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Tobiano G, Latimer S, Manias E, Marshall AP, Rattray M, Jenkinson K, Teasdale T, Wren K, Chaboyer W. Co-design of an intervention to improve patient participation in discharge medication communication. Int J Qual Health Care 2024; 36:mzae013. [PMID: 38492231 PMCID: PMC10944286 DOI: 10.1093/intqhc/mzae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 03/18/2024] Open
Abstract
Patients can experience medication-related harm and hospital readmission because they do not understand or adhere to post-hospital medication instructions. Increasing patient medication literacy and, in turn, participation in medication conversations could be a solution. The purposes of this study were to co-design and test an intervention to enhance patient participation in hospital discharge medication communication. In terms of methods, co-design, a collaborative approach where stakeholders design solutions to problems, was used to develop a prototype medication communication intervention. First, our consumer and healthcare professional stakeholders generated intervention ideas. Next, inpatients, opinion leaders, and academic researchers collaborated to determine the most pertinent and feasible intervention ideas. Finally, the prototype intervention was shown to six intended end-users (i.e. hospital patients) who underwent usability interviews and completed the Theoretical Framework of Acceptability questionnaire. The final intervention comprised of a suite of three websites: (i) a medication search engine; (ii) resources to help patients manage their medications once home; and (iii) a question builder tool. The intervention has been tested with intended end-users and results of the Theoretical Framework of Acceptability questionnaire have shown that the intervention is acceptable. Identified usability issues have been addressed. In conclusion, this co-designed intervention provides patients with trustworthy resources that can help them to understand medication information and ask medication-related questions, thus promoting medication literacy and patient participation. In turn, this intervention could enhance patients' medication self-efficacy and healthcare utilization. Using a co-design approach ensured authentic consumer and other stakeholder engagement, while allowing opinion leaders and researchers to ensure that a feasible intervention was developed.
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Affiliation(s)
- Georgia Tobiano
- Centre of Research Excellence in Wiser Wound Care, Griffith University, Parklands Drive, Gold Coast, Queensland 4215, Australia
- Gold Coast Health, Gold Coast University Hospital, Hospital Boulevard, Gold Coast, Queensland 4215, Australia
| | - Sharon Latimer
- Centre of Research Excellence in Wiser Wound Care, Griffith University, Parklands Drive, Gold Coast, Queensland 4215, Australia
- School of Nursing and Midwifery, Griffith University, Parklands Drive, Gold Coast, Queensland 4215, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Wellington Road, Clayton, Victoria 3800, Australia
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Andrea P Marshall
- Gold Coast Health, Gold Coast University Hospital, Hospital Boulevard, Gold Coast, Queensland 4215, Australia
- School of Nursing and Midwifery, Griffith University, Parklands Drive, Gold Coast, Queensland 4215, Australia
| | - Megan Rattray
- College of Medicine & Public Health, Flinders University, 1284 South Road, Clovelly Park, Adelaide, South Australia 5042, Australia
| | - Kim Jenkinson
- Gold Coast Health, Gold Coast University Hospital, Hospital Boulevard, Gold Coast, Queensland 4215, Australia
| | - Trudy Teasdale
- Gold Coast Health, Gold Coast University Hospital, Hospital Boulevard, Gold Coast, Queensland 4215, Australia
| | - Kellie Wren
- Gold Coast Health, Gold Coast University Hospital, Hospital Boulevard, Gold Coast, Queensland 4215, Australia
| | - Wendy Chaboyer
- Centre of Research Excellence in Wiser Wound Care, Griffith University, Parklands Drive, Gold Coast, Queensland 4215, Australia
- School of Nursing and Midwifery, Griffith University, Parklands Drive, Gold Coast, Queensland 4215, Australia
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Abstract
OBJECTIVE To describe the extent to which older patients participate in discharge medication communication, and identify factors that predict patient participation in discharge medication communication. DESIGN Observational study. SETTING An Australian metropolitan tertiary hospital. PARTICIPANTS 173 older patients were observed undertaking one medication communication encounter prior to hospital discharge. OUTCOME Patient participation measured with MEDICODE, a valid and reliable coding framework used to analyse medication communication. MEDICODE provides two measures for patient participation: (1) Preponderance of Initiative and (2) Dialogue Ratio. RESULTS The median for Preponderance of Initiative was 0.7 (IQR=0.5-1.0) and Dialogue Ratio was 0.3 (IQR=0.2-0.4), indicating healthcare professionals took more initiative and medication encounters were mostly monologue rather than a dialogue or dyad. Logistic regression revealed that patients had 30% less chance of having dialogue or dyads with every increase in one medication discussed (OR 0.7, 95% CI 0.5 to 0.9, p=0.01). Additionally, the higher the patient's risk of a medication-related problem, the more initiative the healthcare professionals took in the conversation (OR 1.5, 95% CI 1.0 to 2.1, p=0.04). CONCLUSION Older patients are passive during hospital discharge medication conversations. Discussing less medications over several medication conversations spread throughout patient hospitalisation and targeting patients at high risk of medication-related problems may promote more active patient participation, and in turn medication safety outcomes.
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Affiliation(s)
- Georgia Tobiano
- NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Lukman Thalib
- Department of Biostatistics, Istanbul Aydin University, Istanbul, Turkey
| | - Gemma Dornan
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Trudy Teasdale
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jeremy Wellwood
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Wendy Chaboyer
- NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
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