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    From hospital to home: a mixed methods exploration of post-discharge medicines management for older people living with long-term conditions

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    PhD Thesis (7.088Mb)
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    Publication date
    2020
    Author
    Tomlinson, Justine
    Supervisor
    Silcock, Jonathan
    Fylan, Beth
    Smith, Heather
    Karban, Kate
    Keyword
    Medication management
    Medication safety
    Older people
    Patient safety
    Hospital discharge
    Transitions of care
    Qualitative interviews
    Systematic review
    Complex intervention
    Post-discharge medicines management
    Rights
    Creative Commons License
    The University of Bradford theses are licenced under a Creative Commons Licence.
    Institution
    University of Bradford
    Department
    School of Pharmacy and Medical Sciences, Faculty of Life Sciences
    Awarded
    2020
    
    Metadata
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    Abstract
    There are numerous threats to medication safety at care transitions, which are heightened for older people, because they live with multiple long-term conditions as well as polypharmacy, and have frequent hospital admissions. Whilst evidence of the severity and scale of these medicines-related problems exists, there is insufficient detail about the lived experience of post-discharge medicines management, in particular what helps or what hinders, and how better support could be enabled. This thesis, underpinned by the Medicines Research Council framework for complex intervention design, aimed to find acceptable intervention components, which would enhance patient experience. This research followed a sequential, mixed method design to: establish the evidence base through critical literature review, develop theory using an interview study grounded in behaviour change theory, and finally to model potential intervention components by expert consensus. Interviews revealed that there were gaps in current service provision, which impacted on participants’ knowledge of and capabilities with their medicines. Despite these challenges, some participants took actions to safeguard from problems after discharge. The literature review found that effective components of trialled interventions were self-management advice, post-discharge telephone follow up and medicines reconciliation. Further behaviour change techniques from the literature, alongside expert consensus and theory-driven analysis of interview findings resulted in final selection of eight potential components. Real-world implementation of these must be coupled with key changes to current healthcare practices and policy, including better engagement with patients and carers, as well as pro-active post-discharge follow-up. Future work must carefully explore how these components can be tested pragmatically.
    URI
    http://hdl.handle.net/10454/18983
    Type
    Thesis
    Qualification name
    PhD
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    Theses

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