A formative evaluation of the implementation of a medication management transition of care stewardship service for patients discharged from rural and remote hospitals: A qualitative study of clinicians and patients.

Abstract

The transition of care from the hospital to the home is a period of high risk for medication-related errors. This risk is further increased in hospitals in rural and regional areas, which face unique challenges such as geographical isolation and limited access to healthcare and healthcare providers. To explore the formative perspectives of key stakeholders towards the implementation of a virtual Transitions of Care Stewardship (TOCS) service to improve medication management upon discharge from rural and regional hospitals, including facilitating a home medicines review (HMR). An interview guide was developed using the updated Consolidated Framework for Implementation Research. Key stakeholders were identified through professional networks and local healthcare providers and approached to participate. Semi-structured interviews were conducted in person or virtually (videoconference or teleconference) with patients, pharmacists, medical practitioners, nurses and allied health professionals between August and September 2024. Interviews were audio-recorded, transcribed verbatim, and continued until data saturation was reached. Data analysis was conducted using the framework approach to identify themes. In total, 37 interviews were conducted with healthcare professionals and patients in rural and regional New South Wales. Three main themes were identified: (1) factors affecting service acceptability (access to primary care, older patient demographic, health literacy, cultural acceptability of First Nations Peoples); (2) utilising existing components of healthcare (virtual pharmacists in rural areas, rural HMR-credentialed pharmacists, improving utilisation of allied health assistants, strategies to improve awareness); and (3) workflow of a TOCS pharmacist (coordination of HMR referral, importance of continuity). Overall, a medication-centred discharge service in the form of a virtual TOCS pharmacist and their facilitation of post-discharge HMRs were found to be an acceptable intervention to enhance continuity of medication management for patients discharged from hospital to home in rural and remote areas.