Medication communication and management: exploring the experiences and observations of older patients with multimorbidity and their families at hospital discharge

Medication management at hospital discharge is particularly complex for older patients with multimorbidity, with additional communication challenges arising from both patient and healthcare-related factors. Breakdowns in communication can lead to medication-related problems after hospital transfer. Little is known about the experiences and perspectives of older patients with multimorbidity in this context. The aim of the study was to explore the experiences and perspectives of older patients with multimorbidity and their families, regarding medication communication and management during discharge with models aimed at improving transitional communication. A qualitative multi-method study was conducted across two public hospitals (Victoria, Australia) with older patients (≥ 65 years) with ≥ 2 chronic conditions and their family members, alongside observations of pharmacist-patient discharge communication. Participants were recruited from subacute and At Home units (Hospital-at-Home), with the latter providing multidisciplinary inpatient care in patients’ homes. Patients were interviewed face-to-face pre- and post-discharge, with an additional home interview for At Home care patients following pharmacist–patient observations. Data analysis involved an inductive approach followed by deductive analysis. Thirty-two semi-structured interviews were conducted with 16 patients and 5 family members, along with 325 min of observation during 21 pharmacist discharge interactions. Patients reported greater comfort, privacy, focus, and time for medication discussions with At Home pharmacists compared to subacute or acute care settings. Patients and families received varying levels of medication information, ranging from basic to detailed explanations. Cognitive and physical challenges, including poor eyesight, hearing difficulties, and managing multiple medications, were major barriers to engagement. When pharmacists tailored and simplified information to patients’ understanding, satisfaction appeared improved, reflected in patient feedback suggesting this resulted in better understanding, reassurance, and confidence in medication use. Older people with multimorbidity face complex health needs that complicate discharge medication communication for patients, families, and pharmacists. Medication communication at hospital discharge is mostly one-way, with pharmacists informing rather than engaging older patients. The care environment and delivery approach significantly influence how these communications occur. Multiple conditions hinder understanding and involvement, but personalised information and Hospital-at-Home care may improve effective communication.