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A qualitative study of patient involvement in medicines management after hospital discharge: an under-recognised source of systems resilience
  1. Beth Fylan1,
  2. Gerry Armitage2,3,
  3. Deirdre Naylor1,
  4. Alison Blenkinsopp1
  1. 1School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
  2. 2Faculty of Health, University of Bradford, Bradford, UK
  3. 3Bradford District Care NHS Foundation Trust, Bradford, UK
  1. Correspondence to Dr Beth Fylan, School of Pharmacy and Medical Sciences, University of Bradford, Richmond Rd, Bradford BD7 1DP, UK; b.fylangwynn{at}bradford.ac.uk

Abstract

Introduction There are risks to the safety of medicines management when patient care is transferred between healthcare organisations, for example, when a patient is discharged from hospital. Using the theoretical concept of resilience in healthcare, this study aimed to better understand the proactive role that patients can play in creating safer, resilient medicines management at a common transition of care.

Methods Qualitative interviews with 60 cardiology patients 6 weeks after their discharge from 2 UK hospitals explored patients’ experiences with their discharge medicines. Data were initially subjected to an inductive thematic analysis and a subsequent theory-guided deductive analysis.

Results During interviews 23 patients described medicines management resilience strategies in two main themes: identifying system vulnerabilities; and establishing self-management strategies. Patients could anticipate problems in the system that supplied them with medicines and took specific actions to prevent them. They also identified when errors had occurred both before and after medicines had been supplied and took corrective action to avoid harm. Some reported how they had not foreseen problems or experienced patient safety incidents. Patients recounted how they ensured information about medicines changes was correctly communicated and acted upon, and described their strategies to enhance their own reliability in adherence and resource management.

Conclusion Patients experience the impact of vulnerabilities in the medicines management system across the secondary–primary care transition but many are able to enhance system resilience through developing strategies to reduce the risk of medicines errors occurring. Consequently, there are opportunities—with caveats—to elicit, develop and formalise patients’ capabilities which would contribute to safer patient care and more effective medicines management.

  • medication safety
  • patient safety
  • human factors
  • health services research
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Footnotes

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval NHS REC proportionate review. NHS ethics approval was obtained (13/NI/0118).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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