‘Seamless care? Just a list would have helped!’ Older people and their carer’s experiences of support with medication on discharge home from hospital

Knight, Denise; Thompson, Donovan J.; Mathie, Elspeth; Dickinson, Angela

doi:10.1111/j.1369-7625.2011.00714.x

Cited by 87 publications

(131 citation statements)

References 7 publications

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“…A broad range of admitting conditions were reported across the studies, and the types and extent of information on social support for patients varied greatly. The experience of involvement in transitions was a specific focus within four studies . The remaining studies were concerned with general experiences of care and transitions.…”

Section: Resultsmentioning

confidence: 99%

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How older people enact care involvement during transition from hospital to home: A systematic review and model

Murray

Hardicre

Birks

et al. 2019

Health Expectations

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BackgroundCurrent models of patient‐enacted involvement do not capture the nuanced dynamic and interactional nature of involvement in care. This is important for the development of flexible interventions that can support patients to ‘reach‐in’ to complex health‐care systems.ObjectiveTo develop a dynamic and interactional model of patient‐enacted involvement in care.Search strategyElectronic search strategy run in five databases and adapted to run in an Internet search engine supplemented with searching of reference lists and forward citations.Inclusion criteriaQualitative empirical published reports of older people's experiences of care transitions from hospital to home.Data extraction and synthesisReported findings meeting our definition of involvement in care initially coded into an existing framework. Progression from deductive to inductive coding leads to the development of a new framework and thereafter a model representing changing states of involvement.Main resultsPatients and caregivers occupy and move through multiple states of involvement in response to perceived interactions with health‐care professionals as they attempt to resolve health‐ and well‐being‐related goals. ‘Non‐involvement’, ‘information‐acting’, ‘challenging and chasing’ and ‘autonomous‐acting’ were the main states of involvement. Feeling uninvolved as a consequence of perceived exclusion leads patients to act autonomously, creating the potential to cause harm.Discussion and conclusionThe model suggests that involvement is highly challenging for older people during care transitions. Going forward, interventions which seek to support patient involvement should attempt to address the dynamic states of involvement and their mediating factors.

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Section: Resultsmentioning

confidence: 99%

“… This resulted in patients and caregivers moving between states of involvement in attempting to resolve a single aspect of care. Challenging and chasing, as the third type of involvement, highlighted the work and effort required to question staff and source information . Examples of chasing were seen exclusively in caregivers.…”

Section: Resultsmentioning

confidence: 99%

How older people enact care involvement during transition from hospital to home: A systematic review and model

Murray

Hardicre

Birks

et al. 2019

Health Expectations

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“…In der Schweiz entfielen 2012 zirka 30 % der stationären Krankenhausfälle auf 70-Jährige und Ältere (BfS, 2014b). Während der Hospitalisation wird die Medikation bei diesen Patient(inn)en fast täglich geändert, in der Folge weicht das Medikamentenregime bei Austritt im Vergleich zum Eintritt ab (Knight, Thompson, Mathie & Dickinson, 2011). Eine zusätzliche Schwierigkeit bildet die Umstellung der angestammten Medikamente auf Generika mit anderen Namen und anderem Aussehen (Pruszydlo, Quinzler, Kaltschmidt & Haefeli, 2008 (Ritchie & Lewis, 2003;Sandelowski, 2010 (Gläser & Laudel, 2009 (Flick, 2011;Gläser & Laudel, 2009 (Miles & Huberman, 1994;Creshwell, 2007 (Graefe et al, 2011).…”

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“…Die vorliegende Studie zeigt aber auch, dass Informationen der Gesundheitsfachpersonen zur medikamentösen Therapie oft nicht der Lebenssituation der Patient(inn)en angepasst sind, zum falschen Zeitpunkt vermittelt werden und nicht nachgefragt wird, wie der Patient/die Patientin nach Austritt die neu verordneten Medikamente organisieren kann. Im Gegensatz zur Studie von Knight et al (2011) …”

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Komplexe Medikamentenregime bei multimorbiden älteren Menschen nach Spitalaufenthalt – eine qualitative Studie

Stauffer

Spichiger

Mischke

2015

Pflege

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“…99 As with the research conducted in previous eras, most did not provide information about the nature of the pharmacist-patient interaction or the communication process that took place as part of the interventions. Instead the majority of the studies emphasised quantitative measurements such as time spent communicating, content or types of information provided to or requested by patients, [100][101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116] while others investigated pharmacist consultations using programs, tools or techniques to enhance patient understanding. [117][118][119][120] In comparison, smaller numbers of qualitative research studies have been published exploring or detailing pharmacist-patient communication interaction.…”

Section: Medication Therapy Management/medicines Management Eramentioning

confidence: 99%

Investigating the effectiveness of communication taking place between hospital pharmacists and patients during medication counselling

Chevalier¹

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However, before these relationships could be explored, it was essential to first investigate what was taking place in these pharmacist-patient interactions.The overall aim of this thesis was to investigate the effectiveness of communication between hospital pharmacists and patients during medication counselling.This theory-driven research employed qualitative, quantitative and mixed methods.Communication accommodation theory (CAT) was the theoretical framework invoked to study, analyse and interpret the pharmacist-patient communication exchanges. There are five CAT strategies which measure whether effective communication has occurred: approximation (speech tone, volume, rate, accent), interpretability (using easy-to-understand language, avoiding jargon), discourse management (asking open-ended questions or repairing conversations), emotional expression (appropriate reassurance to patients' concerns) and interpersonal control (strategies to promote equality between speakers and encourage patients to take active roles in managing their healthcare). In this thesis, effective pharmacist-patient communication refers to the extent pharmacists accommodate, or not, to patients' conversational needs based on accommodative behaviour described within CAT strategies.There were two phases to this thesis. The first involved six focus groups (24 pharmacists) from two large metropolitan hospitals. Pharmacists shared their perceptions of their roles and goals in patient medication counselling, and barriers and facilitators in meeting their goals.Audio recorded transcripts were thematically analysed and goals identified by pharmacists were successfully mapped onto the five CAT strategies. Results of phase one helped inform the contents of the semi-structured interview guides utilised in phase two.iii Phase two represented the major portion of this PhD, and took place at a large hospital with multiple specialities. Twelve pharmacists engaged four patients for a total of 48 medication counselling sessions. Each individual session took place first, followed by separate semistructured interviews with pharmacists and patients. Counselling sessions and interviews were audio recorded and observational field notes were taken. Transcribed recordings were selectively coded for the five CAT strategies in pattern-based discourse analysis. Discursis software, as an adjunct to qualitative analysis, was used to visualise pharmacist-patient speech patterns, episodes of engagement and to detect CAT strategies employed by Analysis of the pharmacist-patient counselling sessions revealed that most pharmacists effectively used all five CAT communication strategies during medication counselling sessions as they adapted to patients' conversational needs. Non-accommodation occurred when pharmacists spoke too quickly, used terms not understood by patients, and did not include patients in the initial, agenda-setting phase. Discursis software identified pharmacistpatient engagement episodes, often revealing effectively applied CAT strategies.Semi-structure...

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‘Seamless care? Just a list would have helped!’ Older people and their carer’s experiences of support with medication on discharge home from hospital

Cited by 87 publications

References 7 publications

How older people enact care involvement during transition from hospital to home: A systematic review and model

How older people enact care involvement during transition from hospital to home: A systematic review and model

Komplexe Medikamentenregime bei multimorbiden älteren Menschen nach Spitalaufenthalt – eine qualitative Studie

Investigating the effectiveness of communication taking place between hospital pharmacists and patients during medication counselling

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