Exploring Medicines Optimisation and Safety in the Community Following Mental Health Hospital Discharge: A Qualitative Interview Study

Abstract

Background: Medication safety issues may be common following mental health hospital discharge. However, there is little research exploring their aetiology and influencing factors for patients with mental illness and their carers in the community. This study aimed to explore medicine taking, continuity and care following mental health hospital discharge from the perspectives of people with lived experience, their carers and community-based health professionals.

Method: Participant recruitment was via social media and the professional networks of the research team. Semi-structured online interviews were conducted with people with mental illness, carers and health professionals (including pharmacists, doctors and nurses in hospital, primary care and community settings) involved in medication use and safety after hospital discharge. Questions focused on medication-related activities, knowledge transfer practice, support needs and key challenges and facilitators of medication safety in the community following discharge. Template analysis involved independent reading, development of a coding framework and coding across the research team.

Results: Analysis of 34 interviews conducted with 17 healthcare professionals, 10 people with lived experience and 7 carers suggested a fragmented and disrupted network of care provision following discharge. This could include diversion of responsibility, lack of collaboration and continuity of care. People with lived experience and carers reported poor provision of information about medications, variable shared decision-making, and feelings of disempowerment and not being listened to.

Conclusion: This study has revealed the system-level challenges associated with maintaining safety with medicines following mental health hospital discharge, particularly around the continuity of care and disempowerment of patients. We suggest that clearer pathways and the organisation of care services based around collaborative working would benefit medicines management post-discharge. Further attention is needed to develop care provision that is holistic and person-centred.

Patient and public contribution: The research team included a person with lived experience. They took part in all aspects of the study, including data analysis, and are co-authors. In addition, our study advisory group included a person with lived experience and a carer.

Keywords: co‐ordination of care; discharge; medication safety; medicines optimisation; mental health; primary care; transition of care.