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dc.contributor.authorFylan, Beth
dc.contributor.authorTranmer, M.
dc.contributor.authorArmitage, Gerry R.
dc.contributor.authorBlenkinsopp, Alison
dc.date.accessioned2018-07-25T13:33:00Z
dc.date.available2018-07-25T13:33:00Z
dc.date.issued2018
dc.identifier.citationFylan B, Tranmer M, Armitage G et al (2018) Cardiology patients' medicines management networks after hospital discharge: A mixed methods analysis of a complex adaptive system. Research in Social and Administrative Pharmacy. Article in Press.en_US
dc.identifier.urihttp://hdl.handle.net/10454/16511
dc.descriptionYesen_US
dc.description.abstractIntroduction: The complex healthcare system that provides patients with medicines places them at risk when care is transferred between healthcare organisations, for example discharge from hospital. Consequently, under-standing and improving medicines management, particularly at care transfers, is a priority.Objectives: This study aimed to explore the medicines management system as patients experience it and determine differences in the patient-perceived importance of people in the system.Methods: We used a Social Network Analysis framework, collecting ego-net data about the importance of people patients had contact with concerning their medicines after hospital discharge. Single- and multi-level logistic regression models of patients' networks were constructed, and model residuals were explored at the patient level.This enabled us to identify patients' networks with support tie patterns different from the general patterns suggested by the model results. Qualitative data for those patients were then analysed to understand their differing experiences.Results: Networks comprised clinical and administrative healthcare staff and friends and family members.Networks were highly individual and the perceived importance of alters varied both within and between patients. Ties to spouses were significantly more likely to be rated as highly important and ties to community pharmacy staff (other than pharmacists) and to GP receptionists were less likely to be highly rated. Patients with low-value medicines management networks described having limited information about their medicines and alack of understanding or help. Patients with high-value networks described appreciating support and having confidence in staff.Conclusions: Patients experienced medicines management as individual systems within which they interacted with healthcare staff and informal support to manage their treatment. Multilevel models indicated that there are unexplained variables impacting on patients' assessments of their medicines management networks. Qualitative exploration of the model residuals can offer an understanding of networks that do not have the typical range of support ties.en_US
dc.description.sponsorshipNational Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC)en_US
dc.language.isoenen_US
dc.relation.isreferencedbyhttps://doi.org/10.1016/j.sapharm.2018.06.016en_US
dc.rights© 2018 Elsevier Inc. Reproduced in accordance with the publisher's self-archiving policy. This manuscript version is made available under the CC-BY-NC-ND 4.0 license.en_US
dc.subjectMedication managementen_US
dc.subjectSocial network analysisen_US
dc.subjectMedication erroren_US
dc.subjectMultilevel modelsen_US
dc.subjectPatient safetyen_US
dc.subjectHealthcare systemsen_US
dc.titleCardiology patients' medicines management networks after hospital discharge: A mixed methods analysis of a complex adaptive systemen_US
dc.status.refereedYesen_US
dc.date.Accepted2018-06-20
dc.date.application2018-06-30
dc.typeArticleen_US
dc.date.EndofEmbargo2019-07-01
dc.type.versionAccepted Manuscripten_US
dc.description.publicnotesThe full-text of this article will be released for public view at the end of the publisher embargo on 01 Jul 2019.en_US
refterms.dateFOA2018-07-25T13:33:03Z


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