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HELSEVEL-H-Gode og effektive helse-, omsorgs- og velferdstjenester

MAny Providers, confused INFOrmation? Coordinated and tailored communication with older patients in hospital-home TRANSitions (MAPINFOTRANS)

Alternative title: Mange leger, forvirrende informasjon? Koordinert og skreddersydd informasjon til eldre pasienter under og etter sykehusopphold

Awarded: NOK 9.3 mill.

In this project, we want to explore in detail how old patients with heart failure are informed about their medications while in the hospital ward, at discharge, and by their GP. We will study oral information exchanged in conversations between clinicians and patients and all written information the patient receives. We do this because wrong use of drugs is an important reason for health deterioration leading to new hospital admissions. We will collect the following data - We will audio record relevant conversations between doctors and patients at hospital and at the first visit with the GP after discharge - After each recorded talk, the patients will be interviewed about their needs and preferences - The doctors also will be interviewed after each recorded talk, and be asked to explain why they informed the way they did - Patients will be visited in their homes about 1 week after the first visit with their GP after the hospital discharge. They will be interviewed about what they remember about the information on medications, their motivations in following the treatment plan, and how they take their medicines - We register how much time passes from discharge to the next admittance in hospital We will evaluate whether the oral information is clear enough for the patient to be able to know how to take the medicines. We will explore whether oral information complies with written information the patient receives. We will also find out if oral information provided in the ward, at discharge and by the GP is sufficiently coordinated. Finally, we will register how well the doctors fit information to the patient’s life situation. The study will help us describe how information about drugs should be conveyed to patients in order to avoid wrong use of drugs. We will be helped by a user panel that includes both patients and health care personnel, and an advisory board that includes a representative from the user panel as well as specialists from general practice and cardiology.

The ultimate goal of this project is to secure informed use of medications among old patients discharged to home from hospital. We will study a cohort of fifty 70+ years old hospitalized patients with heart failure in the Department of Cardiology (DoC) at Akershus University Hospital (Ahus), in nearby municipal general practices, and in their homes. Such patients are common, usually have comorbidities, frequently need several drugs, display low adherence rates, and are often readmitted to hospital. They represent a good case for the general problem of coordinated information about medication. We will collect audio-, interview-, documental-, and observational data from patients, hospital doctors, and general practitioners (WP1). We will use this comprehensive set of data to describe and assess the clarity, coordination, congruency and contextualization of communication of medication information along the hospital-home journey (WPs 2-3), and develop and validate a pilot integrated information quality indicator and uncover its associations with patient characteristics and outcomes (WP4). These data and evidence will form a basis for further studies, teaching, and funding activities (WP5). The critical tasks of the project is the longitudinal and complex data collection, and the integration of results emerged through diverse analytical approaches. Such a comprehensive study to map and assess drug information communicated to older patients has not been done before. Earlier actions have mostly focused on medication accuracy, not considering how (well) this information is communicated, and how it is coordinated with written information and among health providers. Our multidisciplinary group, with extensive experience in research, teaching, and dissemination of new knowledge about communication, will be supplemented with relevant expertise in cardiology, general practice, and health services research to generate evidence teaching that changes communication behavior.

Activity:

HELSEVEL-H-Gode og effektive helse-, omsorgs- og velferdstjenester