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dc.contributor.advisorSilcock, Jonathan
dc.contributor.advisorFylan, Beth
dc.contributor.advisorSmith, Heather
dc.contributor.advisorKarban, Kate
dc.contributor.authorTomlinson, Justine
dc.date.accessioned2022-06-08T14:04:23Z
dc.date.available2022-06-08T14:04:23Z
dc.date.issued2020
dc.identifier.urihttp://hdl.handle.net/10454/18983
dc.description.abstractThere 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.en_US
dc.language.isoenen_US
dc.rights<a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by-nc-nd/3.0/88x31.png" /></a><br />The University of Bradford theses are licenced under a <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/">Creative Commons Licence</a>.eng
dc.subjectMedication managementen_US
dc.subjectMedication safetyen_US
dc.subjectOlder peopleen_US
dc.subjectPatient safetyen_US
dc.subjectHospital dischargeen_US
dc.subjectTransitions of careen_US
dc.subjectQualitative interviewsen_US
dc.subjectSystematic reviewen_US
dc.subjectComplex interventionen_US
dc.subjectPost-discharge medicines managementen_US
dc.titleFrom hospital to home: a mixed methods exploration of post-discharge medicines management for older people living with long-term conditionsen_US
dc.type.qualificationleveldoctoralen_US
dc.publisher.institutionUniversity of Bradfordeng
dc.publisher.departmentSchool of Pharmacy and Medical Sciences, Faculty of Life Sciencesen_US
dc.typeThesiseng
dc.type.qualificationnamePhDen_US
dc.date.awarded2020
refterms.dateFOA2022-06-08T14:04:23Z


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