New intervention paving the way for better drug treatment of elderly patients

The older we get, the greater the risk to contract diseases. Advanced healthcare and complex drug treatments are often required, which in turn requires clear communication between caregiver and patient as well as between different care chain units. Still, a new study at Uppsala University shows that four out of ten medication-related referrals at discharge regarding patients over 65 years of age are inadequate, that many elderly patients are unaware of changes in their drug treatment and that this in several cases can cause an increased risk of unplanned readmissions.

“We know that inadequate referrals and miscommunication can cause both uncertainty and non-optimised use of drugs. We also know that one in three elderly patients suffers from drug-related problems within eight weeks of discharge. When we talk to healthcare staff, they describe systemic barriers, while patients experience that the process does not take their needs into sufficient consideration. Therefore, we have designed an intervention with the aim to structure and quality-assure the chain of communication," says Henrik Cam, PhD student at the Department of Pharmacy and clinical pharmacist at the University Hospital.

The intervention includes four components that run from admission to follow-up. Upon arrival at the hospital, the patient receives a booklet that explains the care chain and provides potential questions to ask the staff. The material also includes a short video to help involve the patient. Before discharge, the pharmacist makes it easier for informal caregivers to participate at the discharge talk, and reviews and documents all drug-related information according to a standardized format that forms the basis for future treatment and review with the patient. Within a week of discharge, a follow-up conversation is also held with the patient to address important information and answer any questions.

“We are currently conducting a study of the intervention at three departments at the University Hospital, and as far as we know both material and process are positively received. Healthcare staff appreciate the initiative and that patients have the opportunity to be involved in their treatment. The patients express gratitude for both the information package and how it is provided, with many wishing they had received it much earlier,” states Henrik Cam.

For many older patients, informal caregivers play an important part in their contacts with healthcare. To meet the needs of both groups, representatives of patient and relatives' organisations have been active in designing the intervention. Utilizing their experiences and input, the ambition is to an even greater extent motivate care recipients to understand and follow treatments, but also to, when the patient wishes, involve informal caregivers in the process.

“We are facing a complex challenge where we must give both the patient and their informal caregiver the best possible conditions to make the right decisions and act if the care chain seem incomplete. In parallel, we must form structures to optimize the benefit of the clinical pharmacists' work in care teams. This is an important task for research, and hopefully the ongoing study will confirm that the intervention we have developed will take us yet another step in the right direction,” says Henrik Cam.

text: Magnus Alsne, photo: Magnus Alsne, Johan Alp, private