The challenge of involving old patients with polypharmacy in their medication during hospitalization in a medical emergency department: An ethnographic study.

Autor: Fabricius PK; Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Andersen O; Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Emergency Department, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark., Steffensen KD; Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.; Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark., Kirk JW; Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.; Department of Public Health, Nursing, Aarhus University, Aarhus C, Denmark.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2021 Dec 30; Vol. 16 (12), pp. e0261525. Date of Electronic Publication: 2021 Dec 30 (Print Publication: 2021).
DOI: 10.1371/journal.pone.0261525
Abstrakt: Background: More than 70% of patients admitted to emergency departments (EDs) in Denmark are older patients with multimorbidity and polypharmacy vulnerable to adverse events and poor outcomes. Research suggests that patient involvement and shared decision-making (SDM) could optimize the treatment of older patients with polypharmacy. The patients become more aware of potential outcomes and, therefore, often tend to choose less medication. However, implementing SDM in clinical practice is challenging if it does not fit into existing workflows and healthcare systems.
Aim: The aim was to explore the determinants of patient involvement in decisions made in the ED about the patient's medication.
Methods: The design was a qualitative ethnographic study. We observed forty-eight multidisciplinary healthcare professionals in two medical EDs focusing on medication processes and patient involvement in medication. Based on field notes, we developed a semi-structured interview guide. We conducted 20 semi-structured interviews with healthcare professionals to elaborate on the findings. Data were analyzed with thematic analyses.
Findings: We found five themes (determinants) which affected patient involvement in decisions about medicine in the ED: 1) blurred roles among multidisciplinary healthcare professionals, 2) older patients with polypharmacy increase complexity, 3) time pressure, 4) faulty IT- systems, and 5) the medicine list as a missed enabler of patient involvement.
Conclusion: There are several barriers to patient involvement in decisions about medicine in the ED and some facilitators. A tailored medication conversation guide based on the SDM methodology combined with the patient's printed medicine list and well-functioning IT- systems can function as a boundary object, ensuring the treatment is optimized and aligned with the patient's preferences and goals.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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