (RACFs) continue to experience medication-related harm. There is ongoing interest in expanding the role of pharmacists, including on-site pharmacists (OSPs), to help improve medication management in RACFs. The objectives of this mixed-methods study were to explore the extent and ways in which on-site pharmacists (OSPs) were normalised within RACFs as part of a complex intervention seeking to improve medication management. This study consisted of semistructured interviews informed by normalisation process theory (NPT) and a quantitative survey adapted from the normalisation measure development questionnaire (NoMAD) instrument which is underpinned by NPT. Semistructured interviews with prescribers, RACF managers, RACF nursing staff, OSPs, residents, and family members (n = 47) indicated that most participants supported OSPs within RACFs that having OSPs in RACFs made sense and was perceived as beneficial and that participants were invested in working with OSPs who often became part of routine practice, i.e., “normalised.” Prescribers, RACF managers, and nursing staff (health care team members) completed the adapted survey, and their responses (n = 16) strongly complemented the positive qualitative findings. Overall, OSPs were positively appraised by health care team members as well as residents and family members and were generally considered to be normalised within their respective RACFs. This study explored the normalisation of OSPs within RACFs. From the perspective of residents, family members, health care team members, and OSPs, OSPs could become part of routine practice within Australian RACFs. The findings of this study also highlighted the value of using theory to guide the evaluation of a pharmacist intervention in RACFs and the utility of applying NPT in a new setting, Australian RACFs. Importantly, the findings of this study could help inform the future role of OSPs working and the rollout of OSPs within Australian RACFs.

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“…Fragmentation in health care is frustrating for consumers and providers (CHFA 2022;Joo 2023). It increases pressure on the system due to unnecessary repetition of tests, duplication of care and greater potential for communication errors (Manias et al 2017(Manias et al , 2022. Duckett (2015) has suggested that 'making existing health services work well together would be the greatest step to sustainability' without a reduction in output or services.…”

Section: Challengesmentioning

confidence: 99%

Simplifying, Innovating, and Collaborating: Educating the Health Workforce for Medicare's Middle‐age

Brock,

Davidson,

Molloy

2024

Australian Economic Review

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Australia's Medicare is at a mid‐life reflection point. This is not a moment for existential dread or rash actions. Instead, it is a time for age‐related improvement. Middle‐aged Medicare would benefit from policy that reflects the benefits of subtractive change to reduce its complexity. In addition, policies prioritising the use of data science to enact technologically innovative approaches would improve overall flexibility. Finally, policy can play an important role in strengthening connections between health profession cadres, incentivising them to work together at the top of scope. With education, practice, and policy collaborating, we can enable Medicare's wellbeing for years to come.

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More than a fleeting conversation: managing medication communication across transitions of care

Cited by 3 publications

References 12 publications

Older patient participation in discharge medication communication: an observational study

Older patient participation in discharge medication communication: an observational study

Exploration of an On-Site Pharmacist Intervention within Australian Residential Aged Care Facilities Using Normalisation Process Theory: A Mixed-Methods Study

Simplifying, Innovating, and Collaborating: Educating the Health Workforce for Medicare's Middle‐age

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