Older patient and family discharge medication communication: A mixed‐methods study

Abstract

Rationale, aims, and objectives Medication discrepancies place patients discharged from hospital at risk of adverse medication events. Patient and family participation in medication communication may improve medication safety. This study aimed to examine older medical patient and family participation in discharge medication communication. Methods Two‐phased mixed‐methods study. Data were collected from July 2018 to May 2019. Phase 1 comprised observations and a questionnaire of 30 patients pre‐hospital discharge. Phase 2 involved telephone interviews with 11 patients and family members post‐hospital discharge. Phase 1 analysis included descriptive statistics and deductive content analysis. Inductive content analysis was used in Phase 2. Phase 1 and 2 findings were integrated. Results For Phase 1, observational data were deductively coded against the “continuum of patient participation”; information‐giving was the most frequent level of participation observed on the continuum, followed by information‐seeking, shared decision making, non‐involved, and finally autonomous decision making. For descriptive statistics, written communication tools, noise, and interruptions were frequently observed during medication communication. In Phase 2, three categories were found about how patients and families participate, and the factors influencing their participation: (a) obtaining comprehensive medication information; (b) preferred approaches for receiving information; and (c) speaking about medications in hospital. Integrated findings showed that written communication tools and routine hospital tasks may promote, while lack of family presence and environmental factors may hinder medication communication. Patients' and families' role in medication communication ranged from asking questions to influencing decisions, and was enhanced by health care professionals' patient‐centred communication. Conclusions More active patient and family participation could be achieved by encouraging them to identify medication‐related problems. To create a climate for patient and family participation, health care professionals should use written communication tools, capitalize on participation opportunities during routine hospital tasks, and use patient‐centred communication.

Towards patient‐centred communication in the management of older patients' medications across transitions of care: A focused ethnographic study

“…There has also been limited research investigating different health professionals' approaches to patient‐centred medication communication (Ozavci et al, 2020 ). Past studies have involved focusing on a single transition point such as discharge (Allen et al, 2018 ; Rognan et al, 2021 ; Tobiano et al, 2021 ), or on interactions with a single health professional group such as patient‐pharmacist interactions (Braaf et al, 2015 ) or patient‐doctor interactions (Kripalani et al, 2007 ). Additionally, little attention has been placed on exploring discourses used by health professionals and older patients during medication interactions.…”

Health professionals’ perspectives of patients’ and family members’ needs in emergency departments and patient pathway improvement: a qualitative study in Denmark

“…The involvement of family members in discharge information, such as medication and treatment adherence, has been acknowledged globally as a factor in improving patient outcomes. 13 14 Moreover, family inclusion and partnership in care strengthen patients’ readiness for discharge. 6 This is particularly important for patients with brief hospital stays, in which there is little time for HCPs to prepare patients for discharge.…”

“…The involvement of family members in discharge information, such as medication and treatment adherence, has been acknowledged globally as a factor in improving patient outcomes 13 14. Moreover, family inclusion and partnership in care strengthen patients’ readiness for discharge 6.…”

Caregivers' experiences of medication management advice for people living with dementia at discharge

“…However, care transitions at discharge can be challenging for patients and their caregivers and a vulnerable stage in the patient pathway 17‐19 . Studies have reported that caregivers experience poor communication about medication plans and changes in medications, limited opportunities to participate in medication decisions and difficulties in following complicated medication regimens 12,20‐24 . To date, there has been a limited focus on caregivers' experience of medication management advice for people with dementia and factors that influence caregiver participation in medication plans specifically at discharge 20‐22 …”