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Original research
Assessing patient work system factors for medication management during transition of care among older adults: an observational study
  1. Yan Xiao1,
  2. Yea-Jen Hsu2,
  3. Susan M Hannum3,
  4. Ephrem Abebe4,
  5. Melinda E Kantsiper5,
  6. Ivonne Marie Pena5,
  7. Andrea M Wessell6,
  8. Sydney M Dy2,7,
  9. Eric E Howell8,
  10. Ayse P Gurses2,5,7
  1. 1College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, Texas, USA
  2. 2Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
  5. 5School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  6. 6Patient Safety Organization, DARTNet Institute, Charleston, South Carolina, USA
  7. 7Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  8. 8Society of Hospital Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Yan Xiao; yan.xiao.phd{at}gmail.com

Abstract

Objective To develop and evaluate measures of patient work system factors in medication management that may be modifiable for improvement during the care transition from hospital to home among older adults.

Design, settings and participants Measures were developed and evaluated in a multisite prospective observational study of older adults (≥65 years) discharged home from medical units of two US hospitals from August 2018 to July 2019.

Main measures Patient work system factors for managing medications were assessed during hospital stays using six capacity indicators, four task indicators and three medication management practice indicators. Main outcomes were assessed at participants’ homes approximately a week after discharge for (1) Medication discrepancies between the medications taken at home and those listed in the medical record, and (2) Patient experiences with new medication regimens.

Results 274 of the 376 recruited participants completed home assessment (72.8%). Among capacity indicators, most older adults (80.6%) managed medications during transition without a caregiver, 41.2% expressed low self-efficacy in managing medications and 18.3% were not able to complete basic medication administration tasks. Among task indicators, more than half (57.7%) had more than 10 discharge medications and most (94.7%) had medication regimen changes. Having more than 10 discharge medications, more than two medication regimen changes and low self-efficacy in medication management increased the risk of feeling overwhelmed (OR 2.63, 95% CI 1.08 to 6.38, OR 3.16, 95% CI 1.29 to 7.74 and OR 2.56, 95% CI 1.25 to 5.26, respectively). Low transportation independence, not having a home caregiver, low medication administration skills and more than 10 discharge medications increased the risk of medication discrepancies (incidence rate ratio 1.39, 95% CI 1.01 to 1.91, incidence rate ratio 1.73, 95% CI 1.13 to 2.66, incidence rate ratio 1.99, 95% CI 1.37 to 2.89 and incidence rate ratio 1.91, 95% CI 1.24 to 2.93, respectively).

Conclusions Patient work system factors could be assessed before discharge with indicators for increased risk of poor patient experience and medication discrepancies during older adults’ care transition from hospital to home.

  • Medication safety
  • Human factors
  • Transitions in care

Data availability statement

Data are available upon reasonable request. The study data by individual study participants were not available.

https://doi.org/10.1136/bmjqs-2024-017297

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    Data availability statement

    Data are available upon reasonable request. The study data by individual study participants were not available.

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    Footnotes

    • X @YanXiaoPhD

    • Contributors YX, APG acquired funding. YJH contributed to statistical analysis. YX, APG, EEH, SEM, AMW designed the study. SMH, EA, MEK, IMP designed the data collection method. YX drafted the manuscript. APY, SMH, EA, AWM, SMD reviewed the manuscript. YX, APG had access to the data and controlled the decision to publish. YX is responsible for the overall content as guarantor and accepts full responsibility for the finished work and the conduct of the study.

    • Funding This study was funded by the Agency for Healthcare Research and Quality (R01 HS 024436).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.