Open Access Open Access  Restricted Access Subscription Access

A qualitative study of community pharmacists’ awareness of and involvement with intermediate care facilities.

Anna N Millar, Carmel M Hughes, Cristan Ryan

Abstract


Rationale, aims and objectives: Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery and maximising independence. The introduction of IC has created a new interface between primary and secondary care. Older people are known to be at an increased risk of medication-related problems when transferring between healthcare settings and pharmacists are often not included as part of IC multidisciplinary teams. This study aimed to explore community pharmacists’ (CPs) awareness of IC services and to investigate their views of and attitudes towards the medicines management aspects of such services, including the transfer of medication information.

Method: Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with CPs practising in the vicinity of IC facilities in Northern Ireland, UK.

Results: Interviews were conducted with 16 CPs. Three themes were identified and named ‘left out of the loop’, ‘chasing things up’ and ‘closing the loop’. CPs felt that they were often ‘left out of the loop’ with regards to both their involvement with local IC services and communication across the healthcare interfaces. As a result, CPs resorted to ‘chasing things up’ as they had to proactively try to obtain information relating to patients’ medications. CPs viewed themselves as ideally placed to facilitate medicines management across the healthcare interfaces (i.e., ‘closing the loop’), but several barriers to potential services were identified.

Conclusion: CPs have limited involvement with IC services. There is a need for improvement of effective communication of patients’ medication information between secondary care, IC and community pharmacy. Increasing CP involvement may contribute to improving continuity of care across such healthcare interfaces, thereby increasing the person-centeredness of service provision.


Keywords


Community pharmacists, continuity of care, information transfer, intermediate care, medicines management, older people, person-centered healthcare, pharmacy, qualitative study

Full Text:

PDF

References


Millar, A.N., Hughes, C.M., Passmore, A.P. & Ryan, C. (2014). Intermediate Care: The Role of Medicines Management. Drugs and Aging 31 (1) 21-31.

Department of Health. (2009). Intermediate Care- Halfway Home- Updated Guidance for the NHS and Local Authorities. Leeds: Department of Health.

Coleman, E. (2003). Falling through the cracks: Challenges and opportunities for improving transitional care for persons with continuous complex care needs. Journal of the American Geriatrics Society 51 (4) 549-555.

Vaughan, B. & Lathlean, J. (1999). Intermediate care: models in practice. London: King's Fund.

Millar, A.N., Hughes, C.M. & Ryan, C. (2015). "It's very complicated": A qualitative study of medicines management in intermediate care facilities in Northern Ireland. BMC Health Services Research In press.

Coyne, I. (1997). Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries? Journal of Advanced Nursing 26 (3) 623-630.

Marshall, M. (1996). Sampling for qualitative research. Family Practice 13 (6) 522-525.

Bradley, E.H., Curry, L.A. & Devers, K.J. (2007). Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Services Research 42 (4) 1758-1772.

Cochrane, R., Mandal, A., Ledger-Scott, M. & Walker, R. (1992). Changes in Drug-Treatment After Discharge from Hospital in Geriatric-Patients. British Medical Journal 305 (6855) 694-696.

Munday, A., Kelly, B., Forrester, J.W.E., Timoney, A. & McGovern, E. (1997). Do general practitioners and community pharmacists want information on the reasons for drug therapy changes implemented by secondary care? British Journal of General Practice 47 (422) 563-566.

Forster, A., Murff, H., Peterson, J., Gandhi, T.K. & Bates, D.W. (2003). The incidence and severity of adverse events affecting patients after discharge from the hospital. Annals of Internal Medicine 138 (3) 161-167.

Kripalani, S., LeFevre, F., Phillips, C.O., Williams, M.V., Basaviah, P. & Baker, D.W. (2007). Deficits in communication and information transfer between hospital-based and primary care physicians - Implications for patient safety and continuity of care. Journal of the American Medical Association 297 (8) 831-841.

Crowe, S., Tully, M.P. & Cantrill, J.A. (2010). Information in general medical practices: the information processing model. Family Practice 27 (2) 230-236.

Penney, T. (1988). Delayed communication between hospitals and general practice: Where does the problem lie? British Medical Journal 297 (6640) 77-82.

Brookes, K., Scott, M. & McConnell, B. (2000). The benefits of a hospital based community services liaison pharmacist. Pharmacy World & Science 22 (2) 33-38.

Rozich, J. & Resar, R. (2001). Medication safety: one organization’s approach to the challenge. Quality Management in Health Care 8, 27-34.

Sexton, J., Ho, Y., Green, C. & Caldwell, N.A. (2000). Ensuring seamless care at hospital discharge: a national survey. Journal of Clinical Pharmacy and Therapeutics 25 (5) 385-393.

Edmunds, J. & Calnan, M.W. (2001), The reprofessionalisation of community pharmacy? An exploration of attitudes to extended roles for community pharmacists amongst pharmacists and General Practioners in the United Kingdom. Social Science & Medicine 53 (7) 943-955.

Al-Rashed, S., Wright, D., Roebuck, N., Sunter, W. & Chrystyn, H. (2002) The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. British Journal of Clinical Pharmacology 54 (6) 657-664.

Bolas, H., Brookes, K., Scott, M. & McElnay, J. (2004). Evaluation of a hospital-based community liaison pharmacy service in Northern Ireland. Pharmacy World & Science 26 (2) 114-120.

Hughes, C. & McCann, S. (2003). Perceived interprofessional barriers between community pharmacists and general practitioners: a qualitative assessment. British Journal of General Practice 53 (493) 600-606.

Carlisle, C., Cooper, H. &Watkins, C. (2004). "Do none of you talk to each other": the challenges facing the implementation of interprofessional education. Medical Teacher 26 (6) 545-552.




DOI: http://dx.doi.org/10.5750/ejpch.v4i1.1063

Refbacks

  • There are currently no refbacks.