Loading...
A qualitative study of patient involvement in medicines management after hospital discharge: an under-recognised source of systems resilience
Armitage, Gerry R. Naylor, Deirdre Blenkinsopp, Alison
Armitage, Gerry R.
Naylor, Deirdre
Blenkinsopp, Alison
Publication Date
2018-07
End of Embargo
Supervisor
Rights
© Article author(s) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. Produced by BMJ Publishing Group Ltd under licence.
Peer-Reviewed
Yes
Open Access status
openAccess
Accepted for publication
2017-09-23
Institution
Department
Awarded
Embargo end date
Collections
Additional title
Abstract
Introduction: There are risks to the safety of medicines management when patient care is transferred between healthcare organisations, for example when a patient is discharged from hospital. Using the theoretical concept of resilience in healthcare, this study aimed to better understand the proactive role that patients can play in creating a safer, resilient medicines management at a common transition of care.
Methods: Qualitative interviews with 60 cardiology patients six weeks after their discharge from two UK hospitals explored patients’ experiences with their discharge medicines. Data were initially subjected to an inductive thematic analysis and a subsequent theory-guided deductive analysis.
Results: During interviews twenty-three patients described medicines management resilience strategies in two main themes: identifying system vulnerabilities; and establishing self-management strategies. Patients could anticipate problems in the system that supplied them with medicines and took specific actions to prevent them. They also identified when errors had occurred both before and after medicines had been supplied and took corrective action to avoid harm. Some reported how they had not foreseen problems or experienced patient safety incidents. Patients recounted how they ensured information about medicines changes was correctly communicated and acted upon, and identified their strategies to enhance their own reliability in adherence and resource management.
Conclusion: Patients experience the impact of vulnerabilities in the medicines management system across the secondary-primary care transition but many are able to enhance system resilience through developing strategies to reduce the risk of medicines errors occurring. Consequently, there are opportunities – with caveats – to elicit, develop and formalise patients’ capabilities which would contribute to safer patient care and more effective medicines management.
Version
Accepted manuscript
Citation
Fylan Gwynn B, Armitage G, Naylor D et al (2017) A qualitative study of patient involvement in medicines management after hospital discharge: an under-recognised source of systems resilience. BMJ Quality & Safety. 27(7): 539-546.
Link to publisher’s version
Link to published version
Link to Version of Record
Type
Article