ABSTRACT
Introduction: Technologies such as electronic prescribing, clinical decision support systems, and electronic medication dispensers, are increasingly being introduced into healthcare. Existing toolkits focus on the implementation of such technologies, rather than identifying and mitigating any unintended consequences technologies may have on patient safety. They also focus on high-level organisational issues instead of those faced by end-users: frontline staff, patients and carers. Aim(s): To identify and classify types of unintended consequences that may be encountered by technologies' end-users, in order to inform development of a tool for identifying and preventing technology-related risks on patient safety. Method(s): Five focus group discussions with healthcare professionals, patients and carers were conducted through video-conferencing. Healthcare professionals with experience of using/implementing healthcare technologies and known to the research team via professional networks were invited to participate. Patient/carer participants were recruited using convenience sampling via an external research-participant organisation. Participants were asked to identify patient safety risks associated with the use of healthcare technologies, drawn from their own experiences and through consideration of hypothetical risks. Discussions were audio-recorded and transcribed verbatim. Transcripts were analysed by two researchers (NVivo R1.6) and two public partners (manually), using iterative inductive thematic analysis. Result(s): Eleven healthcare professionals and 29 patients and carers participated in focus groups. Three focus groups comprised patients, carers, and healthcare professionals. Two involved solely patients and carers. Analysis revealed five areas of unintended consequences (Table 1). Most unintended consequences identified by patients and carers were similar to those described by healthcare professionals. Healthcare professionals also described additional unintended consequences associated with technologies designed specifically for their use. Conclusion(s): A limitation of the study is that many of the unintended consequences identified related to virtual health technologies used during the COVID-19 pandemic, which may affect generalisability. A strength is that unintended consequences that have been overlooked in existing literature, such as the build-up of patients' psychological dependence on technologies, were identified. Developing a tool based on these will allow implementers and users of healthcare technologies to consider such issues and address the potential risks they may have on patient safety before healthcare technologies are fully implemented in practice.
ABSTRACT
Introduction: Housebound patients may face challenges to their medicines management due to reduced household mobility and potential lack of access to healthcare services. Previous literature has explored the medication-related needs of housebound patients from pharmacists' perspectives (1-2). However little work has focussed on the patient/family perspective. In this study, we used data obtained from those staying at home as much as possible during the COVID-19 pandemic to fill this gap. Aim: To explore home medicine practices and safety for people who were housebound during the COVID19 pandemic and to create guidance, from the patient/family perspective, for enabling pharmacists to facilitate safe medicine practices for this population. Methods: Interviews were carried out with people who were taking at least one long term medication and met the criteria for ?shielding' and/or were over 70 years of age during the first wave of the COVID-19 pandemic in the UK and/or their family carers. Respondents were recruited through patient and public involvement representatives, the research team's networks, and support groups. Potential participants were approached via personal contact and social media. Interviews were conducted by telephone or video conferencing and participants asked about their medicines management while staying at home. Inductive thematic analysis was carried out. Patient and public involvement representatives were involved in the data analysis alongside the researchers. Results: Fifty people were interviewed (16 males, 34 females;mean age 68 years, range 26-93 years). Interview data suggested diversity of experiences of medicines management while staying at home. Some respondents reported no or little change, others an initial crisis followed by re-stabilisation, and others that the pandemic was a tipping point, exacerbating underlying challenges and having negative effects on their health and wellbeing. Medicine safety issues reported included omitted doses and less-effective formulations being used. Participants also described experiencing high levels of anxiety related to obtaining medicines, monitoring medicines and feeling at risk of contracting COVID-19 while accessing medicine-related healthcare services. Key factors identified as facilitating a smooth transition included patients' own agency, support from family, friends and community, good communication with pharmacy staff, continuity of pharmacy services and synchronisation of medicines supply so that a maximum of one collection/delivery was required each month. Conclusion: The study findings that we have presented relate to the UK only;this may limit the generalisability of our findings to other countries. Findings from Ireland are in the process of being analysed and will provide a basis of comparison. In addition, more females took part than males, despite efforts to address this. However, our findings suggest pharmacy staff can support medicines management for people who are housebound by synchronisation of medicines supply, delivering medicines where possible, developing/raising awareness of alternative means of communication, providing continuity of pharmacy services and signposting any community support available.