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Klasing S, Dörje F, Hilgarth H, Metzger N, Richling I, Seidling HM. Continuity of medication information transfer and continuous medication supply during hospital-to-home transitions - nationwide surveys in hospital and community pharmacies after implementing new legal requirements in Germany. BMC Health Serv Res 2024; 24:993. [PMID: 39192253 DOI: 10.1186/s12913-024-11208-4] [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: 02/19/2024] [Accepted: 06/17/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND While successful information transfer and seamless medication supply are fundamental to medication safety during hospital-to-home transitions, disruptions are frequently reported. In Germany, new legal requirements came into force in 2017, strengthening medication lists and discharge summaries as preferred means of information transfer. In addition to previous regulations - such as dispensing medication at discharge by hospital pharmacies - hospital physicians were now allowed to issue discharge prescriptions to be supplied by community pharmacies. The aim of this survey study was to gain first nationwide insights into how these requirements are implemented and how they impact the continuity of medication information transfer and continuous medication supply. METHODS Two nationwide self-administered online surveys of all hospital and community pharmacies across Germany were developed and conducted from April 17th to June 30th, 2023. RESULTS Overall, 31.0% (n = 111) of all German hospital pharmacies and 4.5% (n = 811) of all community pharmacies participated. The majority of those hospital pharmacies reported that patients who were discharged were typically provided with discharge summaries (89.2%), medication lists (59.5%) and if needed, discharge prescriptions (67.6%) and/or required medication (67.6%). About every second community pharmacy (49.0%) indicated that up to half of the recently discharged patients who came to their pharmacy typically presented medication lists. 34.0% of the community pharmacies stated that they typically received a discharge summary from recently discharged patients at least once per week. About three in four community pharmacies (73.3%) indicated that most discharge prescriptions were dispensed in time. However, one-third (31.0%) estimated that half and more of the patients experienced gaps in medication supply. Community pharmacies reported challenges with the legal requirements - such as patients´ poor comprehensibility of medication lists, medication discrepancies, unmet formal requirements of discharge prescriptions, and poor accessibility of hospital staff in case of queries. In comparison, hospital pharmacies named technical issues, time/personnel resources, and deficits in patient knowledge of medication as difficulties. CONCLUSION According to the pharmacies´ perceptions, it can be assumed that discontinuation in medication information transfer and lack of medication supply still occur today during hospital-to-home transitions, despite the new legal requirements. Further research is necessary to supplement these results by the perspectives of other healthcare professionals and patients in order to identify efficient strategies.
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Affiliation(s)
- Sophia Klasing
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- Joined Discharge Management Project Group of the Federal Association of German Hospital Pharmacists (ADKA) e.V. and the German Pharmaceutical Society (DPhG) e. V., Alt-Moabit 96/Varrentrappstraße 40-42, 10559/60486, Berlin/Frankfurt am Main, Germany
| | - Frank Dörje
- Joined Discharge Management Project Group of the Federal Association of German Hospital Pharmacists (ADKA) e.V. and the German Pharmaceutical Society (DPhG) e. V., Alt-Moabit 96/Varrentrappstraße 40-42, 10559/60486, Berlin/Frankfurt am Main, Germany
- Pharmacy Department, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Palmsanlage 3, 91054, Erlangen, Germany
| | - Heike Hilgarth
- Joined Discharge Management Project Group of the Federal Association of German Hospital Pharmacists (ADKA) e.V. and the German Pharmaceutical Society (DPhG) e. V., Alt-Moabit 96/Varrentrappstraße 40-42, 10559/60486, Berlin/Frankfurt am Main, Germany
- Federal Association of German Hospital Pharmacists (ADKA) e. V./ADKA Academy of Hospital Pharmacy gGmbH, Alt-Moabit 96, 10559, Berlin, Germany
| | - Nadine Metzger
- Joined Discharge Management Project Group of the Federal Association of German Hospital Pharmacists (ADKA) e.V. and the German Pharmaceutical Society (DPhG) e. V., Alt-Moabit 96/Varrentrappstraße 40-42, 10559/60486, Berlin/Frankfurt am Main, Germany
- German Pharmaceutical Society (DPhG) e. V, Varrentrappstraße 40-42, 60486, Frankfurt am Main, Germany
| | - Ina Richling
- Joined Discharge Management Project Group of the Federal Association of German Hospital Pharmacists (ADKA) e.V. and the German Pharmaceutical Society (DPhG) e. V., Alt-Moabit 96/Varrentrappstraße 40-42, 10559/60486, Berlin/Frankfurt am Main, Germany
- Central Pharmacy of the catholic clinics of Märkischer Kreis (Zentralapotheke der Katholischen Kliniken im Märkischen Kreis), Hochstraße 63, 58638, Iserlohn, Germany
- Pharmacy, St.-Johannes-Hospital, Johannesstraße 9-13, 44137, Dortmund, Germany
| | - Hanna M Seidling
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- Joined Discharge Management Project Group of the Federal Association of German Hospital Pharmacists (ADKA) e.V. and the German Pharmaceutical Society (DPhG) e. V., Alt-Moabit 96/Varrentrappstraße 40-42, 10559/60486, Berlin/Frankfurt am Main, Germany.
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Klasing S, Jungreithmayr V, Morath B, Scherkl C, Meid AD, Haefeli WE, Seidling HM. [Quality of medication documentation in patientś discharge summaries after implementing new legal requirements]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 188:1-13. [PMID: 38918158 DOI: 10.1016/j.zefq.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/27/2024] [Accepted: 05/06/2024] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Discharge from hospital is a risk to drug continuity and medication safety. In Germany, new legal requirements concerning the management of patient discharge from the hospital came into force in 2017. They set minimum requirements for the documentation of medications in patient discharge summaries, which are the primary means of communication at transitions of care. Six years later, data on their practical implementation in routine care are lacking. METHODS Within the scope of an explorative retrospective observational study, the minimum requirements were operationalized and a second set of assessment criteria was derived from the recommendation "Good Prescribing Practice in Drug Therapy" published by the Aktionsbündnis Patientensicherheit e.V. as a comparative quality standard. A sample of discharge summaries was drawn from routine care at the University Hospital Heidelberg and assessed according to their fulfilment of the criteria sets. In addition, the potential influence of certain context factors (e. g., involvement of clinical pharmacists or software usage) was evaluated. RESULTS In total, 11 quality criteria were derived from the minimum requirements. According to the eligibility criteria (i. e., three or more discharge medications) 352 discharge summaries (42 wards; issued in May-July 2021), containing in total 3,051 medications, were included. The practical implementation of the minimum requirements for documenting medications in patient discharge summaries differed considerably depending on the criterion and defined context factors. Core elements (i. e., drug name, strength, and dosage at discharge) were fulfilled in 82.8 %, while further minimum requirements were rarely met or completely lacking (e. g., explanations for special pharmaceutical forms). Involvement of clinical pharmacists and usage of software were shown to be a facilitator of documentation quality, while on-demand medication (compared to long-term medication) as well as newly prescribed medication (compared to home medication or medication changed during hospitalisation) showed poorer documentation quality. In addition, the documentation quality seemed to depend on the department and the day of discharge. CONCLUSION To date, the wording of the German legal requirements allows for different interpretations without considering the respective clinical setting and the medication actually prescribed. For future clarification of the requirements, implications of the wording for the clinical setting should be considered.
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Affiliation(s)
- Sophia Klasing
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Viktoria Jungreithmayr
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Benedict Morath
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Apotheke des Universitätsklinikums Heidelberg, Heidelberg, 69120, Deutschland
| | - Camilo Scherkl
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Andreas D Meid
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Walter E Haefeli
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Hanna M Seidling
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland.
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Tung JYM, Gill SR, Sng GGR, Lim DYZ, Ke Y, Tan TF, Jin L, Elangovan K, Ong JCL, Abdullah HR, Ting DSW, Chong TW. Comparison of the Quality of Discharge Letters Written by Large Language Models and Junior Clinicians: Single-Blinded Study. J Med Internet Res 2024; 26:e57721. [PMID: 39047282 PMCID: PMC11306941 DOI: 10.2196/57721] [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: 02/25/2024] [Revised: 04/18/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Discharge letters are a critical component in the continuity of care between specialists and primary care providers. However, these letters are time-consuming to write, underprioritized in comparison to direct clinical care, and are often tasked to junior doctors. Prior studies assessing the quality of discharge summaries written for inpatient hospital admissions show inadequacies in many domains. Large language models such as GPT have the ability to summarize large volumes of unstructured free text such as electronic medical records and have the potential to automate such tasks, providing time savings and consistency in quality. OBJECTIVE The aim of this study was to assess the performance of GPT-4 in generating discharge letters written from urology specialist outpatient clinics to primary care providers and to compare their quality against letters written by junior clinicians. METHODS Fictional electronic records were written by physicians simulating 5 common urology outpatient cases with long-term follow-up. Records comprised simulated consultation notes, referral letters and replies, and relevant discharge summaries from inpatient admissions. GPT-4 was tasked to write discharge letters for these cases with a specified target audience of primary care providers who would be continuing the patient's care. Prompts were written for safety, content, and style. Concurrently, junior clinicians were provided with the same case records and instructional prompts. GPT-4 output was assessed for instances of hallucination. A blinded panel of primary care physicians then evaluated the letters using a standardized questionnaire tool. RESULTS GPT-4 outperformed human counterparts in information provision (mean 4.32, SD 0.95 vs 3.70, SD 1.27; P=.03) and had no instances of hallucination. There were no statistically significant differences in the mean clarity (4.16, SD 0.95 vs 3.68, SD 1.24; P=.12), collegiality (4.36, SD 1.00 vs 3.84, SD 1.22; P=.05), conciseness (3.60, SD 1.12 vs 3.64, SD 1.27; P=.71), follow-up recommendations (4.16, SD 1.03 vs 3.72, SD 1.13; P=.08), and overall satisfaction (3.96, SD 1.14 vs 3.62, SD 1.34; P=.36) between the letters generated by GPT-4 and humans, respectively. CONCLUSIONS Discharge letters written by GPT-4 had equivalent quality to those written by junior clinicians, without any hallucinations. This study provides a proof of concept that large language models can be useful and safe tools in clinical documentation.
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Affiliation(s)
- Joshua Yi Min Tung
- Department of Urology, Singapore General Hospital, Singapore, Singapore
- Data Science and Artificial Intelligence Laboratory, Singapore General Hospital, Singapore, Singapore
| | | | - Gerald Gui Ren Sng
- Data Science and Artificial Intelligence Laboratory, Singapore General Hospital, Singapore, Singapore
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Daniel Yan Zheng Lim
- Data Science and Artificial Intelligence Laboratory, Singapore General Hospital, Singapore, Singapore
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Yuhe Ke
- Data Science and Artificial Intelligence Laboratory, Singapore General Hospital, Singapore, Singapore
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Ting Fang Tan
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
| | - Liyuan Jin
- Duke-NUS Medical School, Singapore, Singapore
| | - Kabilan Elangovan
- Artificial Intelligence Office, Singapore Health Services, Singapore, Singapore
| | | | - Hairil Rizal Abdullah
- Data Science and Artificial Intelligence Laboratory, Singapore General Hospital, Singapore, Singapore
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Artificial Intelligence Office, Singapore Health Services, Singapore, Singapore
| | - Tsung Wen Chong
- Department of Urology, Singapore General Hospital, Singapore, Singapore
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Kim WY, Baek A, Kim Y, Suh Y, Lee E, Lee EE, Lee JY, Lee J, Park HS, Kim ES, Lim Y, Kim NH, Ohn JH, Kim SW, Ryu J, Kim HW. The Impact of Real-Time Documentation of In-Hospital Medication Changes on Preventing Undocumented Discrepancies at Discharge and Improving Physician-Pharmacist Communication: A Retrospective Cohort Study and Survey. J Multidiscip Healthc 2024; 17:2999-3010. [PMID: 38948395 PMCID: PMC11214548 DOI: 10.2147/jmdh.s460877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/06/2024] [Indexed: 07/02/2024] Open
Abstract
Background Transitional medication safety is crucial, as miscommunication about medication changes can lead to significant risks. Unclear or incomplete documentation during care transitions can result in outdated or incorrect medication lists at discharge, potentially causing medication errors, adverse drug events, and inadequate patient education. These issues are exacerbated by extended hospital stays and multiple care events, making accurate medication recall challenging at discharge. Objective Thus, we aimed to investigate how real-time documentation of in-hospital medication changes prevents undocumented medication changes at discharge and improves physician-pharmacist communication. Methods We conducted a retrospective cohort study in a tertiary hospital. Two pharmacists reviewed medical records of patients admitted to the acute medical unit from April to June 2020. In-hospital medication discrepancies were determined by comparing preadmission and hospitalization medication lists and it was verified whether the physician's intent of medication changes was clarified by documentation. By a documentation rate of medication changes of 100% and <100%, respectively, fully documented (FD) and partially documented (PD) groups were defined. Any undocumented medication changes at discharge were considered a "documentation error at discharge". Pharmacists' survey was conducted to assess the impact of appropriate documentation on the pharmacists. Results After reviewing 400 medication records, patients were categorized into FD (61.3%) and PD (38.8%) groups. Documentation errors at discharge were significantly higher in the PD than in the FD group. Factors associated with documentation errors at discharge included belonging to the PD group, discharge from a non-hospitalist-managed ward, and having three or more intentional discrepancies. Pharmacists showed favorable attitudes towards physician's documentation. Conclusion Appropriate documentation of in-hospital medication changes, facilitated by free-text communication, significantly decreased documentation errors at discharge. This analysis underlines the importance of communication between pharmacists and hospitalists in improving patient safety during transitions of care.
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Affiliation(s)
- Woo-Youn Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, South Korea
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Anna Baek
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yoonhee Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yewon Suh
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, South Korea
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Eunsook Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eunkyung Euni Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, South Korea
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Ju-Yeun Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, South Korea
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
| | - Jongchan Lee
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hee Sun Park
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Sun Kim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Yejee Lim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Nak-Hyun Kim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Hun Ohn
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sun-wook Kim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jiwon Ryu
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hye Won Kim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Yahalom S, Manias E. Nurses engaging with referral letters and discharge summaries: A qualitative study. J Clin Nurs 2024; 33:2309-2323. [PMID: 38304996 DOI: 10.1111/jocn.17054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
AIMS To investigate the ways that nurses engage with referral letters and discharge summaries, and the qualities of these documents they find valuable for safe and effective practice. DESIGN This study comprised a qualitative, case-study design within a constructivist paradigm using convenience sampling. METHODS Interviews were conducted with nurses to investigate their practices relating to referral letters and discharge summaries. Data collection also involved nurses' examination and evaluation of a diverse range of 10 referral letters and discharge summaries from medical records at two Australian hospitals through focus-group sessions. The data were transcribed and analysed inductively. RESULTS In all, 67 nurses participated in interviews or focus groups. Nurses indicated they used referral letters and discharge summaries to inform their work when caring for patients at different times throughout their hospitalisation. These documents assisted them with verbal handovers, to enable them to educate patients about their condition and treatment and to provide a high standard of care. The qualities of referral letters and discharge summaries that they most valued were language and communication, an awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information. CONCLUSION Nurses relied on referral letters and discharge summaries to ensure safe and effective patient care. They used these documents to enhance their verbal handovers, contribute to patient care and to educate the patient about their condition and treatment. They identified several qualities of these documents that assisted them in maintaining patient safety including clarity and conciseness of information. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE It is important that referral letters and discharge summaries are written clearly, concisely and comprehensively because nurses use them as key sources of evidence in planning and delivering care, and in communicating with other health professionals in relaying goals of care and implementing treatment plans. IMPACT Nurses reported that they regularly used referral letters and discharge summaries as valuable sources of evidence throughout their patients' hospitalisation. The qualities of these documents which they most valued were language and communication styles, awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information. This research has important impact on the patient experience in relation to encouraging effective referral letter and discharge summary writing. REPORTING METHOD We have adhered to the relevant EQUATOR guidelines through the SRQR reporting method. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Sharon Yahalom
- Faculty of Medicine, Nursing and Health Sciences, Student Academic Support Unit, Monash University, Melbourne, Victoria, Australia
- Faculty of Arts, School of Languages and Linguistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Manias
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Mikkelsen TH, Søndergaard J, Kjær NK, Nielsen JB, Ryg J, Kjeldsen LJ, Mogensen CB. Designing a tool ensuring older patients the right medication at the right time after discharge from hospital- the first step in a participatory design process. BMC Health Serv Res 2024; 24:511. [PMID: 38658997 PMCID: PMC11040918 DOI: 10.1186/s12913-024-10992-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND On average, older patients use five or more medications daily, increasing the risk of adverse drug reactions, interactions, or medication errors. Healthcare sector transitions increase the risk of information loss, misunderstandings, unclear treatment responsibilities, and medication errors. Therefore, it is crucial to identify possible solutions to decrease these risks. Patients, relatives, and healthcare professionals were asked to design the solution they need. METHODS We conducted a participatory design approach to collect information from patients, relatives, and healthcare professionals. The informants were asked to design their take on a tool ensuring that patients received the correct medication after discharge from the hospital. We included two patients using five or more medications daily, one relative, three general practitioners, four nurses from different healthcare sectors, two hospital physicians, and three pharmacists. RESULTS The patients' solution was a physical location providing a medication overview, including side effects and interactions. Healthcare professionals suggested different solutions, including targeted and timely information that provided an overview of the patient's diagnoses, treatment and medication. The common themes identified across all sub-groups were: (1) Overview of medications, side effects, and diagnoses, (2) Sharing knowledge among healthcare professionals, (3) Timely discharge letters, (4) Does the shared medication record and existing communication platforms provide relevant information to the patient or healthcare professional? CONCLUSION All study participants describe the need for a more concise, relevant overview of information. This study describes elements for further elaboration in future participatory design processes aimed at creating a tool to ensure older patients receive the correct medication at the correct time.
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Affiliation(s)
- Thorbjørn Hougaard Mikkelsen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Kristian Kjær
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Lene Juel Kjeldsen
- The hospital pharmacy research unit, Hospital Sønderjylland, Aabenraa, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Waeschle RM, Epperlein T, Demmer I, Hummers E, Quintel Q. Intersectoral cooperation between university hospitals and physicians in private practice in Germany- where the potential for optimization lies. BMC Health Serv Res 2024; 24:497. [PMID: 38649877 PMCID: PMC11034040 DOI: 10.1186/s12913-024-10963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Intersectoral cooperation between physicians in private practice and hospitals is highly relevant for ensuring the quality of medical care. However, the experiences and potential for optimization at this interface from the perspective of physicians in private practice have not yet been systematically investigated. The aim of this questionnaire survey was to record participants' experiences with regard to cooperation with university hospitals and to identify the potential for optimizing intersectoral cooperation. METHODS We performed a prospective cross-sectional study using an online survey among practising physicians of all disciplines offering ambulatory care in Germany. The link to a 41-item questionnaire was sent via mail using a commercial mail distributor in which 1095 practising physicians participated. Baseline statistics were performed with SurveyMonkey and Excel. RESULTS A total of 70.6%/722 of the responding physicians in private practice rated cooperation with university hospitals as satisfactory. Satisfaction with the quality of treatment was confirmed by 87.2%/956 of the physicians. The subjectively perceived complication rate in patient care was assessed as rare (80.9%/886). However, the median waiting time for patients in the inpatient discharge letter was 4 weeks. The accessibility of medical contact persons was rated as rather difficult by 52.6%/577 of the physicians. A total of 48.6%/629 of the participants considered better communication as an equal partner to be an important potential for optimization. Likewise, 65.2%/714 participants wished for closer cooperation in pre- and/or post inpatient care. CONCLUSION The following optimization potentials were identified: timely discharge letters, clear online presentations of clinical contacts, improved accessibility by telephone, introduction or further development of a referral portal, regular intersectoral training and/or "get-togethers", regular surveys of general practitioners and implementation of resulting measures, further development of cross-sectoral communication channels and strengthening of hospital IT.
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Affiliation(s)
- R M Waeschle
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
| | - T Epperlein
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - I Demmer
- Department of General Practice, University Medical Centre Göttingen, Göttingen, Germany
| | - E Hummers
- Department of General Practice, University Medical Centre Göttingen, Göttingen, Germany
| | - Q Quintel
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
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8
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Strumann C, Pfau L, Wahle L, Schreiber R, Steinhäuser J. Designing and Implementation of a Digitalized Intersectoral Discharge Management System and Its Effect on Readmissions: Mixed Methods Approach. J Med Internet Res 2024; 26:e47133. [PMID: 38530343 PMCID: PMC11005442 DOI: 10.2196/47133] [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: 03/09/2023] [Revised: 06/13/2023] [Accepted: 01/31/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Digital transformation offers new opportunities to improve the exchange of information between different health care providers, including inpatient, outpatient and care facilities. As information is especially at risk of being lost when a patient is discharged from a hospital, digital transformation offers great opportunities to improve intersectoral discharge management. However, most strategies for improvement have focused on structures within the hospital. OBJECTIVE This study aims to evaluate the implementation of a digitalized discharge management system, the project "Optimizing instersectoral discharge management" (SEKMA, derived from the German Sektorübergreifende Optimierung des Entlassmanagements), and its impact on the readmission rate. METHODS A mixed methods design was used to evaluate the implementation of a digitalized discharge management system and its impact on the readmission rate. After the implementation, the congruence between the planned (logic model) and the actual intervention was evaluated using a fidelity analysis. Finally, bivariate and multivariate analyses were used to evaluate the effectiveness of the implementation on the readmission rate. For this purpose, a difference-in-difference approach was adopted based on routine data of hospital admissions between April 2019 and August 2019 and between April 2022 and August 2022. The department of vascular surgery served as the intervention group, in which the optimized discharge management was implemented in April 2022. The departments of internal medicine and cardiology formed the control group. RESULTS Overall, 26 interviews were conducted, and we explored 21 determinants, which can be categorized into 3 groups: "optimization potential," "barriers," and "enablers." On the basis of these results, 19 strategies were developed to address the determinants, including a lack of networking among health care providers, digital information transmission, and user-unfriendliness. On the basis of these strategies, which were prioritized by 11 hospital physicians, a logic model was formulated. Of the 19 strategies, 7 (37%; eg, electronic discharge letter, providing mobile devices to the hospital's social service, and generating individual medication plans in the format of the national medication plan) have been implemented in SEKMA. A survey on the fidelity of the application of the implemented strategies showed that 3 of these strategies were not yet widely applied. No significant effect of SEKMA on readmissions was observed in the routine data of 14,854 hospital admissions (P=.20). CONCLUSIONS This study demonstrates the potential of optimizing intersectoral collaboration for patient care. Although a significant effect of SEKMA on readmissions has not yet been observed, creating a digital ecosystem that connects different health care providers seems to be a promising approach to ensure secure and fast networking of the sectors. The described intersectoral optimization of discharge management provides a structured template for the implementation of a similar local digital care networking infrastructure in other care regions in Germany and other countries with a similarly fragmented health care system.
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Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Lisa Pfau
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Laila Wahle
- Lacanja GmbH Health Innovation Port, Hamburg, Germany
| | - Raphael Schreiber
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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9
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Wang B, Manskow US. Health professionals' experience and perceived obstacles with managing patients' medication information in Norway: cross-sectional survey. BMC Health Serv Res 2024; 24:68. [PMID: 38218841 PMCID: PMC10790274 DOI: 10.1186/s12913-023-10485-9] [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: 08/28/2023] [Accepted: 12/15/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Access to correct and up to date medication information is crucial for effective patient treatment. However, persistent discrepancies exist. This study examines the experiences and challenges health professionals encounter while utilizing current digital solutions in the Norwegian healthcare system to manage patients' medication information. METHODS A cross-sectional descriptive analysis using quantitative survey data was conducted to investigate how health professionals managed patients' medication information. Content analysis was used to analyze free-text responses concerning challenges they encountered when transferring medication information and to identify factors deemed necessary for implementing the Shared Medication List in Norway. RESULTS A total of 262 doctors and 244 nurses responded to the survey. A higher percentage of doctors (72.2%) expressed concerns regarding obtaining accurate and updated medication lists than nurses (42.9%), particularly for patients with polypharmacy (35.3%) or transitioning between primary and specialist care services (27.6%). The patient's verbal information was the main source for hospital doctors (17%) to obtain an overview of the patient's medication usage, while general practitioners (19%) and nurses (working in both primary and specialist care services, 28% and 27% respectively) predominantly relied on electronic prescriptions. Doctors, in particular general practitioners, reported carrying excessive responsibilities in coordinating with other health actors (84.8%) and managing patients' medication information. The vast majority of both doctors (84.4%) and nurses (82.0%) were in favor of a Shared Medication List. However, about a third of doctors (36.3%) and nurses (29.8%) expressed the need for a more balanced responsibility in updating and managing patients' medication information, while ensuring compatibility with existing digital systems. CONCLUSIONS Fragmented resources for medication information and unclear responsibilities were prevalent concerns among both professional groups. Doctors voiced more concern than nurses about the accuracy of patients' medication list. While both groups are positive about a shared medication list, successful implementation requires proactive training initiatives and clearer role clarification.
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Affiliation(s)
- Bo Wang
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Sykehusvegen 23, Forskningsparken, Tromsø, Norway.
| | - Unn Sollid Manskow
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Sykehusvegen 23, Forskningsparken, Tromsø, Norway
- Department of Health and Care Sciences, Centre for Care Research, UiT- The Arctic University of Norway, Tromsø, Norway
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10
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Javanparast S, Roeger L, Reed RL. General practice staff and patient experiences of a multicomponent intervention for people at high risk of poor health outcomes: a qualitative study. BMC PRIMARY CARE 2024; 25:18. [PMID: 38191349 PMCID: PMC10775450 DOI: 10.1186/s12875-023-02256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND This study reports the experiences of general practice staff and patients at high risk of poor health outcomes who took part in a clustered randomised controlled trial of a multicomponent general practice intervention. The intervention comprised patient enrolment to a preferred General Practitioner (GP) to promote continuity of care, access to longer GP appointments, and timely general practice follow-up after hospital care episodes. The aims of the study were to better understand participant's (practice staff and patients) perspectives of the intervention, their views on whether the intervention had improved general practice services, reduced hospital admissions and finally whether they believed the intervention would be sustainable after the trial had completed. METHODS A qualitative study design with semi-structured interviews was employed. The practice staff sample was drawn from both the control and intervention groups. The patient sample was drawn from those who had expressed an interest in taking part in an interview during the trial and who had also experienced a recent hospital care episode. RESULTS Interviews were conducted with 41 practice staff and 45 patients. Practice staff and patients expressed support for the value of appointments with a regular GP and having sufficient time in appointments for the provision of comprehensive care. There were mixed views with respect to the extent to which the intervention had improved services. The positive changes reported were related to services being provided in a more proactive, thorough, and systematic manner with a greater emphasis on team based care involving the Practice Nurse. Patients nominated after hours care and financial considerations as the key reasons for seeking hospital care. Practice staff noted that the intervention would be difficult to sustain financially in the absence of additional funding. CONCLUSIONS The multicomponent intervention was supported by practice staff and patients and some patients perceived that it had led to improvements in care.
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Affiliation(s)
- Sara Javanparast
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Leigh Roeger
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Richard L Reed
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
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11
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Kruys E, Wu CJJ. Hospital doctors' and general practitioners' perspectives of outpatient discharge processes in Australia: an interpretive approach. BMC Health Serv Res 2023; 23:1225. [PMID: 37940986 PMCID: PMC10634127 DOI: 10.1186/s12913-023-10221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Unnecessary delays in patient discharge from hospital outpatient clinics have direct consequences for timely access of new patients and the length of outpatient waiting times. The aim of this study was to gain better understanding of hospital doctors' and general practitioners' perspectives of the barriers and facilitators when discharging from hospital outpatients to general practice. METHODS An interpretative approach incorporating semi-structured interviews with 15 participants enabled both hospital doctors and general practitioners to give their perspectives on hospital outpatient discharge processes. RESULTS Participants mentioned various system problems hampering discharge from hospital outpatient clinics to general practice, such as limitations of electronic communication tools, workforce and workload challenges, the absence of agreed discharge principles, and lack of benchmark data. Hospital clinicians may keep patients under their care out of a concern about lack of follow-up and an inability to escalate timely hospital care following discharge. Some hospital clinicians may have a personal preference to provide ongoing care in the outpatient setting. Other factors mentioned were insufficient supervision of junior doctors, a patient preference to remain under hospital care, and the ease of scheduling follow-up appointments. An effective handover process requires protected time, a systematic approach, and a supportive clinical environment including user-friendly electronic communication and clinical handover tools. Several system improvements and models of care were suggested, such as agreed discharge processes, co-designed between hospitals and general practice. Recording and sharing outpatient discharge data may assist to inform and motivate hospital clinicians and support the training of junior doctors. General practitioners participating in the study were prepared to provide continuation of care but require timely clinical management plans that can be applied in the community setting. A hospital re-entry pathway providing rapid access to outpatient hospital resources after discharge could act as a safety net and may be an alternative to the standard 12-month review in hospital outpatient clinics. CONCLUSION Our study supports the barriers to discharge as mentioned in the literature and adds the perspectives of both hospital clinicians and general practitioners. Potential solutions were suggested including co-designed discharge policies, improved electronic communication tools and a rapid hospital review pathway following discharge.
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Affiliation(s)
- Edwin Kruys
- General Practice Liaison Unit, Sunshine Coast Hospital and Health Service, Birtinya, QLD4575, Australia
| | - Chiung-Jung Jo Wu
- School of Health, University of the Sunshine Coast, 1 Moreton Parade, Petrie, QLD, 4502, Australia.
- Royal Brisbane and Women's Hospital (RBWH), Herston, QLD, 4006, Australia.
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12
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Biringer E, Helgeland J, Hellesen HB, Aβmus J, Hartveit M. Development and testing of the QDis-MH checklist for discharge letters from specialised mental healthcare: a stakeholder-centred study. BMJ Open Qual 2023; 12:bmjoq-2022-002036. [PMID: 37019467 PMCID: PMC10083855 DOI: 10.1136/bmjoq-2022-002036] [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: 07/06/2022] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND The 'discharge letter' is the mandatory written report sent from specialists in the specialist services to general practitioners (GPs) on patient discharge. Clear recommendations from relevant stakeholders for contents of discharge letters and instruments to measure the quality of discharge letters in mental healthcare are needed. The objectives were to (1) detect which information relevant stakeholders defined as important to include in discharge letters from mental health specialist services, (2) develop a checklist to measure the quality of discharge letters and (3) test the psychometric properties of the checklist. METHODS We used a stepwise multimethod stakeholder-centred approach. Group interviews with GPs, mental health specialists and patient representatives defined 68 information items with 10 consensus-based thematic headings relevant to include in high-quality discharge letters. Information items rated as highly important by GPs (n=50) were included in the Quality of Discharge information-Mental Health (QDis-MH) checklist. The 26-item checklist was tested by GPs (n=18) and experts in healthcare improvement or health services research (n=15). Psychometric properties were assessed using estimates of intrascale consistency and linear mixed effects models. Inter-rater and test-retest reliability were assessed using Gwet's agreement coefficient (Gwet's AC1) and intraclass correlation coefficients. RESULTS The QDis-MH checklist had satisfactory intrascale consistency. Inter-rater reliability was poor to moderate, and test-retest reliability was moderate. In descriptive analyses, mean checklist scores were higher in the category of discharge letters defined as 'good' than in 'medium' or 'poor' letters, but differences did not reach statistical significance. CONCLUSIONS GPs, mental health specialists and patient representatives defined 26 information items relevant to include in discharge letters in mental healthcare. The QDis-MH checklist is valid and feasible. However, when using the checklist, raters should be trained and the number of raters kept to a minimum due to questionable inter-rater reliability.
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Affiliation(s)
- Eva Biringer
- Department of Research and Innovation, Helse Fonna HF, Haugesund/Valen/Stord, Norway
| | | | | | - Jörg Aβmus
- Centre for Clinical Research, Helse Bergen HF, Bergen, Norway
| | - M Hartveit
- Department of Research and Innovation, Helse Fonna HF, Haugesund/Valen/Stord, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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13
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Catapano AL, De Caterina R, Jukema JW, Klempfner R, Landmesser U, Schiele F, Sionis A. Addressing current challenges in optimization of lipid management following an ACS event: Outcomes of the ACS EuroPath III initiative. Clin Cardiol 2023; 46:407-415. [PMID: 36799113 PMCID: PMC10106658 DOI: 10.1002/clc.23988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/29/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Low-density lipoprotein cholesterol (LDL-C) lowering is key to reduce atherosclerotic disease progression and recurrent events for patients after acute coronary syndrome (ACS). However, LDL-C management for post-ACS patients remains challenging in clinical practice. HYPOTHESIS The ACS EuroPath III project was designed to optimize LDL-C management in post-ACS patients by promoting guideline implementation and translating existing evidence into effective actions. METHODS Three surveys targeting cardiologists (n = 555), general practitioners (GPs; n = 445), and patients (n = 662) were conducted in Europe, with the aim of capturing information on patient characteristics and treatment during acute phase, discharge and follow-up. GPs' and patients' opinions on key treatment aspects were also collected. Based on survey results, international experts and clinicians identified areas of improvement and generated prototype solutions. Participants voted to select the most feasible and replicable proposals for co-development and implementation. RESULTS Five key areas of improvement were identified: (1) inappropriate treatment prescribed at discharge; (2) lack of lipid guidance in the discharge letter; (3) inadequate lipid-lowering therapy (LLT) optimization; (4) gaps in guideline knowledge and lack of referral practices for GPs; (5) patients' concerns about lipid management. Proposed solutions for these focus areas included development of a treatment algorithm for the acute phase, a standardized GP discharge letter, an assessment tool for LLT efficacy at follow-up, an education plan for GPs/patients and a patient engagement discharge kit. The standardized GP discharge letter and treatment algorithm have been selected as the highest priority solutions for development. CONCLUSION These initiatives have the potential to improve adherence to guidelines and patient management after ACS.
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Affiliation(s)
- Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Raffaele De Caterina
- Division of Cardiovascular, Department of Cardiothoracic and Vascular, Pisa University Hospital, University of Pisa, Pisa, Azienda Ospedaliero-Universitaria Pisana, Pisa, and Fondazione Villaserena per la Ricerca, Città Sant'Angelo, Pescara, Italy
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Robert Klempfner
- Cardiac Rehabilitation Institute, Sheba Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Ulf Landmesser
- Department of Cardiology, Charité University Medicine Berlin, German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - François Schiele
- Department of Cardiology, University of Burgundy Franche-Comte, University Hospital Jean Minjoz, Besançon, France
| | - Alessandro Sionis
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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14
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Weetman K, Dale J, Mitchell SJ, Ferguson C, Finucane AM, Buckle P, Arnold E, Clarke G, Karakitsiou DE, McConnell T, Sanyal N, Schuberth A, Tindle G, Perry R, Grewal B, Patynowska KA, MacArtney JI. Communication of palliative care needs in discharge letters from hospice providers to primary care: a multisite sequential explanatory mixed methods study. Palliat Care 2022; 21:155. [PMID: 36064662 PMCID: PMC9444706 DOI: 10.1186/s12904-022-01038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background The provision of palliative care is increasing, with many people dying in community-based settings. It is essential that communication is effective if and when patients transition from hospice to community palliative care. Past research has indicated that communication issues are prevalent during hospital discharges, but little is known about hospice discharges. Methods An explanatory sequential mixed methods study consisting of a retrospective review of hospice discharge letters, followed by hospice focus groups, to explore patterns in communication of palliative care needs of discharged patients and describe why these patients were being discharged. Discharge letters were extracted for key content information using a standardised form. Letters were then examined for language patterns using a linguistic methodology termed corpus linguistics. Thematic analysis was used to analyse the focus group transcripts. Findings were triangulated to develop an explanatory understanding of discharge communication from hospice care. Results We sampled 250 discharge letters from five UK hospices whereby patients had been discharged to primary care. Twenty-five staff took part in focus groups. The main reasons for discharge extracted from the letters were symptoms “managed/resolved” (75.2%), and/or the “patient wishes to die/for care at home” (37.2%). Most patients had some form of physical needs documented on the letters (98.4%) but spiritual needs were rarely documented (2.4%). Psychological/emotional needs and social needs were documented in 46.4 and 35.6% of letters respectively. There was sometimes ambiguity in “who” will be following up “what” in the discharge letters, and whether described patients’ needs were resolved or ongoing for managing in the community setting. The extent to which patients received a copy of their discharge letter varied. Focus groups conveyed a lack of consensus on what constitutes “complexity” and “complex pain”. Conclusions The content and structure of discharge letters varied between hospices, although generally focused on physical needs. Our study provides insights into patterns associated with those discharged from hospice, and how policy and guidance in this area may be improved, such as greater consistency of sharing letters with patients. A patient-centred set of hospice-specific discharge letter principles could help improve future practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01038-8.
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Affiliation(s)
- Katharine Weetman
- Interactive Studies Unit, Institute of Clinical Sciences, Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK. .,Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Claire Ferguson
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | - Anne M Finucane
- Marie Curie Hospice Edinburgh, Edinburgh, UK.,The University of Edinburgh School of Health in Social Science, Clinical Psychology, Edinburgh, UK
| | - Peter Buckle
- Marie Curie Research Voices Group, Marie Curie, England, London, UK
| | | | - Gemma Clarke
- Marie Curie Hospice Bradford, Bradford, UK.,University of Leeds, Academic Unit of Palliative Care, Leeds, West Yorkshire, UK
| | | | - Tracey McConnell
- Marie Curie Hospice Belfast, Belfast, UK.,Queen's University Belfast School of Nursing and Midwifery, Belfast, UK
| | - Nikhil Sanyal
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | | | - Georgia Tindle
- Marie Curie Hospice Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Rachel Perry
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | | | | | - John I MacArtney
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK.,Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
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15
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Henriksen BT, Andersson Y, Davies MN, Mathiesen L, Krogseth M, Andersen RD. Development and initial validation of MedHipPro-Q: a questionnaire assessing medication management of hip fracture patients in different care settings. BMC Health Serv Res 2022; 22:240. [PMID: 35193572 PMCID: PMC8862359 DOI: 10.1186/s12913-022-07524-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background A validated questionnaire to assess medication management of hip fracture patients within and outside the hospital setting was lacking. The study aims were to describe the hip fracture patient pathway, and develop a valid and feasible questionnaire to assess clinicians’ experience with medication management of hip fracture patients in different care settings throughout the patient pathway. Methods This qualitative, descriptive methodological study used strategic and snowball sampling. The questionnaire was developed, and face and content validity explored through interviews with stakeholders. Phase I described the hip fracture patient pathway, and identified questionnaire dimensions in semi-structured interviews with management and clinicians (n = 37). The patient pathway was also discussed in six meetings (n = 70). Phase II refined a first draft of the questionnaire through cognitive interviews with future respondents (n = 23). The draft was modified after each interview. Post hoc, cognitive interview data were analysed using matrix analysis to condense problems and solutions into themes and subthemes. Phase III, converted the final version to a digital format, and tested its feasibility with a subset of the cognitive interview participants (n = 21) who completed the questionnaire and provided feedback. Results Phase I: Hip fracture patients were cared for in at least three different care settings, and went through at least four handovers between and within primary and secondary care. Three questionnaire dimensions were identified: 1) Medication reconciliation and review, 2) Communication of key information, and 3) Profession and setting. Phase II: The MedHipPro-Q was representative of how the different professions experienced medication management in all settings, and hence showed face and content validity. Post hoc analysis: Problem themes (with sub-themes) were Representativeness (-of patient pathway and -of respondent reality) and Presentation (Language and Appearance). Solution themes (with sub-themes) were: Content (added or deleted) and Presentation (modified appearance or corrected language). Phase III: Participants did not identify technical, linguistic or content flaws in the questionnaire, and the digital version was considered feasible for use. Conclusion The novel MedHipPro-Q showed good face and content validity, and was feasible for use throughout the hip fracture patient pathway. The rigorous development process supports its construct validity and reliability. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07524-2.
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Affiliation(s)
- Ben Tore Henriksen
- Tonsberg Hospital Pharmacy, Hospital Pharmacies Enterprise, South-Eastern Norway, Tonsberg, Norway. .,Vestfold Hospital Trust, Tonsberg, Norway. .,Department of Pharmacy, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
| | - Yvonne Andersson
- Hospital Pharmacies Enterprise, South-Eastern Norway, Oslo, Norway
| | - Maren Nordsveen Davies
- Tonsberg Hospital Pharmacy, Hospital Pharmacies Enterprise, South-Eastern Norway, Tonsberg, Norway
| | - Liv Mathiesen
- Department of Pharmacy, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Maria Krogseth
- Department of Internal Medicine, Telemark Hospital Trust, Skien, Norway.,Old Age Psychiatry Research Network, Telemark Hospital Trust and Vestfold Hospital Trust, Tonsberg, Norway.,University of South-Eastern Norway, Drammen, Norway
| | - Randi Dovland Andersen
- Department of Research, Telemark Hospital Trust, Skien, Norway.,Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), The Faculty of Medicine, University of Oslo, Oslo, Norway
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16
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Implementation of a shared medication list in primary care - a controlled pre-post study of medication discrepancies. BMC Health Serv Res 2021; 21:1335. [PMID: 34903215 PMCID: PMC8670071 DOI: 10.1186/s12913-021-07346-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
Background Access to medicines information is important when treating patients, yet discrepancies in medication records are common. Many countries are developing shared medication lists across health care providers. These systems can improve information sharing, but little is known about how they affect the need for medication reconciliation. The aim of this study was to investigate whether an electronically Shared Medication List (eSML) reduced discrepancies between medication lists in primary care. Methods In 2018, eSML was tested for patients in home care who received multidose drug dispensing (MDD) in Oslo, Norway. We followed this transition from the current paper-based medication list to an eSML. Medication lists from the GP, home care service and community pharmacy were compared 3 months before the implementation and 18 months after. MDD patients in a neighbouring district in Oslo served as a control group. Results One hundred eighty-nine patients were included (100 intervention; 89 control). Discrepancies were reduced from 389 to 122 (p < 0.001) in the intervention group, and from 521 to 503 in the control group (p = 0.734). After the implementation, the share of mutual prescription items increased from 77 to 94%. Missing prescriptions for psycholeptics, analgesics and dietary supplements was reduced the most. Conclusions The eSML greatly decreases discrepancies between the GP, home care and pharmacy medication lists, but does not eliminate the need for medication reconciliation.
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Weetman K, Dale J, Scott E, Schnurr S. Discharge communication study: a realist evaluation of discharge communication experiences of patients, general practitioners and hospital practitioners, alongside a corresponding discharge letter sample. BMJ Open 2021; 11:e045465. [PMID: 34290064 PMCID: PMC8296817 DOI: 10.1136/bmjopen-2020-045465] [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] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To develop a programme theory for the intervention of patients receiving discharge letters. DESIGN We used a realist evaluation approach and captured multiple perspectives of hospital discharge to refine our previously developed programme theory. General practitioner (GP), patient and hospital clinician views of a single discharge event in which they were all involved were collected using semi-structured interviews and surveys. These were then triangulated to match the corresponding discharge letter. Data were qualitatively synthesised and compared in meta-matrices before interrogation with realist logic of analysis to develop the programme theory that maps out how patients receiving discharge letters works in specific contexts. SETTING 14 GP practices and four hospital trusts in West Midlands, UK. PARTICIPANTS 10 complete matched cases (GP, patient and hospital practitioner), and a further 26 cases in which a letter was matched with two out of the three participants. RESULTS We identified seven context mechanism outcome configurations not found through literature searching. These related to the broad concepts of: patient preference for receiving letters, patient comprehension of letters, patient-directed letters, patient harm and clinician views on patients receiving letters. 'Patient choice' was important to the success (or not) of the intervention. Other important contexts for positive effects included: letters written in plain English, lay explanations for jargon, verbal information also provided, no new information in letter and patient choice acknowledged. Three key findings were: patient understanding is perhaps greater than clinicians perceive, clinician attitudes are a barrier to patients receiving letters and that, negative outcomes more commonly manifested when patients had not received letters, rather than when they had. CONCLUSIONS We suggest how patients receiving discharge letters could be improved to enhance patient outcomes. Our programme theory has potential for use in different healthcare contexts and as a framework for policy development relating to patient discharge.
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Affiliation(s)
- Katharine Weetman
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Emma Scott
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
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