A systematic review of older patients’ experiences and perceptions of communication about managing medication across transitions of care

Abstract

Background Communication about managing medications may be difficult when older people move across transitions of care. Communication breakdowns may result in medication discrepancies or incidents. Objective The aim of this systematic review was to explore older patients' experiences and perceptions of communication about managing medications across transitions of care. Design A systematic review Methods A comprehensive review was conducted of qualitative, quantitative and mixed method studies using CINAHL Complete, MEDLINE, Embase and PsycINFO, Web of Science, INFORMIT and Scopus. These databases were searched from inception to 14.12.2018. Key article crosschecking and hand searching of reference lists of included papers were also undertaken. Inclusion criteria: studies of the medication management perspectives of people aged 65 or older who transferred between care settings. These settings comprised patients' homes, residential aged care and acute and subacute care. Only English language studies were included. Comments, case reports, systematic reviews, letters, editorials were excluded. Thematic analysis was undertaken by synthesising qualitative data, whereas quantitative data were summarised descriptively. Methodological quality was assessed with the Mixed Methods Appraisal Tool. Results The final review comprised 33 studies: 12 qualitative, 17 quantitative and 4 mixed methods studies. Twenty studies addressed the link between communication and medication discrepancies; ten studies identified facilitators of self-care through older patient engagement; 18 studies included older patients' experiences with health professionals about their medication regimen; and, 13 studies included strategies for communication about medications with older patients. Poor communication between primary and secondary care settings was reported as a 2 reason for medication discrepancy before discharge. Older patients expected ongoing and tailored communication with providers and timely, accurate and written information about their medications before discharge or available for the post-discharge period. Conclusions Communication about medications was often found to be ineffective. Most emphasis was placed on older patients' perspectives at discharge and in the post-discharge period. There was little exploration of older patients' views of communication about medication management on admission, during hospitalisation, or transfer between settings.

How to reduce medication errors in patients over the age of 65?

“…Patients should be encouraged to participate actively. The easiest thing is to listen to them, and even then, it is not always done [32]. The following is to allow them to participate in the design of proposals that help other patients avoid MEs at home.…”

Interprofessional and Intraprofessional Communication about Older People’s Medications across Transitions of Care

“…Recent research examining medication management across transitions of care has focused on medication incidents [ 3 , 8 ], pharmacist-led interventions [ 9 , 10 , 11 , 12 ] and patient and family perspectives [ 13 , 14 ]. Research also identifies communication breakdowns contributing to medication incidents across transitions [ 15 , 16 ]; yet, little is known about what influences how health professionals communicate with each other to manage medications and avoid potential breakdowns in communication across transitions.…”

Empowering the patient? Medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway

“…Effective communication and patient empowerment before hospital discharge are important steps to ensure medication safety. [1][2][3][4] Patients discharged from hospitals are often expected to assume selfmanagement, frequently without healthcare personnel (HCP) having ensured patients' knowledge, motivation and/or skills. [5][6][7][8][9][10] Over the last decades, healthcare systems have shifted focus from the conventional (biomedical) way of practising medicine to an ambition to become involved in the full range of difficulties that patients experience (biopsychosocial model and patient-centred care, PCC), thus covering a larger picture than purely the biological factors.…”

“…7 8 In this shift, patients are expected to move from the traditional, passive role, towards being more involved and participating in planning and decision-making regarding their health and treatment. 7 In this study, we defined medication communication in accordance with Ozavci et al, 3 that is, verbal and non-verbal exchange and understanding of information about the Strengths and limitations of this study ► We combined real-time observations and patient interviews, which is a powerful approach to understand and describe what happened. ► The sample size is limited; however, as the analysis had a specific aim, with full observations and rich interview data, the information power is high.…”

“…In this study, we defined medication communication in accordance with Ozavci et al , 3 that is, verbal and non-verbal exchange and understanding of information about the treatment, focusing on medications, between patients, patients’ next of kin and any HCP attending to the patient.…”