Multidisciplinary telephone conferences about medication therapy after discharge of older inpatients: a feasibility study

Abstract

Background Studies have shown poor post-discharge implementation by the general practitioner of changes made to patients’ medication during admission. Objective To assess the feasibility of conducting telephone conferences delivering information about changes in older patients’ medications from hospital to general practitioners. Setting Two departments of geriatric medicine in a Danish routine healthcare setting. Method Older polypharmacy patients (≥ 65 years and ≥ 5 prescriptions) consecutively admitted were eligible for inclusion. Telephone conferences based on a review of these patient’s medication therapy during hospital stay were arranged between a pharmacist and a geriatrician from the hospital, and a general practitioner. Interviews were conducted with pharmacists, geriatricians, and general practitioners about their perspectives on the feasibility of telephone conferences. Interviews were analyzed using systematic text condensation. Main outcome measure The proportion of telephone conferences conducted and perspectives on the feasibility of the study. Results A total of 113 patients were included and 82 patients (75%) were eligible for telephone conferences. A total of 40 (49%) telephone conferences were conducted. The main reasons for conferences not being conducted were general practitioners not wanting to participate or not returning the calls from the pharmacists. Three themes emerged from the qualitative analysis: considerations on planning and running the project, Barriers, facilitators, and implications of the telephone conference, and Actual and desirable cross-sectorial communication. Conclusion Telephone conferences were only possible for half of the patients. The participating general practitioners, pharmacists and geriatricians expressed varied benefit and agreed that telephone conferences were mainly relevant for complex patients.

Appendix: Additional information on reporting according to the consolidated criteria for reporting qualitative research (COREQ)

Domain 1: Research team and reflexivity
Personal characteristics
Interviewer/facilitator	Trine Graabæk (TG) and Alaa Burghle (AB). TG was the interviewer in the two focus groups with geriatricians and all telephone interviews with general practitioners and the facilitator in the focus group with pharmacists and interviews with geriatrician and general practitioner from the project group. AB was the interviewer in the focus group with pharmacists and interviews with geriatrician and general practitioner from the project group and the facilitator in the two focus groups with geriatricians. There was no facilitator during the telephone interviews
Credentials	PhD, MSc. Pharm. (TG) and MSc. Pharm. PhD student (AB)
Occupation	Health services researcher (TG and AB)
Gender	Female (TG and AB)
Experience and training	TG has previously carried out some semi-structured interviews and focus group interviews in both hospital and community settings. TG trained AB during the first focus groups for AB to be able to carry out the last focus group as an interviewer
Relationship with participants
Relationship established	Both TG and AB were known before the project start by the pharmacists participating in focus group. The geriatricians were familiar with the names of TG and AB but had never met them before the interview. The geriatrician and the general practitioner in the project group had worked with TG and AB from the planning of the study. The general practitioners were contacted by telephone and had no previous knowledge of TG
Participant knowledge of interviewer	TG and AB were aware of the possibility for more unspoken perspectives, as many of the participants knew TG and AB beforehand. However, it was underlined in the beginning of each interview that the participants could speak freely and not worry about upsetting TG or AB. It was our impression that all participants did speak freely as they all mentioned negative things about the study as well as positive things
Interviewer characteristics	Both TG and AB tried to be open towards any opinion represented by the participants and did never state that something was right or wrong
Domain 2: Study design
Theoretical framework
Methodological orientation and theory	For evaluation of attitudes towards and perspectives on the feasibility of the study, we used a hermeneutic-phenomenological approach, which explores the perspectives of the participants about the telephone conferences openly and incorporates preunderstandings of the researchers to interpret the explored experiences. The analysis was performed by systematic text condensation according to Malterud (see methods section)
Participant selection
Sampling	Purposive sampling
Method of approach	TG or AB sent email invitations to geriatricians and pharmacists and the geriatrician and general practitioner from the project group. General practitioners were contacted by TG via telephone
Sample size	In total 19 healthcare professionals: 6 pharmacists, 5 geriatricians, 1 geriatrician and 1 general practitioner from the project group and 6 general practitioners
Non-participation	All invited pharmacists participated. The geriatricians who were at work at the day of the interview were asked to participate, therefore we do not know how many geriatricians involved in the project did not participate in focus groups. Of the 22 invited general practitioners, 16 did not participate. Two of the 16 non-participating general practitioners rejected the invitation due to not having time for the interview. The receptionists at the remaining 14 general practitioners, promised to contact TG if the general practitioner wanted to participate. None of them made further contact
Setting
Setting of data collection	Odense University Hospital and Svendborg Hospital
Presence of non-participants	None
Description of sample	The participants had all been involved in the project with telephone conferences between pharmacists, geriatricians and general practitioners
Data collection
Interview guide	The semi-structured interview guide consisted mostly of open-ended questions. The interview guide was not piloted
Repeat interviews	No interviews were repeated
Audio/visual recording	Interviews were audio recorded. The transcription was carried out by two research assistants, and the transcripts were checked for accuracy according to the audio records by TG or AB
Field notes	The facilitator made field notes during the interviews
Duration	The interviews had a duration of 8–75 min
Data saturation	Data saturation was not discussed. However, it is presumed that sufficient data was collected to reveal the themes in the analysis
Transcripts returned	No transcripts were returned to participants for comments
Domain 3: Analysis and findings
Data analysis
Number of data coders	One (TG)
Description of coding tree	Codes were grouped in code groups, which were organized in subthemes and arranged in main themes
Derivation of themes	Themes were derived inductively from the collected data
Software	NVivo 11 (QSR International, Melbourne, Australia)
Participant checking	Participants did not provide feedback on the findings
Reporting
Quotations presented	In order to illustrate the findings, quotations are presented in the paper along with the identification of the participant
Data and findings consistent	There is consistency between the data presented in the paper and the findings
Clarity of major themes	Major themes (main themes) are clearly presented in the paper
Clarity of minor themes	Minor themes (subthemes) are clearly presented in the paper