Problems in continuity of medication management upon transition between primary and secondary care: patients’ and professionals’ experiences

Abstract

Background and objectives Patients often experience drug-related problems at admission or after discharge from hospital. The objective of this study was to identify the main problems in medication management at transition between settings of care, as experienced by health care professionals (HCPs) and patients. Methods Focus group discussions were organised between December 2009 and February 2010; nine focus groups with primary and secondary care HCPs and patients and two with stakeholders. Focus group discussions were audiotaped and observation files were constructed. For the analysis, a thematic framework approach was used. Between November 2015 and April 2016, 19 additional interviews and 1 focus group were performed with general practitioners (GP) and community pharmacists (CP). Results This qualitative study provided a long list of problems that could be summarised in five clusters: (1) problems at admission, e.g. incomplete list of medication, absence of information in case of emergency admission; (2) problems at discharge, e.g. lack of communication with GP, insufficient supplies of medication for the weekend; (3) problems as to professions, e.g. GP's opinion different to that of the medical specialist; (4) problems as to patients and family, e.g. failure to understand treatment; (5) problems as to processes, e.g. medication substitutions. Conclusion HCPs and patients experience many problems in medication management at transition between settings of care. The fact that these problems occur at different stages and persist over time stresses the necessity for multilevel solutions.

Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review

“…In addition, attention has recently been drawn to the patient's experience of hospital discharge, where patients reported pressured discharges, the complicated nature of discharge, communication issues and healthcare system fragmentation (e.g. lack of shared electronic records across care boundaries affected their medication management post-discharge [9,137,150,151]). Indeed, recent research has included the valuable patient perspective on discharge and how they may manage their medication effectively [8,[150][151][152][153][154][155].…”

“…lack of shared electronic records across care boundaries affected their medication management post-discharge [9,137,150,151]). Indeed, recent research has included the valuable patient perspective on discharge and how they may manage their medication effectively [8,[150][151][152][153][154][155]. This research should be used by academics, policymakers and healthcare staff alongside the findings of this review and explorations of the causes of MEs/ADEs post-discharge from the health provider perspective to connect patients and health systems together to reduce medication safety risks from a more holistic perspective.…”

Intervention fidelity and process outcomes of medication reviews including post‐discharge follow‐up in older hospitalized patients: Process evaluation of the MedBridge trial

“…Older patients are at risk of experiencing drug-related problems (DRPs) like adverse drug reactions, 1 particularly at transitions of care. 2,3 DRPs lead to increased morbidity, which poses a growing burden on healthcare resources worldwide. 4,5 One of the proposed activities to prevent and solve DRPs in older patients is the performance of comprehensive medication reviews (CMRs).…”

Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the “Memory and Neuropsychiatry Clinic” in Hospital Del Salvador, Chile

“…Regarding prescription delivery, the creation of a joined-up service could facilitate the medication continuity in the transition from specialist care to primary based. That is one of the changes, among others, needed toward building capacity for dementia care in primary care, as it has been suggested elsewhere (71,72).…”