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Schönenberger N, Blanc AL, Hug BL, Haschke M, Goetschi AN, Wernli U, Meyer-Massetti C. Developing indicators for medication-related readmissions based on a Delphi consensus study. Res Social Adm Pharm 2024; 20:92-101. [PMID: 38433064 DOI: 10.1016/j.sapharm.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Medication-related readmissions challenge healthcare systems by burdening patients, increasing costs and straining resources. However, to date, there has been no consensus study on indicators for medication-related readmissions. OBJECTIVES This Delphi study aimed to develop a consensus-based set of indicators for detecting patients at risk of medication-related readmission. METHODS An expert panel of clinical pharmacists, physicians and nursing experts participated in a two-round Delphi study. In round 1, 31 indicators taken from the literature were rated for relevance on a scale from 1 to 9, with a median rating of 7 or higher suggesting relevance. The RAND/UCLA method was used to determine consensus. In round 2, indicators lacking consensus were re-rated together with a series of new indicators generated by the experts. Additional details were sought for some indicators. The main outcomes were the relevance of, consensus on, and completeness of the proposed indicators for identifying risks of 30-day medication-related readmission. RESULTS Thirty-eight experts participated in round 1. Consensus was found for all the indicators, with 25 included and 6 excluded. Thirty-four experts participated in round 2. Consensus was found for all 5 newly suggested indicators, and 4 were included. The expert panel prioritized the following indicators: (1) insufficient communication between different healthcare providers, (2) polypharmacy (≥7 medications), (3) low rates of medication adherence (twice-weekly mistakes or missing administration), (4) complex medication regimens (≥3 doses, ≥2 dosage forms and ≥2 administration routes per day), and (5) multimorbidity (≥3 chronic conditions). The final set comprised 29 indicators. CONCLUSIONS The indicator set developed for flagging potential medication-related readmissions could guide priorities for clinical pharmacy services at hospital discharge, improving patient outcomes and resource use. A validation study of these indicators is planned.
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Affiliation(s)
- Nicole Schönenberger
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland.
| | - Anne-Laure Blanc
- Pharmacy of the Eastern Vaud Hospitals, 1847, Rennaz, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1205, Geneva, Switzerland
| | - Balthasar L Hug
- Department of Internal Medicine, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland; University of Lucerne, Faculty of Health Sciences and Medicine, 6005, Lucerne, Switzerland
| | - Manuel Haschke
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland
| | - Aljoscha N Goetschi
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Ursina Wernli
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010, Bern, Switzerland; Institute of Primary Healthcare (BIHAM), University of Bern, 3012, Bern, Switzerland
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Costello J, Barras M, Foot H, Cottrell N. The impact of hospital-based post-discharge pharmacist medication review on patient clinical outcomes: A systematic review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100305. [PMID: 37655116 PMCID: PMC10466898 DOI: 10.1016/j.rcsop.2023.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 06/20/2023] [Accepted: 07/08/2023] [Indexed: 09/02/2023] Open
Abstract
Background Clinical pharmacists have been shown to identify and resolve medication related problems post-discharge, however the impact on patient clinical outcomes is unclear. Aims To undertake a systematic review to identify, critically appraise and present the evidence on post-discharge hospital clinics that provide clinical pharmacist medication review; report the patient clinical outcomes measured; and describe the activities of the clinical pharmacist. Methods Published studies evaluating a patient clinical outcome following a post-discharge hospital clinic pharmacy service were included. All studies needed a comparative design (intervention vs control or comparator). Pubmed, Embase, CINAHL, PsycnINFO, Web of Science, IPA and APAIS-Health databases were searched to identify studies. The type of clinic and the clinical pharmacist activities were linked to patient clinical outcomes. Results Fifty-seven studies were included in the final analysis, 14 randomised controlled trials and 43 non-randomised studies. Three key clinic types were identified: post-discharge pharmacist review alone, inpatient care plus post-discharge review and post-discharge collaborative clinics. The three main outcome metrics identified were hospital readmission and/or representation, adverse events and improved disease state metrics. There was often a mix of these outcomes reported as primary and secondary outcomes. High heterogeneity of interventions and clinical pharmacist activities reported meant it was difficult to link clinical pharmacist activities with the outcomes reported. Conclusions A post-discharge clinic pharmacist may improve patient clinical outcomes such as hospital readmission and representation rates. Future research needs to provide a clearer description of the clinical pharmacist activities provided in both arms of comparative studies.
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Affiliation(s)
- Jaclyn Costello
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Redcliffe Hospital, Metro North Health, Brisbane, QLD, Australia
| | - Michael Barras
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
| | - Holly Foot
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Neil Cottrell
- The School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
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3
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Lawal BK, Mohammed S. Integrating patient safety education into pharmacy curriculum in Nigeria. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2022; 30:583-585. [PMID: 36355916 DOI: 10.1093/ijpp/riac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/13/2022] [Indexed: 11/12/2022]
Abstract
Recognition has been given to patient safety and healthcare quality as central components of a functional health system which has resulted in increased advocacy for elaborate patient safety content in education and training programmes for health professionals. The World Health Organisation's patient safety curriculum is an evidence-based framework that provides a valuable resource for the training of healthcare professionals in enhancing patient safety. Other international organisations have also advocated for the need to restructure healthcare professionals' education to include the concept of patient safety. The ideal time to initiate patient safety education is suggested to be during schooling through curricula that inculcate learning from adverse events. This will prepare pharmacy students as future healthcare professionals who will become better prepared for clinical practice leading to improved healthcare quality and safety.
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Affiliation(s)
- Basira Kankia Lawal
- Department of Clinical Pharmacy and Pharmacy Management, Kaduna State University, Kaduna, Nigeria
| | - Shafiu Mohammed
- Department of Clinical Pharmacy and Pharmacy Practice, Ahmadu Bello University, Zaria, Nigeria.,Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
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Vesela R, Elenjord R, Lehnbom EC, Ofstad EH, Johnsgård T, Zahl-Holmstad B, Risør T, Wisløff T, Røslie L, Filseth OM, Valle PC, Svendsen K, Frøyshov HM, Garcia BH. Integrating the clinical pharmacist into the emergency department interdisciplinary team: a study protocol for a multicentre trial applying a non-randomised stepped-wedge study design. BMJ Open 2021; 11:e049645. [PMID: 34824109 PMCID: PMC8627400 DOI: 10.1136/bmjopen-2021-049645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The 'emergency department (ED) pharmacist' is an integrated part of the ED interdisciplinary team in many countries, which have shown to improve medication safety and reduce costs related to hospitalisations. In Norway, few EDs are equipped with ED pharmacists, and research describing effects on patients has not been conducted. The aim of this study is to investigate the impact of introducing clinical pharmacists to the interdisciplinary ED team. In this multicentre study, the intervention will be pragmatically implemented in the regular operation of three EDs in Northern Norway; Tromsø, Bodø and Harstad. Clinical pharmacists will work as an integrated part of the ED team, providing pharmaceutical care services such as medication reconciliation, review and/or counselling. The primary endpoint is 'time in hospital during 30 days after admission to the ED', combining (1) time in ED, (2) time in hospital (if hospitalised) and (3) time in ED and/or hospital if re-hospitalised during 30 days after admission. Secondary endpoints include time to rehospitalisation, length of stay in ED and hospital and rehospitalisation and mortality rates. METHODS AND ANALYSIS We will apply a non-randomised stepped-wedge study design, where we in a staggered way implement the ED pharmacists in all three EDs after a 3, 6 and 9 months control period, respectively. We will include all patients going through the three EDs during the 12-month study period. Patient data will be collected retrospectively from national data registries, the hospital system and from patient records. ETHICS AND DISSEMINATION The Regional Committee for Medical and Health Research Ethics and Local Patient Protection Officers in all hospitals have approved the study. Patients will be informed about the ongoing study on a general basis with ads on posters and flyers. TRIAL REGISTRATION NUMBER NCT04722588.
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Affiliation(s)
- Renata Vesela
- Hospital Pharmacy of North Norway Trust, Tromso, Norway
| | - Renate Elenjord
- Hospital Pharmacy of North Norway Trust, Tromso, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Norway
| | - Elin C Lehnbom
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Norway
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Eirik Hugaas Ofstad
- Department of Medicine, Nordland Hospital Trust, Bodo, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Tine Johnsgård
- Hospital Pharmacy of North Norway Trust, Tromso, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Norway
| | - Birgitte Zahl-Holmstad
- Hospital Pharmacy of North Norway Trust, Tromso, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Norway
| | - Torstein Risør
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
- Department of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Torbjørn Wisløff
- Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Lars Røslie
- Department of Emergency Medicine, University Hospital of North Norway Trust, Tromso, Norway
| | - Ole Magnus Filseth
- Department of Emergency Medicine, University Hospital of North Norway Trust, Tromso, Norway
| | - Per-Christian Valle
- Department of Emergency Medicine, University Hospital of North Norway Trust, Harstad, Norway
| | - Kristian Svendsen
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Norway
| | - Hanne Mathilde Frøyshov
- Department of Emergency Medicine, University Hospital of North Norway Trust, Harstad, Norway
| | - Beate H Garcia
- Hospital Pharmacy of North Norway Trust, Tromso, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromso, Norway
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Aires-Moreno GT, Alcântara TDS, Araújo DCSAD, Soares SDM, Gubert VT, Marcon de Oliveira V, Ferreira CM, Vasconcelos-Pereira EF, Lira ARP, Chemello C, Oliveira LMSD, Oliveira-Filho ADD, Lyra D. Medication discrepancies in transition of care of hospitalised children in Brazil: a multicentric study. Arch Dis Child 2021; 106:1018-1023. [PMID: 33958348 DOI: 10.1136/archdischild-2020-320225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/22/2021] [Accepted: 04/17/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the incidence of medication discrepancies in transition points of care of hospitalised children. DESIGN A prospective observational multicentre study was carried out between February and August 2019. Data collection consisted of the following steps: sociodemographic data collection, clinical interview with the patient's caregiver, review of patient prescriptions and evaluation of medical records. Medication discrepancies were classified as intentional (documented or undocumented) and unintentional. In addition, discrepancies identified were categorised according to the medication discrepancy taxonomy. Unintentional discrepancies were assessed for potential clinical harm to the patient. SETTING Paediatric clinics of four teaching hospitals in Brazil. PATIENTS Children aged 1 month-12 years. FINDINGS A total of 248 children were included, 77.0% (n=191) patients had at least one intentional discrepancy; 20.2% (n=50) patients had at least one unintended discrepancy and 15.3% (n=38) patients had at least one intentional discrepancy and an unintentional one. The reason for the intentional discrepancy was not documented in 49.6% (n=476) of the cases. The most frequent unintentional discrepancy was medication omission (54.1%; n=66). Low potential to cause discomfort was found in 53 (43.4%) unintentional discrepancies, while 55 (45.1%) had the potential to cause moderate discomfort and 14 (11.5%) could potentially cause severe discomfort. CONCLUSIONS Although most medication discrepancies were intentional, the majority of these were not documented by the healthcare professionals. Unintentional discrepancies were often related to medication omission and had a potential risk of causing harm to hospitalised children.
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Affiliation(s)
- Giulyane Targino Aires-Moreno
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Sao Cristóvão, Brazil
| | - Thaciana Dos Santos Alcântara
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Sao Cristóvão, Brazil
| | | | | | - Vanessa Terezinha Gubert
- Pharmacy School Professor Ana Maria Cervantes Baraza, Faculty of Pharmacy, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Vanessa Marcon de Oliveira
- Pharmacy School Professor Ana Maria Cervantes Baraza, Faculty of Pharmacy, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Cristiane Munaretto Ferreira
- Pharmacy School Professor Ana Maria Cervantes Baraza, Faculty of Pharmacy, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Erica Freire Vasconcelos-Pereira
- Pharmacy School Professor Ana Maria Cervantes Baraza, Faculty of Pharmacy, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Ana Rafaela Pires Lira
- Center for Pharmaceutical Care Studies, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Clarice Chemello
- Center for Pharmaceutical Care Studies, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Divaldo Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Sao Cristóvão, Brazil
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Ratigan AR, Michaud V, Turgeon J, Bikmetov R, Gaona Villarreal G, Anderson HD, Pulver G, Pace WD. Longitudinal Association of a Medication Risk Score With Mortality Among Ambulatory Patients Acquired Through Electronic Health Record Data. J Patient Saf 2021; 17:249-255. [PMID: 33994532 PMCID: PMC8132895 DOI: 10.1097/pts.0000000000000829] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The use of electronic health records allows for the application of a novel medication risk score for the rapid identification of ambulatory patients at risk of adverse drug events. We sought to examine the longitudinal association of medication risk score with mortality. This retrospective cohort study included patients whose data were available through electronic health records from multiple health care organizations in the United States that provided data as part of a Patient Safety Organization. Patients were included if they had ≥1 visit and ≥1 medication in their record between January 1, 2011, to June 30, 2017. Cox proportional hazards regression was used to examine the association between continuous and categorized medication risk score with all-cause mortality. Among 427,103 patients, the median age was 50 years (interquartile range, 29-64 years); 61% were female; 50% were White, 11% were Black, and 38% were Hispanic; and 6873 had a death date recorded. Patients 30 to 49 years old had the highest hazard ratios (HRs), followed by the 50- to 64-year-olds and lastly those 65 years or older. Controlling for all covariates, 30- to 49-year-olds with a score of 20 to 30 (versus <10) had a 604% increase in the hazard of death (HR, 7.04; 95% confidence interval [CI], 3.86-12.85), 50- to 64-year-olds had a 254% increase (HR, 3.54; 95% CI, 2.71-4.63), and ≥65-year-olds had an 87% increase (HR, 1.87; 95% CI, 1.67-2.09). The medication risk score was independently associated with death, adjusting for multimorbidities and other conditions. Risk was found to vary by age group and score. Results suggest that pharmaceutical interventions among those with elevated scores could improve medication safety for patients taking multiple medications.
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Affiliation(s)
| | - Veronique Michaud
- Precision Pharmacotherapy Research and Development Institute, Tabula Rasa HealthCare, Lake Nona, Orlando, Florida
| | - Jacques Turgeon
- Precision Pharmacotherapy Research and Development Institute, Tabula Rasa HealthCare, Lake Nona, Orlando, Florida
| | - Ravil Bikmetov
- Precision Pharmacotherapy Research and Development Institute, Tabula Rasa HealthCare, Lake Nona, Orlando, Florida
| | | | - Heather D. Anderson
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Aires-Moreno GT, Silvestre CC, Araújo DCSA, Matos VTG, Marcon de Oliveira V, Ferreira CM, Vasconcelos-Pereira EF, Lira ARP, Chemello C, Oliveira LMS, Oliveira-Filho AD, Lyra DP. Perceptions of nurses, pharmacists and physicians about medication reconciliation: A multicenter study. Saudi Pharm J 2020; 28:1435-1439. [PMID: 33250651 PMCID: PMC7679437 DOI: 10.1016/j.jsps.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Giulyane T Aires-Moreno
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Carina C Silvestre
- Department of Pharmacy, Life Sciences Institute, Federal University of Juiz de Fora, Governador Valadares, MG, Brazil
| | - Dyego C S A Araújo
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Vanessa T G Matos
- Pharmacy School Professor Ana Maria Cervantes Baraza, Faculty of Pharmacy, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Vanessa Marcon de Oliveira
- Pharmacy School Professor Ana Maria Cervantes Baraza, Faculty of Pharmacy, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Cristiane M Ferreira
- Pharmacy School Professor Ana Maria Cervantes Baraza, Faculty of Pharmacy, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Erica F Vasconcelos-Pereira
- Pharmacy School Professor Ana Maria Cervantes Baraza, Faculty of Pharmacy, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Ana R P Lira
- Center for Pharmaceutical Care Studies, Department of Social Pharmacy, College of Pharmacy of Federal University of Minas Gerais, MG, Brazil
| | - Clarice Chemello
- Center for Pharmaceutical Care Studies, Department of Social Pharmacy, College of Pharmacy of Federal University of Minas Gerais, MG, Brazil
| | - Layse M S Oliveira
- School of Nursery and Pharmacy (ESENFAR), Federal University of Alagoas, Maceió, AL, Brazil
| | - Alfredo D Oliveira-Filho
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil.,School of Nursery and Pharmacy (ESENFAR), Federal University of Alagoas, Maceió, AL, Brazil
| | - Divaldo P Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, SE, Brazil
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Oyesanya TO, Arulselvam K, Thompson N, Norelli J, Seel RT. Health, wellness, and safety concerns of persons with moderate-to-severe traumatic brain injury and their family caregivers: a qualitative content analysis. Disabil Rehabil 2019; 43:685-695. [PMID: 31298958 DOI: 10.1080/09638288.2019.1638456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Persons with moderate-to-severe traumatic brain injury (TBI) face issues with health, wellness, and safety that affect their ability to independently manage their care, even for individuals who are ≥75% independent in activities of daily living. These issues often lead to increased family involvement in managing the person's condition after discharge home. PURPOSE We explored health, wellness, and safety concerns after discharge home from inpatient rehabilitation from the perspectives of persons with TBI who are ≥75% independent in activities of daily living and their family caregivers. MATERIALS AND METHODS We interviewed 27 persons with TBI and family caregivers and used conventional content analysis to analyse the data. RESULTS Seven themes related to health, wellness, and safety encompassed participants' experience. Health themes included: (1) attempting to manage medications and (2) navigating mental health difficulties. Wellness themes included: (1) working to stay physically active, (2) dealing with sleep and sleeplessness, and (3) adjusting to changing social relationships. Safety themes were: (1) addressing mobility challenges and (2) compensating for complications with cognitive functioning. CONCLUSIONS Findings can guide the development of tools, supports, and resources to promote health, wellness, and safety of persons with TBI as they recover after discharge home.Implications for rehabilitationFindings on numerous concerns related to health, wellness, and safety suggest the need for implementation or development and testing of tools, supports, and resources to promote health, wellness, and safety of persons with traumatic brain injury as they recover after discharge home.Our findings can be used to educate healthcare providers and increase awareness of the nuanced challenges patients and families face after discharge home.Findings can also be used by providers to educate patients and families on realistic expectations for life after discharge.
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Affiliation(s)
- Tolu O Oyesanya
- Shepherd Center, Crawford Research Institute, Atlanta, GA, USA.,School of Nursing, Duke University, Durham, NC, USA
| | | | - Nicole Thompson
- Shepherd Center, Crawford Research Institute, Atlanta, GA, USA
| | - Jenna Norelli
- Shepherd Center, Crawford Research Institute, Atlanta, GA, USA
| | - Ronald T Seel
- Shepherd Center, Crawford Research Institute, Atlanta, GA, USA.,Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Science and Engineering, VCU School of Medicine, Richmond, VA, USA
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