Valérie Lacour

Problems in continuity of medication management upon transition between primary and secondary care: patients’ and professionals’ experiences

Abstract Background and objectives Patients often experience drug-related problems at admission or after discharge from hospital. The objective of this study was to identify the main problems in medication management at transition between settings of care, as experienced by health care professionals (HCPs) and patients. Methods Focus group discussions were organised between December 2009 and February 2010; nine focus groups with primary and secondary care HCPs and patients and two with stakeholders. Focus group discussions were audiotaped and observation files were constructed. For the analysis, a thematic framework approach was used. Between November 2015 and April 2016, 19 additional interviews and 1 focus group were performed with general practitioners (GP) and community pharmacists (CP). Results This qualitative study provided a long list of problems that could be summarised in five clusters: (1) problems at admission, e.g. incomplete list of medication, absence of information in case of emergency admission; (2) problems at discharge, e.g. lack of communication with GP, insufficient supplies of medication for the weekend; (3) problems as to professions, e.g. GP’s opinion different to that of the medical specialist; (4) problems as to patients and family, e.g. failure to understand treatment; (5) problems as to processes, e.g. medication substitutions. Conclusion HCPs and patients experience many problems in medication management at transition between settings of care. The fact that these problems occur at different stages and persist over time stresses the necessity for multilevel solutions.

Clinical drug related problems and interventions of pharmacists on prescribed medicines in Belgium

Aim of study Health literacy concerns the knowledge and competences of an individual person that are necessary for adequate response to information about health(care). Health literacy is strongly associated with educational level and overall literacy. Previous research has shown low (health) literacy to be associated with poor adherence, increased health consumption and poor health outcomes. The assumption of health care providers that their patients can read, understand and respond adequately to the instructions found on prescription drug labels may (sometimes) be unfounded. The aim of this study was to assess understanding of drug label instructions in different (non-native) populations living in the Netherlands. Method Four different populations living in the Netherlands were studied: people born in Iran, Turkey, the (former) Antilles and Surinam (Hindustani). Participants were recruited at meeting places for a particular ethnic group (mosques, cultural centres). Only people with sufficient comprehension of the Dutch language were included (tested by a short screening questionnaire on literacy skills). First year pharmacy students, who were born in the Netherlands, were included as reference group. All participants completed a survey with questions about the correct interpretation of 4 drug label instructions, with instructions like “Complete the prescribed course (antibiotics prescribed for 7 days)” and “Take 1 tablet as needed, maximal 6 tablets a day (acetaminophen)”. For correct interpretations of the instructions presented in the survey experts of the university (staff members, practicing pharmacists) and the Royal Dutch Pharmacist Association were consulted. Results In total, 180 Iranian, 188 Turkish, 168 Antillean, 155 Hindustani born in Suriname and 153 Dutch (reference) participants were included in the study. Some drug label instructions were misunderstood; misunderstanding of instructions occurred both in non-natives and Dutch natives (3 out of 4 labels were misunderstood by the majority of participants), but non-natives had more often problems with the instructions. For example, the instruction “Complete the prescribed course (antibiotics prescribed for 7 days)” was more often correctly answered (use the drugs for 1 week) by the Dutch reference group (95.4 %) compared to the other groups: Iranian (80.6 %), Turkish (88.3 %), Hindustani (91.6 %) and Antillean (81.0 %) participants (p