From exploration to intervention: Enhancing medication communication at hospital discharge

Background: Older hospitalised patients are particularly prone to drug-related problems (DRPs) following hospital discharge, often due to ineffective medication communication and limited patient involvement. This thesis aimed to explore the discharge medication communication process for older patients and apply these insights to improve it. Methods: A process evaluation of a clinical trial assessed how hospital-based medication reviews and discharge-related communication components were carried out by clinical pharmacists. A retrospective chart review evaluated the adequacy of medication-related referrals (MRRs) at discharge and their association with unplanned hospital revisits. Qualitative studies involving focus groups, interviews, and observations explored the perspectives of healthcare professionals (HCPs) and patients regarding discharge communication. These findings, combined with public co-production, informed the development of an intervention, alongside a study protocol. Results: Intervention fidelity in the clinical trial was high for admission-related components, with clinical pharmacists resolving DRPs and medication discrepancies in three out of four patients. However, discharge-related fidelity was lower: medication reconciliations were completed for half of the patients, and MRRs were sent at similar rates in both intervention and control groups. MRRs were found to be inadequate in a substantial proportion of patients (40 %), with one in twenty cases potentially contributing to an unplanned hospital revisit. HCPs perceived discharge communication as complex and fragmented, hindered by systemic and organisational barriers. Patients experienced it as a one-way transfer of information from HCPs to patients, primarily structured around HCPs' priorities rather than their own needs. In response, a multifaceted intervention was developed, incorporating a structured and integrated role for clinical pharmacists in the discharge process. The intervention included components to enhance the quality of medication-related discharge documents, empower patients through an information package, strengthen informal caregiver involvement, and provide follow-up calls after discharge. A pre-post study design was established to evaluate the intervention’s effects on medication communication and patient outcomes compared to usual care. Conclusions: Medication communication at hospital discharge remains a critical challenge, characterised by information gaps between HCPs and insufficient focus on equipping patients with the prerequisites to resume self-care after returning home. A multifaceted intervention study was developed to address these challenges.