Information transfer and medication safety for elderly patients in care transitions

Sammanfattning: Introduction: Accurate discharge summaries counteract drug-related problems due to insufficient information transfer in care transitions, but require optimal transfer and use. Careful follow-up is often essential after hospital discharge, for example when it comes to pain management in elderly patients; a common and challenging task in primary care. Aims: To assess the transfer and use of the discharge summary for elderly patients, including the experiences and perceptions of the GPs, and to examine the presence of any discharge summary medication discrepancies and associated risk factors. In addition, to examine a common medication situation i.e. pain medication, and its follow-up in primary care after hospital discharge. Methods: Data on pain medication and any follow-up plans were collected from electronic medical records, nurses in municipality care and the multidose drug system. Community-dwelling patients with medication aid from nurses in municipality care and nursing home residents > 75 years discharged from orthopaedic care were included (paper I). Data on discharge summary medication discrepancies and related factors as well as transfer rate and the use of the discharge summary were collected from electronic medical records for patients > 75 years with > five drugs (paper II and IV). Primary care experiences of the information transfer were examined by using an electronic survey (paper II), and the views and perceptions of the GPs were further investigated by focus group discussions and analysed with qualitative content analysis (paper III). Results: The proportion of patients prescribed paracetamol and opioids increased significantly from prior to admission to after 12 weeks, and primary care pain medication follow-up plans were not very common (paper I). Transfer to primary care was noted for less than half of the discharge summaries, and one-third of the respondents of the electronic survey noted that the discharge summary was never/seldom received. Patient chart entries regarding medication or its follow-up were noted for less than half of the patients and medication lists were updated for one-third of the patients with drug changes during hospitalization, while noted as being performed to a higher extent by the survey respondents (paper II). Three final overall themes appeared: “Importance of the discharge summary”, “Role of the GP” and “Create dialogue”. The GPs viewed the discharge summary to be of considerable advantage when it was accurate, particularly regarding medication information, but also expressed great distrust due to lacking quality (paper III). Medication discrepancies were noted in more than one-third of the discharge summaries. The most common discrepancy type was unintentional addition of drug, and central nervous system drugs/analgesics were most commonly affected. Main risk factors for the presence of discrepancies were multidose drug dispensing and increasing number of drugs in the discharge summary, while an increasing number of drug changes reduced the likelihood of a discrepancy (paper IV). Conclusions: Information transfer shortcomings in the quality, transfer and use of the discharge summary were common. While accurate medication information was much appreciated by the GPs, deficits were rife and the discharge summary was often perceived to be of poor quality, which may affect its use. Overall, improving information transfer and follow-up may help increase medication safety for elderly patients in care transitions.