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    Medicines Management after Hospital Discharge: Patients’ Personal and Professional Networks

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    PhD Thesis (8.952Mb)
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    Publication date
    2015
    Author
    Fylan, Beth
    Supervisor
    Blenkinsopp, Alison
    Armitage, Gerry R.
    Naylor, Deirdre
    Keyword
    Patient safety; Medicines management; Hospital discharge; Social network analysis; Medications; Care transitions; Human factors
    Rights
    Creative Commons License
    The University of Bradford theses are licenced under a Creative Commons Licence.
    Institution
    University of Bradford
    Department
    Faculty of Life Sciences
    Awarded
    2015
    
    Metadata
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    Abstract
    Improving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.
    URI
    http://hdl.handle.net/10454/14465
    Type
    Thesis
    Qualification name
    PhD
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