Polypharmacy and continuity of care: medicines optimisation in the era of multidisciplinary teams

Tarrant, Carolyn; Lewis, Rachel; Armstrong, Natalie

doi:10.1136/bmjqs-2022-015082

Cited by 9 publications

(5 citation statements)

References 15 publications

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“…Patients with polypharmacy, 17 mental health issues 15 and those aged 65 and older 18 benefit more from relational continuity. Conversely, quicker access to care is traded‐off against continuity of care most by younger patients; men aged 17–45 and women aged 17–35 19 .…”

Section: Methodsmentioning

confidence: 99%

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Investigating the impact of primary care networks on continuity of care in English general practice: Analysis of interviews with patients and clinicians from a mixed methods study

Goff,

Jacobs,

Hammond

et al. 2024

Health Expectations

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IntroductionIn England, primary care networks (PCNs) offer opportunities to improve access to and sustainability of general practice through collaboration between groups of practices to provide care with a broader range of practitioner roles. However, there are concerns that these changes may undermine continuity of care. Our study investigates what the organisational shift to PCNs means for continuity of care.MethodsThe paper uses thematic analysis of qualitative data from interviews with general practitioners and other healthcare professionals (HCPs, n = 33) in 19 practices in five PCNs, and their patients (n = 35). Three patient cohorts within each participating practice were recruited, based on anticipated higher or lower needs for continuity of care: patients over 65 years with polypharmacy, patients with anxiety or depression and ‘working age’ adults aged between 18 and 45 years.FindingsPatients and clinicians perceived changes to continuity in PCNs in our study. Larger‐scale care provision in PCNs required better care coordination and information‐sharing processes, aimed at improving care for ‘vulnerable’ patients in target groups. However, new working arrangements and ways of delivering care in PCNs undermine HCPs' ability to maintain continuity through ongoing relationships with patients. Patients experience this in terms of reduced availability of their preferred clinician, inefficiencies in care and unfamiliarity of new staff, roles and processes.ConclusionsNew practitioners need to be effectively integrated to support effective team‐based care. However, for patients, especially those not deemed ‘vulnerable’, this may not be sufficient to counter the loss of relationship with their practice. Therefore, caution is required in relation to designating patients as in need of, or not in need of continuity. Rather, continuity for all patients could be maintained through a dynamic understanding of the need for it as fluctuating and situational and by supporting clinicians to provide follow‐up care.Patient and Public Involvement (PPI)A PPI group was recruited and consulted during the study for feedback on the study design, recruitment materials and interpretation of findings.

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Section: Methodsmentioning

confidence: 99%

“…Patients with polypharmacy, 17 mental health issues 15 and those aged 65 and older 18 benefit more from relational continuity.…”

Section: Data Collectionmentioning

confidence: 99%

Investigating the impact of primary care networks on continuity of care in English general practice: Analysis of interviews with patients and clinicians from a mixed methods study

Goff,

Jacobs,

Hammond

et al. 2024

Health Expectations

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“…This role requires effective collaboration with GPs and other health professionals. Despite this need for collaboration, little is known about the factors related to effective collaboration between the pharmacist and other general practice staff members [ 1 , 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Interprofessional collaboration within general practice teams following the inclusion of non-dispensing pharmacists

Sudeshika

Deeks

Naunton

et al. 2023

J of Pharm Policy and Pract

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Background Pharmacists have been included in general practice teams to provide non-dispensing services in the Australian Capital Territory (ACT) since 2016. Interprofessional collaboration and team effectiveness are key considerations in providing high-quality patient care. These concepts have not been well studied following the inclusion of a pharmacist in general practice teams. Methods A mixed methods study was conducted to explore collaboration between pharmacists and health professionals in eight general practices in the ACT, where pharmacists were included in their teams. A validated survey instrument was adapted and utilised to assess the changes in interprofessional collaboration over time following the addition of a pharmacist. Another validated survey was utilised to explore team effectiveness at the end of the study. Semi-structured interviews, with a thematic analysis, were conducted with a purposeful sample of general practice staff members to understand the factors influencing the development of interprofessional collaboration. Results In total, 56 and 41 participants completed the baseline and follow-up survey, including 26 who completed both surveys to assess the change in collaboration over time. Interprofessional collaboration scores were high initially and did not change over time. Team effectiveness was also high at the end of the study. Twenty-one individuals participated in interviews, which generated four main interrelated themes related to interprofessional collaboration: professional working relationships, trust, commitment to collaboration, and barriers to collaboration. Trust was integral to professional working relationships and commitment to collaboration. The barriers to collaboration included not having a role description for pharmacists, inadequate interest to initiate working relationships, lack of dedicated time for interaction, lack of utilisation, and poor awareness of pharmacist-led activities in general practice. Conclusion Interprofessional collaboration was initially high and not influenced by the addition of a pharmacist, perhaps reflecting the inherent nature of the general practices willing to include a pharmacist within their team. Introducing a clear job description for pharmacists, and dedicating time to interact with pharmacists, could be beneficial in improving trust and professional working relationships and enhancing collaboration between the pharmacists and other general practice team members.

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“…The intention was to secure safe and optimised pharmacotherapy in every care setting by performing repeated medication reconciliations, reviews and assisting in communication between care settings. The intervention would also be in line with recommendations for continuity of healthcare providers in coordination of medication management with multidisciplinary teams [27,28]. Previous studies have included clinical pharmacists in discharge management and care transitions, which resulted in optimised medication information and reduced discrepancies [11,[29][30][31][32].…”

Section: Introductionmentioning

confidence: 99%

Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial

et al. 2023

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Background Hip fracture patients face a patient safety threat due to medication discrepancies and adverse drug reactions when they have a combination of high age, polypharmacy and several care transitions. Consequently, optimised pharmacotherapy through medication reviews and seamless communication of medication information between care settings is necessary. The primary aim of this study was to investigate the impact on medication management and pharmacotherapy. The secondary aim was to evaluate implementation of the novel Patient Pathway Pharmacist intervention for hip fracture patients. Methods Hip fracture patients were included in this nonrandomised controlled trial, comparing a prospective intervention group (n = 58) with pre-intervention controls who received standard care (n = 50). The Patient Pathway Pharmacist intervention consisted of the steps: (A) medication reconciliation at admission to hospital, (B) medication review during hospitalisation, (C) recommendation for the medication information in the hospital discharge summary, (D) medication reconciliation at admission to rehabilitation, and (E) medication reconciliation and (F) review after hospital discharge. The primary outcome measure was quality score of the medication information in the discharge summary (range 0–14). Secondary outcomes were potentially inappropriate medications (PIMs) at discharge, proportion receiving pharmacotherapy according to guidelines (e.g. prophylactic laxatives and osteoporosis pharmacotherapy), and all-cause readmission and mortality. Results The quality score of the discharge summaries was significantly higher for the intervention patients (12.3 vs. 7.2, p < 0.001). The intervention group had significantly less PIMs at discharge (− 0.44 (95% confidence interval − 0.72, − 0.15), p = 0.003), and a higher proportion received prophylactic laxative (72 vs. 35%, p < 0.001) and osteoporosis pharmacotherapy (96 vs. 16%, p < 0.001). There were no differences in readmission or mortality 30 and 90 days post-discharge. The intervention steps were delivered to all patients (step A, B, E, F = 100% of patients), except step (C) medication information at discharge (86% of patients) and step (D) medication reconciliation at admission to rehabilitation (98% of patients). Conclusion The intervention steps were successfully implemented for hip fracture patients and contributed to patient safety through a higher quality medication information in the discharge summary, fewer PIMs and optimised pharmacotherapy. Trial registration: NCT03695081.

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Polypharmacy and continuity of care: medicines optimisation in the era of multidisciplinary teams

Cited by 9 publications

References 15 publications

Investigating the impact of primary care networks on continuity of care in English general practice: Analysis of interviews with patients and clinicians from a mixed methods study

Investigating the impact of primary care networks on continuity of care in English general practice: Analysis of interviews with patients and clinicians from a mixed methods study

Interprofessional collaboration within general practice teams following the inclusion of non-dispensing pharmacists

Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial

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