General practitioners\u2019 continuation and acceptance of medication changes at sectorial transitions of geriatric patients - a qualitative interview study

Anja G Strehlau,Michael Due Larsen,Jens-Ulrik Rosholm,Anna B Almarsdóttir,Jens Søndergaard

doi:10.1186/s12875-018-0855-x

Anja G Strehlau, Michael Due Larsen + Show 3 more

Open Access

https://doi.org/10.1186/s12875-018-0855-x

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Abstract

BackgroundFollow-up in general practice on medication initiated during hospitalisation is often perceived to be inadequate, which leads to unintended drug interaction and over- or underdosage of medication. Little is known about General Practitioners (GPs’) views on medication changes during the transition from hospital to primary care. We conducted a qualitative interview study to understand GPs’ views on the medication changes made for their patients by hospital physicians in a geriatric ward and the GPs’ actions after discharge.MethodsQualitative semi-structured interviews comprising ten GPs from general practices in the Region of Southern Denmark, using a phenomenological approach. The GPs were selected strategically based on the principle of maximum variation. The analysis process was a cross-sectional analysis based on a phenomenological analysis.ResultsThe GPs identified many reasons for the lack of medication continuation, including miscommunication between hospital doctors and GPs and delayed discharge letters. Several factors were involved, including patients not taking responsibility for their medication, no structure for follow-up visits to their GPs and for the renewal of their prescriptions.ConclusionThe main reason for the poor continuity of medication changes for geriatric patients at sector transition was neither the GPs’ deliberate actions of removing the patients’ medications, nor the patients’ lack of compliance or of willingness to take the medication. It is largely due to procedural errors in the follow-up on the patient after discharge, due to the lack of a structured process and due to miscommunication between the primary sector and the hospital.

Highlights

Follow-up in general practice on medication initiated during hospitalisation is often perceived to be inadequate, which leads to unintended drug interaction and over- or underdosage of medication
The results are divided into two main themes, namely Theme 1: Information about hospitalisation and discharge, and the role of the discharge letter and Theme 2: Follow-up on medication changes initiated during hospitalisation
We found that there is a lack of a structured process after discharge, which results in discontinuity for patients going through sectorial transitions

Summary

Introduction

Follow-up in general practice on medication initiated during hospitalisation is often perceived to be inadequate, which leads to unintended drug interaction and over- or underdosage of medication. Little is known about General Practitioners (GPs’) views on medication changes during the transition from hospital to primary care. We conducted a qualitative interview study to understand GPs’ views on the medication changes made for their patients by hospital physicians in a geriatric ward and the GPs’ actions after discharge. One of the cornerstones of modern geriatric care is a comprehensive geriatric assessment (CGA), which is a multidimensional diagnostic process. CGA is carried out by geriatricians, and ideally, changes in studies have documented a frequent and significant problem in the follow-ups in general practice on the medication changes made in hospitals [3–11]. A register study from Denmark showed that only about one third of the changes made in hospitals was followed up in general practice [3]. We learned from a prospective cohort study that, for only 3% of patients, discharge letters adhered to the national guidelines, and that the median time delay between the discharge date and the date of sending the discharge letters was 6 days [12].

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