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How can patient-held lists of medication enhance patient safety? A mixed-methods study with a focus on user experience
  1. Sara Garfield1,2,3,
  2. Dominic Furniss4,
  3. Fran Husson1,
  4. Mike Etkind3,
  5. Marney Williams1,
  6. John Norton2,
  7. Della Ogunleye3,
  8. Barry Jubraj5,6,
  9. Hanaa Lakhdari3,
  10. Bryony Dean Franklin1,2,3
  1. 1 Pharmacy department, Imperial College Healthcare NHS Trust, London, UK
  2. 2 Patient Safety Translational Research Centre, Imperial College London, London, UK
  3. 3 Department of Practice and Policy, UCL School of Pharmacy, London, UK
  4. 4 UCLIC, UCL, London, UK
  5. 5 NIHR CLAHRC, London, UK
  6. 6 Medicines Use & Safety Division, Specialist Pharmacy Service, London, UK
  1. Correspondence to Dr Sara Garfield, Imperial College Healthcare NHS Trust, London W2 1NY, UK; sara.garfield{at}nhs.net

Abstract

Background Patients often carry medication lists to mitigate information loss across healthcare settings. We aimed to identify mechanisms by which these lists could be used to support safety, key supporting features, and barriers and facilitators to their use.

Methods We used a mixed-methods design comprising two focus groups with patients and carers, 16 semistructured interviews with healthcare professionals, 60 semistructured interviews with people carrying medication lists, a quantitative features analysis of tools available for patients to record their medicines and usability testing of four tools. Findings were triangulated using thematic analysis. Distributed cognition for teamwork models were used as sensitising concepts.

Results We identified a wide range of mechanisms through which carrying medication lists can improve medication safety. These included improving the accuracy of medicines reconciliation, allowing identification of potential drug interactions, facilitating communication about medicines, acting as an aide-mémoire to patients during appointments, allowing patients to check their medicines for errors and reminding patients to take and reorder their medicines. Different tools for recording medicines met different needs. Of 103 tools examined, none met the core needs of all users. A key barrier to use was lack of awareness by patients and carers that healthcare information systems can be fragmented, a key facilitator was encouragement from healthcare professionals.

Conclusion Our findings suggest that patients and healthcare professionals perceive patient-held medication lists to have a wide variety of benefits. Interventions are needed to raise awareness of the potential role of these lists in enhancing patient safety. Such interventions should empower patients and carers to identify a method that suits them best from a range of options and avoid a ‘one size fits all’ approach.

  • patient safety
  • patient activation
  • patient-held medication records
  • transitions of care
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Footnotes

  • Twitter @domfurniss, @BryonyDF

  • Contributors SG, FH, BDF and DF conceived and designed the study. SG and HL collected the data. All authors contributed to the analysis of the data. SG wrote the paper. All authors edited the paper and approved the final version.

  • Funding This work was supported by the Pharmacy Research UK (grant number PRUK-2016-PG2-2-A) and the National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre. This report presents independent research funded by the Pharmacy Research UK (PRUK). Infrastructure support for this research was provided by the NIHR Imperial Biomedical Research Centre. NIHR Clinical Research Network North West London supported the study with recruitment.

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of PRUK, the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study has been approved by East Midlands-Nottingham 2 Research Ethics Committee (Ref 17/EM/0477).

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

  • Data availability statement Data are available upon reasonable request. Participants did not consent to having their full transcripts publicly available. However, anonymised excerpts are available from the authors who may be contacted on sara.garfield@nhs.net.

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