Together towards safer medication treatment for older persons

Abstract: This thesis focuses on promoting patient safety in older persons using medications. Given that medications can unintentionally harm patients, the World Health Organisation emphasises “Medication without harm” as a global patient safety challenge. Older persons are more likely to experience harm, and harm tends to occur when prescribing or monitoring medications. Co-production of healthcare with patients may reduce the risk of adverse events and can serve as a resource to promote safety in healthcare. Accordingly, this thesis aims to increase knowledge of how older persons and healthcare professionals can co-produce a solution for improved medication evaluation and thereby promote patient safety.Co-design is an approach that emphasises patient involvement in improvements of healthcare services. Therefore, the thesis was guided by the four phases of the Double Diamond framework for co-design. In the Discover phase experiences of medication evaluations were collected. Older persons were interviewed and data were analysed using qualitative inductive content analysis (Paper I). Critical Incident Technique was used to collect and analyse data from interviews with healthcare professionals in primary care (Paper II). In the Define and Develop phases, a case study design was used to explore older persons’, nurses’ and physicians’ design choices for a medication and their experiences of a remote co-design approach. Collected data were analysed using descriptive statistics along with directed content analysis (Paper III) and thematic analysis (Paper IV). In the Deliver phase, the feasibility of applying a medication plan in primary care, as well as the study methods used were examined. Data were analysed using descriptive statistics and inductive content analysis (Paper V).The findings showed that older persons reported having a responsibility to engage in their medication evaluations, even if some felt unable to do so or considered themselves unconcerned. Continuity of care and participation facilitate evaluations, but a comprehensive medication evaluation was lacking (Paper I). Healthcare professionals experienced that medication evaluations for older persons were influenced by working conditions and working in partnership. Actions taken to manage medication evaluations were carried out through working with a plan and collaborative problem-solving (Paper II). A medication plan, linked to the medication list, had to provide an added everyday value related to safety, effort and engagement, and support communication, continuity and interaction. Important functional requirements were to provide instant access, automation and attention, and content requirements were detailed information about the medication treatment (Paper III). Remote co-design can complement or substitute for face-to-face co-design sessions. The approach allowed an accessible environment, and sharing everyday life experiences created learning and awareness of possible risks and strategies that could promote patient safety (Paper IV). The feasibility of applying a medication plan, assessed as usability, varied and the participants’ experiences of usability concerned a de-prioritised medication plan, functionalities, individualisation and resources. The participants’ perceptions of patient safety addressed awareness and information, challenges beyond the medication plan and patient involvement (Paper V).Healthcare services could promote patient safety by involving older persons in medication evaluations and in co-designing patient safety solutions. However, implementing a medication plan in clinical practice is complex and requires continuous co-produced improvements at different levels within the healthcare system.