UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE The PHIMed Study: A mixed methods study of how patients, carers and healthcare professionals use Patient Held Information about Medicines Dr Sara Garfield Prof Bryony Dean Franklin
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE BACKGROUND
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Medication safety
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Errors at transitions of care • 60% of patients admitted to hospital have at least one discrepancy on their admission drug history. • National Reporting and Learning System for England and Wales: 7,070 medication errors involving admission and discharge with 2 fatalities and 30 severe harm reported in 2007. • 113 London GPs: addressing incomplete reconciliation of medication is the highest priority in improving medication safety.
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE The WHO response to medication errors • Third global challenge 2017: “Medication without harm” • Aim to reduce severe avoidable harm related to medications by 50% over 5 years, globally
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE The WHO response • Four domains: – patients and public – healthcare professionals – systems and practices – medicines • Early priority actions to focus on three areas: – transitions of care – high-risk patients and situations – polypharmacy • Revision of Medication Safety Curriculum Guide
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE The English response
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Short life working group recommendations: • Better linking of primary care and secondary care data to identify medication-related hospital admissions • Focus on patient-friendly packaging and labelling • Accelerating the introduction of hospital electronic prescribing systems • Greater patient involvement • Development of a repository of good practice NHS England Patient Safety Strategy: • Greater involvement of patients, carers and the public
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Self Care Agenda
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Background to PHIMed study • Risks of poor information transfer – Medication a particular issue • Importance of patients as active partners in healthcare • Various types of patient held information about medicines (“PHIMed”)
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Research question • What should healthcare professionals be recommending in relation to PHIMed?”
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Theoretical framework: Distributed cognition • Distributed cognition – useful for understanding systems that involve information being shared across people, tools and artefacts • Distributed Cognition for Teams (DiCoT) - facilitates application of distributed cognition by considering: different information flows in the system, the influence of people , how design of tools and artefacts helps or hinders, how information is processed over physical spaces , and how information processing evolves over time .
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE METHODS
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Overview of methods • Five work packages (WP) • WP0: preparation: ethics and literature review • WP1: interviews and focus groups • WP2: documentary analysis of how PHIMed used • WP3: descriptive analysis of PHIMed solutions • WP4: triangulation and integration of findings to create recommendations for practice and next steps
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE WP 1: Qualitative interviews & focus groups • Two focus groups with patients and carers, including users and non-users of PHIMed • Interviews with 16 healthcare professionals • Explored the roles of PHIMed, key features, barriers and facilitators to its use, and unintended consequences
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE WP 2: Documentary analysis • Recruitment of sample of 60 PHIMed users. Documentary analysis of how PHIMed had been used, what has been documented and read, and by whom, over last three months. Questions around how often carried, how up to date it is, why used, and if and how integrated with other information such as summary care record.
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE WP 3: Analysis of PHIMed features • Descriptive analysis of PHIMed solutions used / available in the UK, both electronic and paper, and categorising their design and key features based on those identified in WP1 and WP2 • Usability testing
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE WP 4: Integration and analysis Findings from WPs 1-3 integrated and analysed to explore how information is recorded, used and transformed among different people and artefacts
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE FINDINGS
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE WP1 Participants • WP1 focus groups – 4 males, 12 females – 7 patients, 6 carers, 3 both patients and carers – 12 PHIMed users, 5 non-PHIMed users • WP1 healthcare professional interviews – 2 GPs, 2 practice nurses, 2 community pharmacists, 2 community opticians, 2 dentists, 2 hospital doctors, 2 hospital nurses, 2 hospital pharmacists. – 7 males, 9 females
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE WP2 participants • 60 PHIMed users in total • 23 male and 37 female • Different types of PHIMed / use of PHIMed: – 15 basic paper users – 15 extensive paper users – 15 basic digital users – 15 extensive digital users
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE WP3: PHIMed tools 103 PHIMed tools assessed: • 57 digital apps • 42 paper-based tools • 4 websites
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Findings: Experience of PHIMed • Patients’ and healthcare professionals’ experiences of PHIMed were mostly positive. – ‘It’s mainly been of surprise that someone has given them a concise, easy to read list being truthful. They can’t believe their luck’ (focus group 1 participant) – ‘I’m always really positive. I’ve always been very pleasantly surprised if they bring it with them, it makes my job a lot easier if they bring it’ (hospital doctor 1)
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE How does PHIMed enhance safety? • Creates the ‘glue’ between a disjointed healthcare system. • Enhances situation awareness • Error checking • Ease of communication • Patient empowerment • Aide memoire during appointments • Reminder to take • Reminder to reorder
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Findings: Specific examples positive outcomes of PHIMed use • Use of PHIMed during emergency admissions of patients or family members • Identifying medicines that would have interacted with what another prescriber would have given • Dealing with medication-related issues when abroad • Identifying an adverse drug reaction
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Findings: Some negative experiences • 'They see what you are on and think you are a trouble case.' (PHIMed user 9) • An ‘old school’ consultant wasn’t satisfied with seeing the prescription list. He said “No, no, no I like to see the actual boxes what the instructions tell you to do” (focus group 1)’
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Findings: Barriers • Many patients had not considered using a hand- held record to help communicate their medicines to healthcare professionals. They thought information would be automatically transferred. • Some people carried extensive information about their medicines but did not share this information at appointments as they were not asked about their medicines.
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Triggers to using PHIMed • PHIMed study: – ‘I always assumed the hospitals would know so I think I’ll have to get a repeat prescription and just keep that on me.’ (focus group 2 participant) – ‘Maybe I should have something about it, I don’t know. Yes, it’s [the PHIMed study] made me think twice about it, I must say’ (focus group 2 participant). • Complexity • Concerns about emergencies • Encouragement by healthcare professionals or friends/family
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Findings: diversity • Type of PHIMed used: – Paper vs digital – Pre defined tool vs patient created • Purpose for which PHIMed is used: – In case of emergency – General communication with healthcare professionals – Other uses • The way in which PHIMed is used: – Aide memoire – Shown to healthcare professionals
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Findings: Paper vs digital tools Paper Digital • Does not require • Is always with the patient smartphone ownership. • Does not become ripped • Is always customisable or torn. • Is always editable • Is easily updated • Can be easier to access • Improved legibility • Does not rely on Wifi or • Can include reminders to charged batteries. take and order medicines. • May be more likely to show medication history • Is easier to hand over to others
UCL SCHOOL OF PHARMACY BRUNSWICK SQUARE Findings: PHIMed tools • No tools had all the 11 core features identified from work packages 1 and 2. • Only a minority of tools had fields for indication/purpose of medicine and allergies. However, these were both considered important by healthcare professionals. • Few patients included indication as they thought healthcare professionals would know what their medicines would be for.
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