TY - JOUR

T1 - Empowering the patient?

T2 - Medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway

AU - Rognan, Stine Eidhammer

AU - Kälvemark-Sporrong, Sofia

AU - Bengtsson, Kajsa Rebecka

AU - Lie, Helene Berg

AU - Andersson, Yvonne

AU - Mowé, Morten

AU - Mathiesen, Liv

N1 - © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2021

Y1 - 2021

N2 - Objective Effective communication and patient empowerment before hospital discharge are important steps to ensure medication safety. Patients discharged from hospitals are often expected to assume self-management, frequently without healthcare personnel (HCP) having ensured patients’ knowledge, motivation and/or skills. In this substudy of a larger study, we explore how patients experience medication communication during encounters with HCPs and how they are empowered at hospital discharge.Design This is a qualitative case study. Data collection was done through qualitative observations of patient–HCP encounters, semistructured interviews with patients and drug reconciliation. Data were analysed using content analysis.Setting An internal medicines ward at a university hospital in Norway.Participants Nine patients aged 49–90 years were included close to the day of discharge.Results The analysis revealed the following themes: (1) patient-centred care (PCC), which included ‘understanding and involvement in the patient-as-person’, ‘establishment of a therapeutic alliance’, and ‘sharing power and responsibility’; and (2) biomedical (conventional) care, including the subthemes ‘HCPs in power and control’ and ‘optimising medical outcomes, following guidelines’. Even though the elements of PCC were observed in several encounters, overall communication was not sufficiently fostering patient empowerment. Spending time with patients and building relations based on mutual trust seemed undervalued.Conclusions The results provide a broader understanding of how patients experience medication communication at hospital discharge. Both the patients and the HCPs appear to be inculcated with biomedical traditions and are uncertain about the roles and opportunities associated with PCC. Attention should be paid to patient preferences and to the core elements of the PCC model from admission to discharge to empower patients in medication self-management.

AB - Objective Effective communication and patient empowerment before hospital discharge are important steps to ensure medication safety. Patients discharged from hospitals are often expected to assume self-management, frequently without healthcare personnel (HCP) having ensured patients’ knowledge, motivation and/or skills. In this substudy of a larger study, we explore how patients experience medication communication during encounters with HCPs and how they are empowered at hospital discharge.Design This is a qualitative case study. Data collection was done through qualitative observations of patient–HCP encounters, semistructured interviews with patients and drug reconciliation. Data were analysed using content analysis.Setting An internal medicines ward at a university hospital in Norway.Participants Nine patients aged 49–90 years were included close to the day of discharge.Results The analysis revealed the following themes: (1) patient-centred care (PCC), which included ‘understanding and involvement in the patient-as-person’, ‘establishment of a therapeutic alliance’, and ‘sharing power and responsibility’; and (2) biomedical (conventional) care, including the subthemes ‘HCPs in power and control’ and ‘optimising medical outcomes, following guidelines’. Even though the elements of PCC were observed in several encounters, overall communication was not sufficiently fostering patient empowerment. Spending time with patients and building relations based on mutual trust seemed undervalued.Conclusions The results provide a broader understanding of how patients experience medication communication at hospital discharge. Both the patients and the HCPs appear to be inculcated with biomedical traditions and are uncertain about the roles and opportunities associated with PCC. Attention should be paid to patient preferences and to the core elements of the PCC model from admission to discharge to empower patients in medication self-management.

U2 - 10.1136/bmjopen-2020-044850

DO - 10.1136/bmjopen-2020-044850

M3 - Journal article

C2 - 34193483

VL - 11

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 6

M1 - e044850

ER -