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Alison Blenkinsopp - One of the best experts on this subject based on the ideXlab platform.

  • gaps traps bridges and props a mixed methods study of resilience in the Medicines Management system for patients with heart failure at hospital discharge
    BMJ Open, 2019
    Co-Authors: Beth Fylan, Gerry Armitage, Iuri Marques, Hanif Ismail, Liz Breen, Peter Gardner, Alison Blenkinsopp
    Abstract:

    Introduction Poor Medicines Management places patients at risk, particularly during care transitions. For patients with heart failure (HF), optimal Medicines Management is crucial to control symptoms and prevent hospital readmission. This study explored the concept of resilience using HF as an example condition to understand how the system compensates for known and unknown weaknesses. Methods We explored resilience using a mixed-methods approach in four healthcare economies in the north of England. Data from hospital site observations, healthcare staff and patient interviews, and documentary analysis were collected between June 2016 and March 2017. Data were synthesised and analysed using framework analysis. Results Interviews were conducted with 45 healthcare professionals, with 20 patients at three time points and 189 hours of observation were undertaken. We identified four primary inter-related themes concerning organisational resilience. These were named as gaps, traps, bridges and props. Gaps were discontinuities in processes that had the potential to result in poorly optimised Medicines. Traps were features of the system that could produce errors or unintended adverse medication events. Bridges were features of the Medicines Management system that promoted safety and continuity which ensured that, despite varying conditions, care could be delivered successfully. Props were informal, temporary or impromptu actions taken by patients or healthcare staff to avoid potential adverse events. Conclusion The numerous opportunities for HF patient safety to be compromised and for suboptimal Medicines Management during this common care transition are mitigated by system resilience. Cross-organisational bridges and temporary fixes or ‘props’ put in place by patients and carers, healthcare teams and organisations are critical for safe and optimal care to be delivered in the face of continued system pressures.

  • Cardiology patients' Medicines Management networks after hospital discharge: A mixed methods analysis of a complex adaptive system.
    Research in Social & Administrative Pharmacy, 2018
    Co-Authors: Beth Fylan, Mark Tranmer, Gerry Armitage, Alison Blenkinsopp
    Abstract:

    Abstract Introduction The complex healthcare system that provides patients with Medicines places them at risk when care is transferred between healthcare organisations, for example discharge from hospital. Consequently, understanding and improving Medicines Management, particularly at care transfers, is a priority. Objectives This study aimed to explore the Medicines Management system as patients experience it and determine differences in the patient-perceived importance of people in the system. Methods We used a Social Network Analysis framework, collecting ego-net data about the importance of people patients had contact with concerning their Medicines after hospital discharge. Single- and multi-level logistic regression models of patients' networks were constructed, and model residuals were explored at the patient level. This enabled us to identify patients' networks with support tie patterns different from the general patterns suggested by the model results. Qualitative data for those patients were then analysed to understand their differing experiences. Results Networks comprised clinical and administrative healthcare staff and friends and family members. Networks were highly individual and the perceived importance of alters varied both within and between patients. Ties to spouses were significantly more likely to be rated as highly important and ties to community pharmacy staff (other than pharmacists) and to GP receptionists were less likely to be highly rated. Patients with low-value Medicines Management networks described having limited information about their Medicines and a lack of understanding or help. Patients with high-value networks described appreciating support and having confidence in staff. Conclusions Patients experienced Medicines Management as individual systems within which they interacted with healthcare staff and informal support to manage their treatment. Multilevel models indicated that there are unexplained variables impacting on patients' assessments of their Medicines Management networks. Qualitative exploration of the model residuals can offer an understanding of networks that do not have the typical range of support ties.

  • A qualitative study of patient involvement in Medicines Management after hospital discharge: an under-recognised source of systems resilience.
    BMJ Quality & Safety, 2017
    Co-Authors: Beth Fylan, Gerry Armitage, Deirdre Naylor, Alison Blenkinsopp
    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.

  • Patients' experiences of a community pharmacy-led Medicines Management service.
    Health & Social Care in The Community, 2008
    Co-Authors: Paul Bissell, Alison Blenkinsopp, Duncan Short, Linda Mason
    Abstract:

    Medicines Management services provided by community pharmacists have been proposed as one means to ensure that patients receive all the Medicines they may benefit from in the English National Health Service. These services may also offer ways of addressing the historic under-utilization of community pharmacists’ clinical skills and expertise. Medicines Management services differ significantly from the dispensing and Medicines sales roles traditionally associated with community pharmacy, particularly in relation to the provision for pharmacists to make recommendations to both patients and doctors about pharmacological treatment and lifestyle Management. This paper describes patients’ experiences of a Medicines Management service provided by community pharmacists for people with coronary heart disease, delivered in England. It draws on findings from semistructured, face-to-face interviews with 49 patients recruited from pilot sites delivering the service. Findings suggest that although patients cautiously welcomed the opportunity to consult with a pharmacist about their Medicines, they had reservations about them making recommendations about treatment, and many still regarded the doctor as the health professional ‘in charge’ of their Medicines. The implications of these findings are discussed in light of the developing sociological literature on pharmacy and Medicines usage.

  • Evaluating patient feedback on a new Medicines Management service provided by community pharmacists
    2005
    Co-Authors: Alison Blenkinsopp, Paul Bissell, D. Short, Michela Tinelli
    Abstract:

    Few services provided by community pharmacists have been subject to extensive and systematic evaluation from the patient’s perspective. As part of the national trial of the Community Pharmacy Medicines Management Service, there was an opportunity to obtain both quantitative and qualitative feedback from patients.1 This paper presents the results of qualitative research.

Birna Trap - One of the best experts on this subject based on the ideXlab platform.

  • evaluating inter rater reliability of indicators to assess performance of Medicines Management in health facilities in uganda
    Journal of Pharmaceutical Policy and Practice, 2018
    Co-Authors: Belinda Blick, Stella Nakabugo, Laura F Garabedian, Morries Seru, Birna Trap
    Abstract:

    To build capacity in Medicines Management, the Uganda Ministry of Health introduced a nationwide supervision, performance assessment and recognition strategy (SPARS) in 2012. Medicines Management supervisors (MMS) assess performance using 25 indicators to identify problems, focus supervision, and monitor improvement in Medicines stock and storage Management, ordering and reporting, and prescribing and dispensing. Although the indicators are well-recognized and used internationally, little was known about the reliability of these indicators. An initial assessment of inter-rater reliability (IRR), which measures agreement among raters (i.e., MMS), showed poor IRR; subsequently, we implemented efforts to improve IRR. The aim of this study was to assess IRR for SPARS indicators at two subsequent time points to determine whether IRR increased following efforts to improve reproducibility. IRR was assessed in 2011 and again after efforts to improve IRR in 2012 and 2013. Efforts included targeted training, providing detailed guidelines and job aids, and refining indicator definitions and response categories. In the assessments, teams of three MMS measured 24 SPARS indicators in 26 facilities. We calculated IRR as a team agreement score (i.e., percent of the MMS teams in which all three MMS had the same score). Two sample tests for proportions were used to compare IRR scores for each indicator, domain, and overall for the initial assessment and the following two assessments. We also compared the IRR scores for indicators classified as simple (binary) versus complex (multi-component). Logistic regression was used to identify supervisor group characteristics associated with domain-specific and overall IRR scores. Initially only five (21%) indicators had acceptable reproducibility, defined as an IRR score ≥ 75%. At the initial assessment, prescribing quality indicators had the lowest and stock Management indicators had the highest IRR. By the third IRR assessment, 12 (50%) indicators had acceptable reproducibility, and the overall IRR score improved from 57% to 72%. The IRR of simple indicators was consistently higher than that of complex indicators in the three assessment periods. We found no correlation between IRR scores and MMS experience or professional background. Assessments of indicator reproducibility are needed to improve IRR. Using simple indicators is recommended.

  • article 2 longitudinal study assessing the one year effects of supervision performance assessment and recognition strategy spars to improve Medicines Management in uganda health facilities
    Journal of Pharmaceutical Policy and Practice, 2018
    Co-Authors: Birna Trap, Martha Embrey, Richard Musoke, Anthony Kirunda, Martin Olowo Oteba, Dennis Rossdegnan
    Abstract:

    In late 2010, Uganda introduced a supervision, performance assessment, and recognition strategy (SPARS) to improve staff capacity in Medicines Management in government and private not-for-profit health facilities. This paper assesses the impact of SPARS in health facilities during their first year of supervision. SPARS uses health workers trained as Medicines Management Supervisors (MMS) to supervise health facilities and address issues identified through indicatorbased performance assessment in five domains: stock Management, storage Management, ordering and reporting, prescribing quality, and dispensing quality. We used routine data generated during SPARS visits to 1222 health facilities to evaluate performance changes during the first year of supervision as well as the time until achieving an adequate score in this period. We also explored variables related to facilities, MMS, and intensity of implementation as predictors of performance improvement and time until achieving an adequate score. Health facilities received an average of 3.4 MMS visits during the first year of supervision, with an average of 88 days between visits; each MMS implemented a median of 28 visits per year. Overall SPARS scores (maximum of 25) improved by 2.3 points (22.3%) per visit from a mean baseline score of 10.3. The adjusted improvement in overall SPARS score was significantly higher in primary health care facilities (2.36) versus higher-level health facilities and hospitals (2.15) (p = 0.001). The incremental improvement was highest at visit 2, with decreasing but continuing positive gains in subsequent visits. The adjusted mean incremental improvement per visit was highest in the prescribing quality domain, followed by dispensing quality, ordering and reporting, stock Management, and storage Management. Adjusted improvement in SPARS scores varied by region, year of implementation, and facility ownership. After one year of SPARS, 22% of facilities achieved an adequate score of 18.75 (75% of maximum score). SPARS was effective in building health facility capacity in Medicines Management, with a median overall improvement of almost 70% during the first year. The greatest improvements occurred in prescribing quality and at lower levels of care, although the highest level of performance was achieved in storage Management. We recommend broad dissemination of the SPARS approach in all Ugandan health facilities as well as in other countries seeking a practical strategy to improve Medicines Management performance.

  • competency in supportive supervision a study of public sector Medicines Management supervisors in uganda
    Journal of Pharmaceutical Policy and Practice, 2017
    Co-Authors: Rachael Henry, Lynda Nantongo, Anita K Wagner, Martha Embrey, Birna Trap
    Abstract:

    Supportive supervision has been found to be more effective than corrective fault-oriented inspections. Uganda’s Ministry of Health in 2012 implemented a comprehensive strategy (SPARS) to build Medicines Management capacity in public sector health facilities. The approach includes supportive supervision. This structured observational study assesses supportive supervision competency among Medicines Management supervisors (MMS). The study used structured observations of two groups of five purposely selected MMS—one group supervising facilities with greater Medicines Management improvement during one year of SPARS and one group with less improvement, based on quantitative metrics. We observed and scored behaviors and skills of supervisors in 11 categories deemed critical for effective and supportive supervision. Supportive supervision was not evenly or adequately implemented, with the median supportive supervision competency score for all observed supervisors being 38%. Supervisors’ main strengths were problem identification, data interpretation, education, and providing constructive feedback (45%–47%). Their weakest areas were assuring continuity and setting targets (17%), and most MMS were fair to strong in effective communication, use of tools, and problem solving. MMS of facilities with little improvement in Medicines Management over time were weak in setting targets and promoting participation. There was a 33 percentage point difference in the median supportive supervision competency scores between MMS of facilities with more versus less improvement (57%–24%) and a 77 percentage point difference in competency between the highest and lowest scoring MMS (77%–0%). We did not find a relationship between MMS experience (number of visits implemented) and their supportive supervision competency or facility improvement in Medicines Management. However, there is a likely relationship between supportive supervision competency and facility improvement. Competency of MMS in supportive supervision among the sampled MMS was generally weak, but with much individual variation. Our results suggest that MMS’ supportive supervision competency is positively related to the SPARS effectiveness scores of the facilities they supervise. We recommend strategies to strengthen supportive supervision behaviors and skills.

  • article 1 supervision performance assessment and recognition strategy spars a multipronged intervention strategy for strengthening Medicines Management in uganda method presentation and facility performance at baseline
    Journal of Pharmaceutical Policy and Practice, 2016
    Co-Authors: Birna Trap, Martha Embrey, Martin Olowo Oteba, Denis Okidi Ladwar, Mohammed Khalid, Anita K Wagner
    Abstract:

    Uganda introduced a multipronged intervention, the supervision, performance assessment, and recognition strategy (SPARS), to improve Medicines Management (MM) in public and not-for-profit health facilities. This paper, the first in a series, describes the SPARS intervention and reports on the MM situation in Uganda before SPARS (baseline). To build MM capacity at health facilities, health workers were trained as MM supervisors to visit health facilities, assess MM performance, and use the findings to provide support and standardize MM practices. Performance is assessed based on 25 MM indicators covering five domains: dispensing quality (7 indicators), prescribing quality (5), stock Management (4), storage Management (5) and ordering and reporting (4). From the end of 2010 to 2013, MM supervisors assessed baseline MM performance of 1384 government (85 %) and private not-for-profit facilities at all levels of care in about half of Uganda’s districts. The overall MM baseline median score was 10.3 out of a maximum of 25 with inter-quartile range (IQR) of 8.7–11.7. Facility domain scores (out of a maximum of 5) were as follows: storage Management, median score of 2.9 (IQR 2.3–3.4); stock Management 2.3 (IQR 2.0–2.8), ordering and reporting 2.2 (IQR 1.3–2.5), and dispensing quality 2.1 (IQR 1.7–2.7). Performance in prescribing quality was 0.9 (IQR 0.4–1.4). Significant regional differences were found: overall scores were highest in the Northern region (10.7; IQR 9.2–12.4) and lowest in the Eastern region (9.6; (IQR 7.8–11.2) (p < 0.001). Overall scores did not differ by facility ownership; however, government facilities scored lower in dispensing and storage and higher in ordering and reporting. Hospitals scored higher overall and in domains other than prescribing and stock Management. Districts classified a priori as having high capacity for implementing SPARS had higher scores at baseline compared to lower-capacity districts. Assessing and building national capacity in MM is needed in both private not-for-profit and government facilities at all levels of care. The indicator-based, multipronged SPARS assessment has been described here, while the strategy’s impact has yet to be documented.

Cristín Ryan - One of the best experts on this subject based on the ideXlab platform.

  • Improving Medicines Management for people with dementia in primary care: a qualitative study of healthcare professionals to develop a theory-informed intervention
    BMC Health Services Research, 2020
    Co-Authors: Heather E. Barry, Mairead Mcgrattan, Cristín Ryan, A. Peter Passmore, A. Louise Robinson, Gerard J. Molloy, Carmel M. Darcy, Hilary Buchanan, Laura E. Bedford, Carmel Hughes
    Abstract:

    People with dementia (PwD) face unique challenges with Medicines Management, yet little is known about these challenges from the perspectives of primary healthcare professionals, particularly general practitioners (GPs) and community pharmacists. Few Medicines Management interventions have been developed which are aimed at community-dwelling PwD. This study sought to develop an intervention to improve Medicines Management for PwD in primary care using a theory-informed approach. Semi-structured interviews were conducted with GPs (n = 15) and community pharmacists (n = 15) to explore participants’ views and experiences of Medicines Management for PwD, and their perceptions of barriers and facilitators to successful Medicines Management for PwD. The 14-domain Theoretical Domains Framework was the underpinning theoretical guide, allowing key theoretical domains to be identified and mapped to behaviour change techniques (BCTs) which are considered the ‘active ingredients’ of an intervention. Draft interventions were developed to operationalise selected BCTs and were presented to GPs and community pharmacists during task groups. Final selection of an intervention for feasibility testing was guided by feedback provided during these task groups and through application of the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria. Participants expressed a number of concerns about Medicines Management for PwD, particularly monitoring adherence to medication regimens and conducting medication review. Two draft interventions comprising selected BCTs (‘Modelling or demonstration of behaviour’; ‘Salience of consequences’; ‘Health consequences’; ‘Social and environmental consequences’; ‘Action planning’; Social support or encouragement’, ‘Self-monitoring of behaviour’) were developed, each targeting GPs and community pharmacists. Following the task groups and discussions within the research team, the community pharmacy-based intervention was selected for future feasibility testing. The intervention will target community pharmacists to conduct a medication review (incorporating an adherence check) with a PwD, delivered as an online video demonstrating key behaviours. The video will include feedback emphasising positive outcomes of performing the behaviours. Action planning and a quick reference guide will be used as complementary intervention components. A community pharmacist-based intervention has been developed targeting Medicines Management for PwD in primary care using a systematic, theory-informed approach. Future work will determine the usability and acceptability of implementing this intervention in clinical practice.

  • the development of a core outcome set for Medicines Management interventions for people with dementia in primary care
    Age and Ageing, 2019
    Co-Authors: Mairead Mcgrattan, Cristín Ryan, Heather E. Barry, Janine A. Cooper, Gerard J. Molloy, Carmel M. Darcy, Peter A Passmore, Louise A Robinson, Hilary Buchanan
    Abstract:

    BACKGROUND people with dementia (PWD), and their carers, face challenges with Medicines Management activities. As interventions to support Medicines Management for PWD are developed, consideration must be given to the outcomes chosen to measure their effectiveness. A Core Outcome Set (COS) is a minimum set of outcomes to be measured in all trials in a particular clinical area, which seeks to reduce heterogeneity of outcome reporting across trials. OBJECTIVE to develop a COS for trials assessing the effectiveness of Medicines Management interventions for PWD in primary care. METHODS a comprehensive list of outcomes was compiled through a systematic review and semi-structured interviews with PWD (n = 18), their carers (n = 15), community pharmacists (n = 15) and general practitioners (n = 15). These outcomes were rated by a Delphi panel (n = 52) on a nine-point Likert scale from 1 (limited importance) to 9 (critical) during three sequential rounds of questionnaire distribution. The Delphi panel comprised participants with expertise in dementia and Medicines Management, including academics and healthcare professionals. An outcome was eligible for inclusion in the COS if ≥70% of participants rated it critical and <15% of participants rated it of limited importance. RESULTS twenty-nine outcomes identified from the systematic review and stakeholder interviews were presented to the Delphi panel. Consensus was reached on 21 outcomes, of which the 7 most highly rated were recommended for inclusion in the COS. CONCLUSION this study used robust methodology to develop a COS for Medicines Management interventions for PWD. Future work should identify the most appropriate tools to measure these outcomes.

  • The development of a Core Outcome Set for Medicines Management interventions for people with dementia in primary care
    Age and Ageing, 2018
    Co-Authors: Mairead Mcgrattan, Cristín Ryan, Heather E. Barry, A. Peter Passmore, Janine A. Cooper, A. Louise Robinson, Gerard J. Molloy, Carmel M. Darcy, Hilary Buchanan, Carmel Hughes
    Abstract:

    BACKGROUND people with dementia (PWD), and their carers, face challenges with Medicines Management activities. As interventions to support Medicines Management for PWD are developed, consideration must be given to the outcomes chosen to measure their effectiveness. A Core Outcome Set (COS) is a minimum set of outcomes to be measured in all trials in a particular clinical area, which seeks to reduce heterogeneity of outcome reporting across trials. OBJECTIVE to develop a COS for trials assessing the effectiveness of Medicines Management interventions for PWD in primary care. METHODS a comprehensive list of outcomes was compiled through a systematic review and semi-structured interviews with PWD (n = 18), their carers (n = 15), community pharmacists (n = 15) and general practitioners (n = 15). These outcomes were rated by a Delphi panel (n = 52) on a nine-point Likert scale from 1 (limited importance) to 9 (critical) during three sequential rounds of questionnaire distribution. The Delphi panel comprised participants with expertise in dementia and Medicines Management, including academics and healthcare professionals. An outcome was eligible for inclusion in the COS if ≥70% of participants rated it critical and

  • Interventions to improve Medicines Management for people with dementia: a systematic review
    Drugs & Aging, 2017
    Co-Authors: Mairead Mcgrattan, Cristín Ryan, Heather E. Barry, Carmel Hughes
    Abstract:

    Background The importance of optimising Medicines Management for people with dementia has been emphasised through research and policy. However, evidence is currently lacking regarding how to achieve this in this patient population.

  • “It’s very complicated”: a qualitative study of Medicines Management in intermediate care facilities in Northern Ireland
    BMC Health Services Research, 2015
    Co-Authors: Anna Millar, Carmel Hughes, Cristín Ryan
    Abstract:

    Background: Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery from illness and maximising independence. Older people are at increased risk of medication-related adverse events, but little is known about the provision of Medicines Management services in IC facilities. This study aimed to describe the current provision of Medicines Management services in IC facilities in Northern Ireland (NI) and to explore healthcare workers’ (HCWs) and patients’ views of, and attitudes towards these services and the IC concept. Methods: Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with HCWs and patients from IC facilities in NI. Results: Interviews were conducted with 25 HCWs and 18 patients from 12 IC facilities in NI. Three themes were identified: ‘concept and reality’, ‘setting and supply’ and ‘responsibility and review’. A mismatch between the concept of IC and the reality was evident. The IC facility setting dictated prescribing responsibilities and the supply of Medicines, presenting challenges for HCWs. A lack of a standardised approach to responsibility for the provision of Medicines Management services including clinical review was identified. Whilst pharmacists were not considered part of the multidisciplinary team, most HCWs recognised a need for their input. Medicines Management was not a concern for the majority of IC patients.

Beth Fylan - One of the best experts on this subject based on the ideXlab platform.

  • Post-discharge Medicines Management: the experiences, perceptions and roles of older people and their family carers.
    Health expectations : an international journal of public participation in health care and health policy, 2020
    Co-Authors: Justine Tomlinson, Jonathan Silcock, Heather Smith, Kate Karban, Beth Fylan
    Abstract:

    Multiple changes are made to older patients' Medicines during hospital admission, which can sometimes cause confusion and anxiety. This results in problems with post-discharge Medicines Management, for example Medicines taken incorrectly, which can lead to harm, hospital readmission and reduced quality of life. To explore the experiences of older patients and their family carers as they enacted post-discharge Medicines Management. Semi-structured interviews took place in participants' homes, approximately two weeks after hospital discharge. Data analysis used the Framework method. Recruitment took place during admission to one of two large teaching hospitals in North England. Twenty-seven participants aged 75 plus who lived with long-term conditions and polypharmacy, and nine family carers, were interviewed. Three core themes emerged: impact of the transition, safety strategies and Medicines Management role. Conversations between participants and health-care professionals about Medicines changes often lacked detail, which disrupted some participants' knowledge and Medicines Management capabilities. Participants used multiple strategies to support post-discharge Medicines Management, such as creating administration checklists, seeking advice or supporting primary care through prompts to ensure Medicines were supplied on time. The level to which they engaged with these activities varied. Participants experienced gaps in their post-discharge Medicines Management, which they had to bridge through implementing their own strategies or by enlisting support from others. Areas for improvement were identified, mainly through better communication about Medicines changes and wider involvement of patients and family carers in their Medicines-related care during the hospital-to-home transition. © 2020 The Authors Health Expectations published by John Wiley & Sons Ltd.

  • gaps traps bridges and props a mixed methods study of resilience in the Medicines Management system for patients with heart failure at hospital discharge
    BMJ Open, 2019
    Co-Authors: Beth Fylan, Gerry Armitage, Iuri Marques, Hanif Ismail, Liz Breen, Peter Gardner, Alison Blenkinsopp
    Abstract:

    Introduction Poor Medicines Management places patients at risk, particularly during care transitions. For patients with heart failure (HF), optimal Medicines Management is crucial to control symptoms and prevent hospital readmission. This study explored the concept of resilience using HF as an example condition to understand how the system compensates for known and unknown weaknesses. Methods We explored resilience using a mixed-methods approach in four healthcare economies in the north of England. Data from hospital site observations, healthcare staff and patient interviews, and documentary analysis were collected between June 2016 and March 2017. Data were synthesised and analysed using framework analysis. Results Interviews were conducted with 45 healthcare professionals, with 20 patients at three time points and 189 hours of observation were undertaken. We identified four primary inter-related themes concerning organisational resilience. These were named as gaps, traps, bridges and props. Gaps were discontinuities in processes that had the potential to result in poorly optimised Medicines. Traps were features of the system that could produce errors or unintended adverse medication events. Bridges were features of the Medicines Management system that promoted safety and continuity which ensured that, despite varying conditions, care could be delivered successfully. Props were informal, temporary or impromptu actions taken by patients or healthcare staff to avoid potential adverse events. Conclusion The numerous opportunities for HF patient safety to be compromised and for suboptimal Medicines Management during this common care transition are mitigated by system resilience. Cross-organisational bridges and temporary fixes or ‘props’ put in place by patients and carers, healthcare teams and organisations are critical for safe and optimal care to be delivered in the face of continued system pressures.

  • Cardiology patients' Medicines Management networks after hospital discharge: A mixed methods analysis of a complex adaptive system.
    Research in Social & Administrative Pharmacy, 2018
    Co-Authors: Beth Fylan, Mark Tranmer, Gerry Armitage, Alison Blenkinsopp
    Abstract:

    Abstract Introduction The complex healthcare system that provides patients with Medicines places them at risk when care is transferred between healthcare organisations, for example discharge from hospital. Consequently, understanding and improving Medicines Management, particularly at care transfers, is a priority. Objectives This study aimed to explore the Medicines Management system as patients experience it and determine differences in the patient-perceived importance of people in the system. Methods We used a Social Network Analysis framework, collecting ego-net data about the importance of people patients had contact with concerning their Medicines after hospital discharge. Single- and multi-level logistic regression models of patients' networks were constructed, and model residuals were explored at the patient level. This enabled us to identify patients' networks with support tie patterns different from the general patterns suggested by the model results. Qualitative data for those patients were then analysed to understand their differing experiences. Results Networks comprised clinical and administrative healthcare staff and friends and family members. Networks were highly individual and the perceived importance of alters varied both within and between patients. Ties to spouses were significantly more likely to be rated as highly important and ties to community pharmacy staff (other than pharmacists) and to GP receptionists were less likely to be highly rated. Patients with low-value Medicines Management networks described having limited information about their Medicines and a lack of understanding or help. Patients with high-value networks described appreciating support and having confidence in staff. Conclusions Patients experienced Medicines Management as individual systems within which they interacted with healthcare staff and informal support to manage their treatment. Multilevel models indicated that there are unexplained variables impacting on patients' assessments of their Medicines Management networks. Qualitative exploration of the model residuals can offer an understanding of networks that do not have the typical range of support ties.

  • A qualitative study of patient involvement in Medicines Management after hospital discharge: an under-recognised source of systems resilience.
    BMJ Quality & Safety, 2017
    Co-Authors: Beth Fylan, Gerry Armitage, Deirdre Naylor, Alison Blenkinsopp
    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.

Anthony Scott - One of the best experts on this subject based on the ideXlab platform.