There are numerous threats to medication safety at care transitions, which are
heightened for older people, because they live with multiple long-term
conditions as well as polypharmacy, and have frequent hospital admissions.
Whilst evidence of the severity and scale of these medicines-related problems
exists, there is insufficient detail about the lived experience of post-discharge
medicines management, in particular what helps or what hinders, and how
better support could be enabled. This thesis, underpinned by the Medicines
Research Council framework for complex intervention design, aimed to find
acceptable intervention components, which would enhance patient
experience.
This research followed a sequential, mixed method design to: establish the
evidence base through critical literature review, develop theory using an
interview study grounded in behaviour change theory, and finally to model
potential intervention components by expert consensus. Interviews revealed
that there were gaps in current service provision, which impacted on
participants’ knowledge of and capabilities with their medicines. Despite these
challenges, some participants took actions to safeguard from problems after
discharge. The literature review found that effective components of trialled
interventions were self-management advice, post-discharge telephone follow up and medicines reconciliation. Further behaviour change techniques from
the literature, alongside expert consensus and theory-driven analysis of interview findings resulted in final selection of eight potential components.
Real-world implementation of these must be coupled with key changes to
current healthcare practices and policy, including better engagement with patients and carers, as well as pro-active post-discharge follow-up. Future work must carefully explore how these components can be tested pragmatically.
| Identifer | oai:union.ndltd.org:BRADFORD/oai:bradscholars.brad.ac.uk:10454/18983 |
| Date | January 2020 |
| Creators | Tomlinson, Justine |
| Contributors | Silcock, Jonathan, Fylan, Beth, Smith, Heather, Karban, Kate |
| Publisher | University of Bradford, School of Pharmacy and Medical Sciences, Faculty of Life Sciences |
| Source Sets | Bradford Scholars |
| Language | English |
| Detected Language | English |
| Type | Thesis, doctoral, PhD |
| Rights | <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by-nc-nd/3.0/88x31.png" /></a><br />The University of Bradford theses are licenced under a <a rel="license" href="http://creativecommons.org/licenses/by-nc-nd/3.0/">Creative Commons Licence</a>. |
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