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Published in: BMC Primary Care 1/2018

Open Access 01-12-2018 | Research article

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

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

Published in: BMC Primary Care | Issue 1/2018

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Abstract

Background

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.

Methods

Qualitative 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.

Results

The 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.

Conclusion

The 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.
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Literature
1.
go back to reference Ellis G, Whitehead MA, Robinson D, O'Neill D, Langhorne P. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ. 2011;343:d6553.CrossRef Ellis G, Whitehead MA, Robinson D, O'Neill D, Langhorne P. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ. 2011;343:d6553.CrossRef
2.
go back to reference Sergi G, De Rui M, Sarti S, Manzato E. Polypharmacy in the elderly: can comprehensive geriatric assessment reduce inappropriate medication use? Drugs Aging. 2011;28(7):509–18.CrossRef Sergi G, De Rui M, Sarti S, Manzato E. Polypharmacy in the elderly: can comprehensive geriatric assessment reduce inappropriate medication use? Drugs Aging. 2011;28(7):509–18.CrossRef
3.
go back to reference Larsen MD, Rosholm JU, Hallas J. The influence of comprehensive geriatric assessment on drug therapy in elderly patients. Eur J Clin Pharmacol. 2014;70(2):233–9.CrossRef Larsen MD, Rosholm JU, Hallas J. The influence of comprehensive geriatric assessment on drug therapy in elderly patients. Eur J Clin Pharmacol. 2014;70(2):233–9.CrossRef
4.
go back to reference Himmel W, Kochen MM, Sorns U, Hummers-Pradier E. Drug changes at the interface between primary and secondary care. IntJ ClinPharmacolTher. 2004;42(2):103–9. Himmel W, Kochen MM, Sorns U, Hummers-Pradier E. Drug changes at the interface between primary and secondary care. IntJ ClinPharmacolTher. 2004;42(2):103–9.
5.
go back to reference Glintborg B, Andersen SE, Dalhoff K. Insufficient communication about medication use at the interface between hospital and primary care. QualSaf Health Care. 2007;16(1):34–9.CrossRef Glintborg B, Andersen SE, Dalhoff K. Insufficient communication about medication use at the interface between hospital and primary care. QualSaf Health Care. 2007;16(1):34–9.CrossRef
6.
go back to reference Himmel W, Tabache M, Kochen MM. What happens to long-term medication when general practice patients are referred to hospital? EurJ ClinPharmacol. 1996;50(4):253–7. Himmel W, Tabache M, Kochen MM. What happens to long-term medication when general practice patients are referred to hospital? EurJ ClinPharmacol. 1996;50(4):253–7.
7.
go back to reference Boockvar KS, Liu S, Goldstein N, Nebeker J, Siu A, Fried T. Prescribing discrepancies likely to cause adverse drug events after patient transfer. Qual Saf Health Care. 2009;18(1):32–6.CrossRef Boockvar KS, Liu S, Goldstein N, Nebeker J, Siu A, Fried T. Prescribing discrepancies likely to cause adverse drug events after patient transfer. Qual Saf Health Care. 2009;18(1):32–6.CrossRef
8.
go back to reference Dedhia P, Kravet S, Bulger J, Hinson T, Sridharan A, Kolodner K, et al. A quality improvement intervention to facilitate the transition of older adults from three hospitals back to their homes. J Am Geriatr Soc. 2009;57(9):1540–6.CrossRef Dedhia P, Kravet S, Bulger J, Hinson T, Sridharan A, Kolodner K, et al. A quality improvement intervention to facilitate the transition of older adults from three hospitals back to their homes. J Am Geriatr Soc. 2009;57(9):1540–6.CrossRef
9.
go back to reference Kripalani S, Roumie CL, Dalal AK, Cawthon C, Businger A, Eden SK, et al. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med. 2012;157(1):1–10.CrossRef Kripalani S, Roumie CL, Dalal AK, Cawthon C, Businger A, Eden SK, et al. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med. 2012;157(1):1–10.CrossRef
10.
go back to reference Cornu P, Steurbaut S, Leysen T, De Baere E, Ligneel C, Mets T, et al. Discrepancies in medication information for the primary care physician and the geriatric patient at discharge. Ann Pharmacother. 2012;46(7–8):983–90.CrossRef Cornu P, Steurbaut S, Leysen T, De Baere E, Ligneel C, Mets T, et al. Discrepancies in medication information for the primary care physician and the geriatric patient at discharge. Ann Pharmacother. 2012;46(7–8):983–90.CrossRef
11.
go back to reference Hendriksen C, Vass M. Uncertain efficiency of follow-up home visits among older patients after hospital discharge. Ugeskr laeger. 2014;176(5a):V04130264.PubMed Hendriksen C, Vass M. Uncertain efficiency of follow-up home visits among older patients after hospital discharge. Ugeskr laeger. 2014;176(5a):V04130264.PubMed
12.
go back to reference Uitvlugt EB, Suijker R, Janssen MJA, Siegert CEH, Karapinar-Carkit F. Quality of medication related information in discharge letters: a prospective cohort study. Eur J Intern Med. 2017;46:e23–e5.CrossRef Uitvlugt EB, Suijker R, Janssen MJA, Siegert CEH, Karapinar-Carkit F. Quality of medication related information in discharge letters: a prospective cohort study. Eur J Intern Med. 2017;46:e23–e5.CrossRef
13.
go back to reference Mansur N, Weiss A, Hoffman A, Gruenewald T, Beloosesky Y. Continuity and adherence to long-term drug treatment by geriatric patients after hospital discharge: a prospective cohort study. Drugs Aging. 2008;25(10):861–70.CrossRef Mansur N, Weiss A, Hoffman A, Gruenewald T, Beloosesky Y. Continuity and adherence to long-term drug treatment by geriatric patients after hospital discharge: a prospective cohort study. Drugs Aging. 2008;25(10):861–70.CrossRef
14.
go back to reference Pedersen KM, Andersen JS, Sondergaard J. General practice and primary health care in Denmark. J Am Board Fam Med. 2012;25(Suppl 1):S34–8.CrossRef Pedersen KM, Andersen JS, Sondergaard J. General practice and primary health care in Denmark. J Am Board Fam Med. 2012;25(Suppl 1):S34–8.CrossRef
15.
go back to reference Malterud K. Qualitative methods in medical research. 2nd ed. Oslo: Universitetsforlaget; 2003. p. 240. Malterud K. Qualitative methods in medical research. 2nd ed. Oslo: Universitetsforlaget; 2003. p. 240.
16.
go back to reference Hesselink G, Schoonhoven L, Barach P, Spijker A, Gademan P, Kalkman C, et al. Improving patient handovers from hospital to primary care: a systematic review. Ann Intern Med. 2012;157(6):417–28.CrossRef Hesselink G, Schoonhoven L, Barach P, Spijker A, Gademan P, Kalkman C, et al. Improving patient handovers from hospital to primary care: a systematic review. Ann Intern Med. 2012;157(6):417–28.CrossRef
17.
go back to reference Nielsen FT, Rosholm JU, Sondergaard J, Gohr T, Tougaard L. A short discharge letter with a copy to the patient--satisfactory for patients and practitioners. Ugeskr Laeger. 1994;156(12):1811–3.PubMed Nielsen FT, Rosholm JU, Sondergaard J, Gohr T, Tougaard L. A short discharge letter with a copy to the patient--satisfactory for patients and practitioners. Ugeskr Laeger. 1994;156(12):1811–3.PubMed
Metadata
Title
General practitioners’ continuation and acceptance of medication changes at sectorial transitions of geriatric patients - a qualitative interview study
Authors
Anja G Strehlau
Michael Due Larsen
Jens Søndergaard
Anna B Almarsdóttir
Jens-Ulrik Rosholm
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2018
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-018-0855-x

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