Empowering the patient? Medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway.

Autor:	Rognan SE; Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Oslo, Norway stine.eidhammer.rognan@sykehusapotekene.no.; Hospital Pharmacies Enterprise, South-Eastern Norway, Oslo, Norway., Kälvemark-Sporrong S; Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark.; Department of Pharmacy, Uppsala University, Uppsala, Sweden., Bengtsson KR; Department of Pharmacy, University of Oslo, Oslo, Norway., Lie HB; Department of Pharmacy, University of Oslo, Oslo, Norway., Andersson Y; Hospital Pharmacies Enterprise, South-Eastern Norway, Oslo, Norway., Mowé M; Division of Medicine, Oslo University Hospital, Oslo, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Mathiesen L; Department of Pharmacy, University of Oslo, Oslo, Norway.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2021 Jun 30; Vol. 11 (6), pp. e044850. Date of Electronic Publication: 2021 Jun 30.
DOI:	10.1136/bmjopen-2020-044850
Abstrakt:	Objective: Effective communication and patient empowerment before hospital discharge are important steps to ensure medication safety. Patients discharged from hospitals are often expected to assume self-management, frequently without healthcare personnel (HCP) having ensured patients' knowledge, motivation and/or skills. In this substudy of a larger study, we explore how patients experience medication communication during encounters with HCPs and how they are empowered at hospital discharge. Design: This is a qualitative case study. Data collection was done through qualitative observations of patient-HCP encounters, semistructured interviews with patients and drug reconciliation. Data were analysed using content analysis. Setting: An internal medicines ward at a university hospital in Norway. Participants: Nine patients aged 49-90 years were included close to the day of discharge. Results: The analysis revealed the following themes: (1) patient-centred care (PCC), which included 'understanding and involvement in the patient-as-person', 'establishment of a therapeutic alliance', and 'sharing power and responsibility'; and (2) biomedical (conventional) care, including the subthemes 'HCPs in power and control' and 'optimising medical outcomes, following guidelines'. Even though the elements of PCC were observed in several encounters, overall communication was not sufficiently fostering patient empowerment. Spending time with patients and building relations based on mutual trust seemed undervalued. Conclusions: The results provide a broader understanding of how patients experience medication communication at hospital discharge. Both the patients and the HCPs appear to be inculcated with biomedical traditions and are uncertain about the roles and opportunities associated with PCC. Attention should be paid to patient preferences and to the core elements of the PCC model from admission to discharge to empower patients in medication self-management. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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