Patient engagement in admission and discharge medication communication: A systematic mixed studies review

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Abstract

Objectives

To synthesise peer-reviewed research evidence concerning patients’ perceptions of how they engage in admission and discharge medication communication, and barriers and enablers to engagement in medication admission and discharge communication.

Design

A systematic mixed studies review.

Data sources

Two search strategies were undertaken including a bibliographic database search, followed by citation tracking. Fifteen studies were included in this review.

Review methods

Study selection and quality appraisal were undertaken independently by two reviewers. One reviewer extracted data and synthesised findings, with input from team members to check the accuracy or confirm/question findings.

Results

Three themes were found during data synthesis. In the first theme ‘desiring and enacting a range of levels of engagement’, patients displayed medication communication by taking responsibility for sharing accurate medication information, and by seeking out different choices during communication. The second theme ‘enabling patients’ medication communication’ uncovered various strategies to promote patients’ medication communication, including informing and empowering patients, and encouraging family involvement. The final theme, ‘barriers to undertaking medication communication’ included challenges enacting two-way information sharing and patients’ preference.

Conclusions

Patients view patient engagement in admission and discharge medication communication as two-way accurate information-sharing; however, they sometimes experience challenges undertaking this role or prefer a passive role in information-sharing. Various strategies inform and empower patients to engage in medication communication, however, further investigation is needed of patients’ experiences and acceptability of these strategies, and of further strategies that empower patients. Enabling health care professionals’ communication skills may promote a patient-centred approach to medication communication, and could enable patient engagement in medication communication.

Section snippets

What is already known about the topic?

  • Hospital admission and discharge are risky transitions of care because of the frequency of medication errors.

  • Patient engagement in medication communication is internationally advocated as an approach to improve medication safety.

  • Patients’ perceptions of the process of engaging in admission and discharge medication communication, and the acceptability of engaging patients in admission and discharge medication communication is poorly understood.

What this paper adds

  • Patient engagement in admission and discharge medication communication is enacted through patients taking some responsibility to ensure accurate information-sharing.

  • A range of strategies have been explored which inform or empower patients, such as patient involvement in health care professionals’ assessments, providing patients with discharge medication summaries and encouraging patients to communicate their understanding of medication. However, a more in-depth understanding of patients'

Background

There is international recognition that patients should be given the opportunity to be engaged in their care to improve hospital safety (Longtin et al., 2010) because they can identify and communicate risks and contribute to solutions. For instance, the WHO’s strategy “Medication without harm” advocates for patients to enhance medication safety by undertaking medication communication with health care professionals, especially during medication reconciliation at transitions of care (World Health

Design

A mixed studies review was undertaken using Pluye and Hong’s (2013) systematic and integrative methodology, where diverse study designs were viewed as producing findings that can address the same research questions and be easily synthesised (Hong and Pluye, 2013; Sandelowski et al., 2006). We followed the seven mixed studies review steps; (1) formulate a review question; (2) define eligibility criteria; (3) identify sources of information; (4) identify potentially relevant studies; (5) select

Results

In all, 15 studies were included (in one study the same sample was reported in two published papers) (Eassey, 2016, 2017)) (Fig. 1). Five studies were non-interventional in nature (Bagge et al., 2014; Eassey, 2016, 2017; Halapy and Kertland, 2012; Knight et al., 2013; Manias et al., 2015), while the remaining studies were interventional (Borgsteede et al., 2011; Cawthon et al., 2012; Jahn et al., 2014; Lee et al., 2015; Lingaratnam et al., 2012; Mortimer et al., 2011; Newnham et al., 2015;

Discussion

Patients' perceptions of undertaking admission and discharge medication communication were accurate information-sharing, which was seen to increase patients' sense of responsibility. Patients desired a higher level of engagement on the ‘Ladder of Patient and Family Engagement', as they wanted to ‘partner' with health care professionals by making medication choices. Enablers to patients' medication communication included ‘informing’ and ‘empowering’ strategies. ‘Informing’ strategies encouraged

Limitations

This review contains limitations. First, we did not exclude studies with low quality, as they provided insight on the phenomenon of interest; instead, we reported quality scores, allowing readers to judge the quality of articles to ensure we are not over-stating findings. Qualitative studies may benefit from more in-depth contextual details, while quantitative studies had varied limitations across studies. Of note, pre- post-intervention designs tended to be of lower methodologic quality,

Recommendations

In practice, health care professionals may benefit from enabling both patients and families in medication communication, as families have a key role in informing health care professionals and supporting patients. Further, health care professional assessment of patients’ medication history is an embedded practice that promotes patient communication (Willeboordse et al., 2014), thus health care professionals could seek ways to more formally enable patient communication, such as using

Conclusions

Currently, engaging patients in their hospital care is internationally advocated; we conclude admission and discharge medication communication is an opportunity to actualise these international calls. Patients want to undertake medication communication with health care professionals. Strategies that enable patients’ medication communication include both informing the patient, and encouraging the patient to inform health care professionals. Yet, the success of patient engagement in medication

Acknowledgements

We would like to acknowledge the research assistants who helped to check the accuracy of some data extraction, and Julie Toohey, the Health Discipline Librarian, who assisted with the search strategy developed.

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