“It’s very complicated”: a qualitative study of medicines management in intermediate care facilities in Northern Ireland

Abstract

BackgroundIntermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery from illness and maximising independence. Older people are at increased risk of medication-related adverse events, but little is known about the provision of medicines management services in IC facilities. This study aimed to describe the current provision of medicines management services in IC facilities in Northern Ireland (NI) and to explore healthcare workers’ (HCWs) and patients’ views of, and attitudes towards these services and the IC concept.MethodsSemi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with HCWs and patients from IC facilities in NI.ResultsInterviews were conducted with 25 HCWs and 18 patients from 12 IC facilities in NI. Three themes were identified: ‘concept and reality’, ‘setting and supply’ and ‘responsibility and review’. A mismatch between the concept of IC and the reality was evident. The IC facility setting dictated prescribing responsibilities and the supply of medicines, presenting challenges for HCWs. A lack of a standardised approach to responsibility for the provision of medicines management services including clinical review was identified. Whilst pharmacists were not considered part of the multidisciplinary team, most HCWs recognised a need for their input. Medicines management was not a concern for the majority of IC patients.ConclusionsMedicines management services are not integral to IC and medicine-related challenges are frequently encountered. Integration of pharmacists into the multidisciplinary team could potentially improve medicines management in IC.

A cross-sectional evaluation of community pharmacists’ perceptions of intermediate care and medicines management across the healthcare interface

“…The questionnaire was informed by the findings of previous qualitative work conducted in the area [3] and consisted of four sections (Fig. 1).…”

“…Whilst various terminologies are used to describe similar care settings globally [1], IC is broadly defined in the United Kingdom (UK) as ‘a range of integrated services to prevent unnecessary hospital admission, promote faster recovery from illness, support timely discharge and maximise independent living’ [2]. Despite the importance placed on the concept of the multidisciplinary team in IC, previous work has highlighted how the pharmacy profession has not been integrated into this care setting [1, 3, 4]. This lack of pharmacy involvement is concerning, given that various aspects of medicines management within the IC setting may be suboptimal [3].…”

“…Despite the importance placed on the concept of the multidisciplinary team in IC, previous work has highlighted how the pharmacy profession has not been integrated into this care setting [1, 3, 4]. This lack of pharmacy involvement is concerning, given that various aspects of medicines management within the IC setting may be suboptimal [3]. …”

“…In Northern Ireland (NI), previous qualitative work with CPs has suggested that they have a limited awareness of, and involvement with, IC [3]. Furthermore, it was revealed that CPs frequently experienced challenges relating to the communication of information at the various healthcare interfaces.…”

“…CPs described often being ‘left out of the loop’, not only in relation to IC, but also the communication of patients’ medication information at the points of transfer between secondary care, IC and primary care. In an attempt to obtain up-to-date information relating to patients’ medications, CPs described how the responsibility fell to them to ‘chase things up.’ Finally, this study’s findings also suggested that CPs could ‘close the loop’ by bridging the gap between healthcare settings, through increased involvement in IC and services targeted at both IC and communication across the healthcare interface [3]. …”