Older patients' experiences and needs regarding pharmacotherapeutic care in-hospital and after discharge

Abstract

Objective: This qualitative study explores the experiences and needs of older patients with polypharmacy regarding transitional pharmacotherapeutic care during hospital admission and following discharge, identifying areas for improvement.

Methods: A qualitative study was conducted using semi-structured interviews with patients discharged from two Dutch hospitals (academic and non-academic). Patients were asked about their experiences and needs related to medication management, information provision, attitude towards medication changes, decision-making, interactions with healthcare providers and involvement of professional and non-professional support networks. Interviews were transcribed verbatim and analyzed thematically using the Framework approach.

Results: Thirteen interviews were conducted. Patients reported diverse experiences and needs regarding transitional pharmacotherapeutic care. Three key themes emerged: patient context, trust in the healthcare system and collaborative decision-making. Participants showed a high level of trust in the organization of healthcare and varying awareness of the benefits of extensive collaboration between healthcare professionals across healthcare settings.

Conclusions: Patients' experiences with pharmacotherapeutic care during hospital admission and following discharge were partly influenced by a high level of trust in the healthcare system. However, shortcomings were noted in adapting care to individual informational needs, patient contexts, and involvement in decision-making about medication changes.

Practice implications: To optimize patients' experiences in pharmacotherapeutic transitional care, it is essential to balance patient autonomy with professional guidance in the development of new patient-centered medication optimization interventions. Healthcare professionals should ask and document patient preferences in communication and support regarding medication decisions. Clear communication about the role of each healthcare professional may enhance patient awareness of potential medication errors, as some patients now put their trust in the organization of healthcare.

Keywords: Inappropriate prescribing; Medication review; Older patients; Patient preferences; Polypharmacy; Shared decision making; Transitional care.