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Dinh TS, Hanf M, Klein AA, Brueckle MS, Rietschel L, Petermann J, Brosse F, Schulz-Rothe S, Klasing S, Muth C, Seidling H, Engler J, Mergenthal K, Voigt K, van den Akker M. Informational continuity of medication management in transitions of care: Qualitative interviews with stakeholders from the HYPERION-TransCare study. PLoS One 2024; 19:e0300047. [PMID: 38573912 PMCID: PMC10996284 DOI: 10.1371/journal.pone.0300047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/20/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The transition of patients between inpatient and outpatient care can lead to adverse events and medication-related problems due to medication and communication errors, such as medication discontinuation, the frequency of (re-)hospitalizations, and increased morbidity and mortality. Older patients with multimorbidity and polypharmacy are particularly at high risk during transitions of care. Previous research highlighted the need for interventions to improve transitions of care in order to support information continuity, coordination, and communication. The HYPERION-TransCare project aims to improve the continuity of medication management for older patients during transitions of care. METHODS AND FINDINGS Using a qualitative design, 32 expert interviews were conducted to explore the perspectives of key stakeholders, which included healthcare professionals, patients and one informal caregiver, on transitions of care. Interviews were conducted between October 2020 and January 2021, transcribed verbatim and analyzed using content analysis. We narratively summarized four main topics (stakeholders' tasks, challenges, ideas for solutions and best practice examples, and patient-related factors) and mapped them in a patient journey map. Lacking or incomplete information on patients' medication and health conditions, inappropriate communication and collaboration between healthcare providers within and across settings, and insufficient digital support limit the continuity of medication management. CONCLUSIONS The study confirms that medication management during transitions of care is a complex process that can be compromised by a variety of factors. Legal requirements and standardized processes are urgently needed to ensure adequate exchange of information and organization of medication management before, during and after hospital admissions. Despite the numerous barriers identified, the findings indicate that involved healthcare professionals from both the inpatient and outpatient care settings have a common understanding.
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Affiliation(s)
- Truc Sophia Dinh
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Maria Hanf
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Astrid-Alexandra Klein
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Maria-Sophie Brueckle
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Lisa Rietschel
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jenny Petermann
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Franziska Brosse
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Sylvia Schulz-Rothe
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Sophia Klasing
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
| | - Christiane Muth
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Department of General Practice and Family Medicine, Medical School Westphalia, Bielefeld University, Bielefeld, Germany
| | - Hanna Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany
| | - Jennifer Engler
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Karen Voigt
- Department of General Practice/Medical Clinic III, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Marjan van den Akker
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven, Leuven, Belgium
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Chaudhry I, Ghassani A, Wray J, Chaudhry B, Coats L. Outpatient care of adults with congenital heart disease in the UK: a qualitative appraisal of the clinician perspective. Open Heart 2024; 11:e002420. [PMID: 38286570 PMCID: PMC10826567 DOI: 10.1136/openhrt-2023-002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/11/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE This study aimed to explore clinicians' perspectives of ambulatory care in adult congenital heart disease (ACHD). METHODS Semistructured interviews were carried out remotely (Zoom) with a range of physicians providing ambulatory care to patients with ACHD across the UK. The chronic care model, thrive and candidacy frameworks were used to design prompt guides and subsequently develop themes. A framework approach was used to code and analyse transcripts, which were managed in NVivo. RESULTS 21 clinicians (43% females, 38% specialists) from 10/12 ACHD networks in the UK participated. Shared themes included the purpose of the clinic appointment, problems in the 'hub-and-spoke' care system, role of the general practitioner and ACHD specialist nurse, communication with patients, burden of ambulatory care and patient self-management. Reflecting on these themes, participants identified resources, what care and how and by it is delivered alongside the role of the patient as key areas for future research. CONCLUSIONS The present structure of ACHD ambulatory care is neither patient-centred nor equitable. The concerned clinicians raise the question whether increasing resource alone without changing structure will lead to better outcomes for patients.
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Affiliation(s)
- Isobel Chaudhry
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anisa Ghassani
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Institute of Cardiovascular Science, UCL, London, UK
| | - Bill Chaudhry
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Coats
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Adult Congenital Heart Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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