The challenge of involving old patients with polypharmacy in their medication during hospitalization in a medical emergency department: An ethnographic study

Pia Keinicke Fabricius; Ove Andersen; Karina Dahl Steffensen; Jeanette Wassar Kirk

doi:10.1371/journal.pone.0261525

The challenge of involving old patients with polypharmacy in their medication during hospitalization in a medical emergency department: An ethnographic study

PLoS One. 2021 Dec 30;16(12):e0261525. doi: 10.1371/journal.pone.0261525. eCollection 2021.

Authors

Pia Keinicke Fabricius^{1

2}, Ove Andersen^{1

2

3}, Karina Dahl Steffensen^{4

5

6}, Jeanette Wassar Kirk^{1

7}

Affiliations

¹ Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark.
² Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
³ Emergency Department, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
⁴ Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.
⁵ Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
⁶ Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.
⁷ Department of Public Health, Nursing, Aarhus University, Aarhus C, Denmark.

Abstract

Background: More than 70% of patients admitted to emergency departments (EDs) in Denmark are older patients with multimorbidity and polypharmacy vulnerable to adverse events and poor outcomes. Research suggests that patient involvement and shared decision-making (SDM) could optimize the treatment of older patients with polypharmacy. The patients become more aware of potential outcomes and, therefore, often tend to choose less medication. However, implementing SDM in clinical practice is challenging if it does not fit into existing workflows and healthcare systems.

Aim: The aim was to explore the determinants of patient involvement in decisions made in the ED about the patient's medication.

Methods: The design was a qualitative ethnographic study. We observed forty-eight multidisciplinary healthcare professionals in two medical EDs focusing on medication processes and patient involvement in medication. Based on field notes, we developed a semi-structured interview guide. We conducted 20 semi-structured interviews with healthcare professionals to elaborate on the findings. Data were analyzed with thematic analyses.

Findings: We found five themes (determinants) which affected patient involvement in decisions about medicine in the ED: 1) blurred roles among multidisciplinary healthcare professionals, 2) older patients with polypharmacy increase complexity, 3) time pressure, 4) faulty IT- systems, and 5) the medicine list as a missed enabler of patient involvement.

Conclusion: There are several barriers to patient involvement in decisions about medicine in the ED and some facilitators. A tailored medication conversation guide based on the SDM methodology combined with the patient's printed medicine list and well-functioning IT- systems can function as a boundary object, ensuring the treatment is optimized and aligned with the patient's preferences and goals.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Anthropology, Cultural*
Attitude of Health Personnel
Communication
Decision Making
Decision Making, Shared*
Denmark
Emergency Service, Hospital*
Geriatrics / methods
Health Personnel
Health Services for the Aged / organization & administration*
Hospitalization
Humans
Multimorbidity
Nurses
Patient Participation / methods*
Pharmacists
Physicians
Polypharmacy*
Professional-Patient Relations
Qualitative Research
Treatment Outcome
Workflow

Grants and funding

Ove Andersen received funding provided by Velux Foundation grant number (00021736): https://veluxfoundations.dk/da/forskning/aldringsforskning. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.