Abstract
BackgroundMedication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services.MethodsA mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George’s and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics.ResultsThe response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service.ConclusionAlthough patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals.
Highlights
Medication problems among patients with long-term conditions (LTCs) are well documented
Despite the huge cost associated with the poor management of chronic obstructive pulmonary disease (COPD) and patients post-discharge, and the fact that shared decision making (SDM) could support patients’ management in relation to medicine optimisation, exacerbations and hospital admissions/re-admissions, the principle is not widely implemented
The current results emphasise the need among healthcare professionals (HCPs) in primary and secondary care to promote awareness among patients about services targeting medicine optimisation, regardless when these services were introduced, in order to enhance care experienced by patients with LTCs
Summary
Medication problems among patients with long-term conditions (LTCs) are well documented. Problems in medication usage are documented in primary care especially among patients with long-term conditions (LTCs) [7] These have been reported to negatively impact patients’ adherence and safety and lead to increased use of medical resources, such as physician visits, emergency department visits, hospital admissions and treatment failure [7]. Poor adherence to medications and poor inhalation technique are widely reported problems among respiratory patients that lead to sub-optimal management and care, and increase the economic burden of COPD [9] Some trusts such as Croydon University Hospital in the UK has established a rapid access clinic, referred to as “the respiratory HoT clinic” to improve the outcomes for COPD patients and prevent unnecessary hospital admissions. The service is managed by Croydon hospital respiratory team and provides the chance for patients to be seen by a specialist from secondary care in the primary care setting on the same day or day, reducing the risk of accident and emergency visits due to sudden deterioration in their COPD condition [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
