Medication practices and experiences of older adults discharged home from hospital: a feasibility study protocol

Abstract

BackgroundSwitzerland’s aging population raises pressing questions about maintaining older adults in their home environments and the problems associated with managing complex treatments requiring medication in such contexts. Few studies have examined older adults’ experiences of changes in their medication on discharge home following hospitalization for illness or an accident. Similarly, few studies have evaluated the involvement of informal and professional caregivers in the medication practices used with older adults living at home. However, medication practices are complex and understanding them requires an interest in their underlying logic and the interactions that constitute them. This study will explore the feasibility of recruiting older adults and then collecting and analyzing data on their medication practices and their experiences of discharge home after hospitalization for an illness or following an accident. Furthermore, it will describe the involvement of informal caregivers and homecare professionals in these processes.Design and methodsThe study will use a qualitative methodology. The first phase will be developed in the general medicine and surgery wards of Sion hospital and in the town’s community healthcare center. This phase will aim to build a close collaboration between the research team and the health care professionals of Valais hospitals and the community healthcare center. It will enable data collection from professional caregivers to identify the tools, and potentially the interventions, which are used to prepare older adults for hospital discharge and return home, particularly with regard to the medication prescribed to them. In the second phase, semi-structured interviews will be conducted with eight patients aged 75 years old or more who have returned home after hospitalization. Interviews will also be conducted with their informal and professional caregivers.ConclusionThis feasibility study will enable the identification of tools that leverage improved adhesion to a medical treatment that has been adjusted and stabilized following discharge home from hospital. It will incorporate the points of view of older adults and the different stakeholders involved in the management of their medication and the development of tangible solutions to encourage treatment adhesion on discharge home. This study’s findings will enable us to design a much larger future study.

Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol

“…To meet the second and third objectives, a qualitative investigation, based on purposive sampling, will draw on work done in a feasibility study 29. This qualitative investigation will consist of collecting and understanding the medication practices and experiences of OAMCC presenting with the risk factors identified in the first phase.…”

Heuristics for designing user‐centric drug products: Lessons learned from Human Factors and Ergonomics

“…In combination with potential declines of cognitive functioning, medication management/administration becomes a major challenge for older patients and their caregivers. To help this user group manage medication regimens and avoid errors or, worse, non‐adherence, information about how to correctly use a drug product must be particularly easy to comprehend . In our own research we have in fact shown for a cancer self‐screening context that, if health information is tailored to the needs of older patients, errors can be reduced and adherence increased …”

“…Examples from clinical practice suggest that putting this information into action is quite challenging, in particular for older drug users. Older patients and their caregivers often need to fit multiple drugs into a treatment plan (poly‐pharmacy), each with specific but different instructions related to dosing, intake frequencies (e.g., weekly versus daily), etc . In addition, if existing drug formulations do not match individual needs, drug users may have to combine several strengths, subdivide, or otherwise modify products prior to use.…”

“…If the design and accompanying informational materials of drug products do not match users' needs and capacities, the proper use—hence safety and effectiveness—of even the most efficacious product can be compromised. In other words, drug products that are difficult to take/administer may not be used properly, resulting in unnecessary medication errors, or may not be used at all, jeopardizing therapeutic success …”

“…In other words, drug products that are difficult to take/administer may not be used properly, resulting in unnecessary medication errors, or may not be used at all, jeopardizing therapeutic success. [1][2][3] Patient-centric and, more generally, user-centric drug development have recently gained attention in the pharmaceutical literature, [4][5][6] the pharmaceutical industry, 7 and the regulatory framework 8 as a way to address this problem. Although the term "patient-centric" is frequently used in the literature on drug development, we use "user-centric" throughout this article to indicate that design efforts should not be limited to patients alone but instead encompass all drug users, including patients, lay caregivers, pharmacists, nurses, physicians, etc.…”