Short summary

On average, older patients use five or more medications daily, increasing the risk of adverse drug reactions, interactions, or medication errors. Healthcare sector transitions increase the risk of information loss, misunderstandings, unclear treatment responsibilities, and medication errors. Therefore, it is crucial to identify possible solutions to decrease these risks. Patients, relatives, and healthcare professionals were asked to design the solution they need.

Rationale

Medication of older patients after hospital discharge is a complex process, and hHealthcare sector transitions increase the risk of information loss, misunderstandings, unclear treatment responsibilities, and medication errors. Medication of older patients following hospital visits is often seen as particularly complex. Polypharmacy addscontributes significantly to thise complexity due to the uncertainty about how often and for how long medication is needed, challenges in sharing information in sector transitions with different healthcare professionals, and the patients' and relatives' cognitive ability and motivation to follow medication plans. During hospitalisation, 60% of patients receive three or more changes to their medication, and the risk of a harmful event increases significantly with each prescription change. Older patients often use five or more prescription medications daily [8, 9], but polypharmacy is not always beneficial for the patient, and some older patients experience severe side effects often due to drug-drug interactions. In addition, previous parts of this study have shown that older patients are often concerned about drug-drug interactions and side effects as well as confused about aspects such as names, labels, and when to take the medication. Therefore, the discharge of elderly patients from the hospital is a complex process where robust tools are needed to support supporting the proper correct medication at the proper correct time are needed. For international readers it is important to know a particular artefact in the Danish healthcare system. When the shared Medication Record (SMR) was established to document prescribed medications for a patient over ten years, a new word, "ordineret medicin," was introduced, which translated means non-prescription medication. This phrase was introduced to distinguish between an active prescription and a passive non-prescription medication. The SMR is a continuously updated and accessible online overview for patients and healthcare professionals regardless of sector, and gives healthcare professionals, and patients access to view current medications, including dose and prescription redemption. SMR also enables healthcare professionals to see the patient's medication history and register changes. Upon discharge, GPs receive a discharge summary from the hospital describing the treatment and suggesting follow-up. If home care is needed, the municipality receives a patient treatment- and care plan from the hospital so the municipality can prepare for the patient's return home. The patient treatment- and care plan will among other things include information regarding the hospitalization, diagnoses, medication, and required nursing and homecare support after discharge. This knowledge is important to understand some of the results belowof this study. Despite these systems enabling sharing of information improvements are needed to ensure the right medication for older patients. To develop a solution for solving major medication challenges facing polypharmacy patients when discharged from the hospital, we invited relevant actors to design their vision of the most suitable and robust tool.

Description of the cohort

FGIs with patients, peers and health care providers.

Data and biological material

FGIs

Collaborating researchers and departments

Emergency Department, Hospital Sønderjylland

Publications associated with the project

Mikkelsen TH, Søndergaard J, Kjaer NK, Nielsen JB, Ryg J, Kjeldsen LJ, Mogensen CB: Handling polypharmacy -a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. BMC Geriatr. 2023, 23(1):477.

Designing a tool ensuring older patients the right medication at the right time after discharge from hospital- the first step in a participatory design process