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BMC Health Services Research

, 15:548

First Online: 12 December 2015Received: 22 April 2015Accepted: 19 November 2015DOI: 10.1186-s12913-015-1193-5

Cite this article as: Lang, A., Macdonald, M., Marck, P. et al. BMC Health Serv Res 2015 15: 548. doi:10.1186-s12913-015-1193-5

Abstract

BackgroundPatient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs. This study addresses the medication management issues faced by seniors with chronic illnesses, their family, caregivers, and paid providers within Canadian publicly funded home care programs in Alberta AB, Ontario ON, Quebec QC and Nova Scotia NS.

MethodsInformed by a socio-ecological perspective, this study utilized Interpretive Description ID methodology and participatory photographic methods to capture and analyze a range of visual and textual data. Three successive phases of data collection and analysis were conducted in a concurrent, iterative fashion in eight urban and-or rural households in each province. A total of 94 participants i.e., seniors receiving home care services, their family-caregivers, and paid providers were interviewed individually. In addition, 69 providers took part in focus groups. Analysis was iterative and concurrent with data collection in that each interview was compared with subsequent interviews for converging as well as diverging patterns.

ResultsSix patterns were identified that provide a rich portrayal of the complexity of medication management safety in home care: vulnerabilities that impact the safe management and storage of medication, sustaining adequate supports, degrees of shared accountability for care, systems of variable effectiveness, poly-literacy required to navigate the system, and systemic challenges to maintaining medication safety in the home.

ConclusionsThere is a need for policy makers, health system leaders, care providers, researchers, and educators to work with home care clients and caregivers on three key messages for improvement: adapt care delivery models to the home care landscape; develop a palette of user-centered tools to support medication safety in the home; and strengthen health systems integration.

KeywordsMedication management Mixed methods Human factors Home care safety Patient safety Seniors Caregivers Family Paid providers Poly-pharmacy Chronic illness Complex care AbbreviationsABAlberta

HFHuman factors

IDInterpretive Description

INRInternational Normalized Ratio-Mean Normal Prothrombin Time Prothrombin time

KTTsKitchen table talks

NSNova Scotia

ONOntario

QCQuebec

RATSQualitative research review guidelines

Electronic supplementary materialThe online version of this article doi:10.1186-s12913-015-1193-5 contains supplementary material, which is available to authorized users.

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Autor: Ariella Lang - Marilyn Macdonald - Patricia Marck - Lynn Toon - Melissa Griffin - Tony Easty - Kimberly Fraser - Neil MacK

Fuente: https://link.springer.com/







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