Cardiology patients' medicines management networks after hospital discharge: a mixed methods analysis of a complex adaptive system

Fylan, B., Tranmer, M. , Armitage, G. and Blenkinsopp, A. (2019) Cardiology patients' medicines management networks after hospital discharge: a mixed methods analysis of a complex adaptive system. Research in Social and Administrative Pharmacy, 15(5), pp. 505-513. (doi: 10.1016/j.sapharm.2018.06.016) (PMID:30001861)

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Introduction: The complex healthcare system that provides patients with medicines places them at risk when care is transferred between healthcare organisations, for example discharge from hospital. Consequently, understanding and improving medicines management, particularly at care transfers, is a priority. Objectives: This study aimed to explore the medicines management system as patients experience it and determine differences in the patient-perceived importance of people in the system. Methods: We used a Social Network Analysis framework, collecting ego-net data about the importance of people patients had contact with concerning their medicines after hospital discharge. Single- and multi-level logistic re- gression models of patients' networks were constructed, and model residuals were explored at the patient level. This enabled us to identify patients' ego-nets with support tie patterns different from the general patterns sug- gested by the model results. Qualitative data for those patients were then analysed to understand their differing experiences. Results: Ego-nets comprised clinical and administrative healthcare sta and friends and family members. Ego-nets were highly individual and the perceived importance of alters varied both within and between patients. Ties to spouses were significantly more likely to be rated as highly important and ties to community pharmacy sta (other than pharmacists) and to GP receptionists were less likely to be highly rated. Patients with low-value medicines management networks described having limited information about their medicines and a lack of un- derstanding or help. Patients with high-value networks described appreciating support and having con dence in sta . Conclusions: Patients experience medicines management as individual systems within which they interacted with healthcare sta and informal support to manage their treatment. Multilevel models indicated that there are un- explained variables impacting on patients' assessments of their medicines management networks. Qualitative ex- ploration of the model residuals can offer an understanding of networks that do not have the typical range of support ties.

Item Type:Articles
Additional Information:This research was supported by the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC).
Keywords:Medication management, social network analysis, medication error, multilevel models, patient safety, healthcare systems.
Glasgow Author(s) Enlighten ID:Tranmer, Professor Mark
Authors: Fylan, B., Tranmer, M., Armitage, G., and Blenkinsopp, A.
College/School:College of Social Sciences > School of Social and Political Sciences
Journal Name:Research in Social and Administrative Pharmacy
ISSN (Online):1934-8150
Published Online:30 June 2018
Copyright Holders:Copyright © 2018 Elsevier Inc.
First Published:First published in Research in Social and Administrative Pharmacy 2018
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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