Study suggests improved communication on drug treatments with elderly patients

Improved communication between healthcare professionals and elderly patients upon discharge from hospital can reduce incorrect medication adherence and unnecessary need of emergency care and readmissions, a new study shows. "We identify room for improvement regarding person-centered communication," states Henrik Cam, PhD student at the Department of Pharmacy.
As our life expectancy increases, we also more often suffer multiple illnesses, need more drugs and run increased risk of being hospitalized. When older patients are transferred within the care chain or discharged from hospital, there is a risk that insufficient communication between care units and to the patients and their relatives, can cause incorrect medication adherence, unnecessary need for emergency care and readmission.
“Improving the patient's participation can provide caregivers with relevant knowledge to adapt communication based on individual needs. This, in turn, can prevent drug-related problems after discharge,” says Henrik Cam, PhD student at Uppsala University and Clinical pharmacist at the Uppsala University Hospital, who has conducted a study of how person-centred care works in terms of dreg related communication between staff and with elderly patients during discharge from the clinic.
The focus of Cam's study, which has been carried out in Region Uppsala and Västmanland, is communication in connection with discharge from hospital, how patients experience the communication and how medication adherence may differ from prescription in the first week after discharge.

The Uppsala University Hospital
“Throughout hospital treatments, there are often changes in treatment; drugs that may have contributed to the hospitalization are removed and new treatments are started. After discharge, the patients are often expected to take care of their medication, understand its purpose and, if necessary, book a return visit. But for elderly who have not been sufficiently involved in treatment during their hospital stay, this is difficult, and there are at risk of taking their drugs in wrong ways,” says Henrik Cam.
Person-centred care is seeing the patient as a full person, not just recipients of diagnoses or treatment. It is keeping the individual at center and taking into account their life, family, medical history, understanding of the disease, needs, wishes and experiences. At the clinic, this requires functional support, leadership and resources, but also personal factors such as cultural insights and the right knowledge. This applies in particular in care of elderly, multi-ill patients who also often suffer from aggravating factors such as hearing and cognitive impairment.
“Unfortunately, our study shows that patients are rarely provided the opportunity to participate in their treatment or are even aware of the information they need to manage their drugs after discharge. We also see inherent authoritarian structures between healthcare staff and the elderly, which can contribute to the reluctance among elderly patients to get more involved,” says Henrik Cam.
According to Henrik Cam, it is up to healthcare staff to find ways to encourage patients to become more involved if they want to be. As possible measures, he mentions more single rooms to create better conversation environments, not giving all information to the patient just before discharge and actively involving the patient’s relatives in drug communication. Cam also identifies lack of clarity regarding how person-centered pharmaceutical communication should be conducted in Sweden. According to the National Board of Health and Welfare, the hospital must provide the patient with an updated, easy-to-read drug list as well as a discharge notice explaining what happened during the hospital stay, any medication changes and plans for follow-up. The doctor should also have a final conversation with the patient and a note with similar summary information should also be sent to the next care provider.
“Despite the National Board of Health and Welfare's guidelines, our study identifies shortcomings in the person-centered communication about drugs as well as how involved patients are in decisions about their medicaion. There is obvious room for improvement, which is also something our research group is working towards.”
Facts
The study is part of the larger research project IMPACT-care (Improved Medication Information and Patient Involvement at Care Transitions).
Contact
Henrik Cam, PhD Student
Department of Pharmacý
henrik.cam@farmaci.uu.se
Ulrika Gillespie, Adjunct senior lecturer
Department of Pharmacý
ulrika.gillespie@akademiska.se
Text: UAS & Magnus Alsne, photo: UAS a o