Development and initial validation of MedHipPro-Q: a questionnaire assessing medication management of hip fracture patients in different care settings

Abstract

Background A validated questionnaire to assess medication management of hip fracture patients within and outside the hospital setting was lacking. The study aims were to describe the hip fracture patient pathway, and develop a valid and feasible questionnaire to assess clinicians’ experience with medication management of hip fracture patients in different care settings throughout the patient pathway. Methods This qualitative, descriptive methodological study used strategic and snowball sampling. The questionnaire was developed, and face and content validity explored through interviews with stakeholders. Phase I described the hip fracture patient pathway, and identified questionnaire dimensions in semi-structured interviews with management and clinicians (n = 37). The patient pathway was also discussed in six meetings (n = 70). Phase II refined a first draft of the questionnaire through cognitive interviews with future respondents (n = 23). The draft was modified after each interview. Post hoc, cognitive interview data were analysed using matrix analysis to condense problems and solutions into themes and subthemes. Phase III, converted the final version to a digital format, and tested its feasibility with a subset of the cognitive interview participants (n = 21) who completed the questionnaire and provided feedback. Results Phase I: Hip fracture patients were cared for in at least three different care settings, and went through at least four handovers between and within primary and secondary care. Three questionnaire dimensions were identified: 1) Medication reconciliation and review, 2) Communication of key information, and 3) Profession and setting. Phase II: The MedHipPro-Q was representative of how the different professions experienced medication management in all settings, and hence showed face and content validity. Post hoc analysis: Problem themes (with sub-themes) were Representativeness (-of patient pathway and -of respondent reality) and Presentation (Language and Appearance). Solution themes (with sub-themes) were: Content (added or deleted) and Presentation (modified appearance or corrected language). Phase III: Participants did not identify technical, linguistic or content flaws in the questionnaire, and the digital version was considered feasible for use. Conclusion The novel MedHipPro-Q showed good face and content validity, and was feasible for use throughout the hip fracture patient pathway. The rigorous development process supports its construct validity and reliability.

Medication management for patients with hip fracture at a regional hospital and associated primary care units in Norway: a descriptive study based on a survey of clinicians’ experience and a review of patient records

“…The development and initial validation of the MedHip-Pro-Q focused on balanced questionnaire wording and representativeness; we found this to reduce information bias. 11 This study still provides insight into clinicians' experiences of hip fracture medication management, a topic where the literature is scarce but needed; the number of patients with hip fracture will likely increase in the future. 6-8 70-72 Another limitation was the use of patient records as a source, which only detects documentation of tasks completed and may differ from what was actually performed.…”

“… 11 14 Nurses were responsible for medication preparation, administration, observation and reporting effects. 11 39 Nurses used about 20% of their time on medication management activities, and spent, in some settings, more time than doctors in direct contact with patients. 39 40 …”

“…The questionnaire has been validated for the setting and was tailored to each respondent, with a selection of items based on profession, setting and medication management responsibilities. 11 The branching logic caused unequal denominators (as seen in questionnaire results) due to respondents being provided a subset of questionnaire items based on their profession, medication management responsibility and previous answers. All questionnaire items relevant to the respondent were mandatory, causing no missing items.…”

“…We used the digital MedHipPro-Q, with its supported face and content validity, 11 via Questback 2018 41 to investigate how clinicians throughout the patient pathway experienced medication management of patients with Open access hip fracture (figure 1). The MedHipPro-Q contained questionnaire items addressing three dimensions: profession and setting, medication reconciliation and review, and communication of key information.…”

“…10 The hip fracture patient pathway was described in a recent study and involved three to five transitions within and between care settings. 11 Multiple care transitions illustrated the importance of correct transfer of information, in addition to the need for optimal pharmacotherapy, to avoid ADRs and medication discrepancies. Thus, for patients to be prescribed and administered medications with best possible outcome and lowest risk, healthcare professionals are accountable for medication management, which comprises particularly these three specific tasks: medication reconciliation, medication review and correct transfer of medication information in care transitions.…”