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      Family involvement in managing medications of older patients across transitions of care: a systematic review

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          Abstract

          Background

          As older patients’ health care needs become more complex, they often experience challenges with managing medications across transitions of care. Families play a major role in older patients’ lives. To date, there has been no review of the role of families in older people’s medication management at transitions of care. This systematic review aimed to examine family involvement in managing older patients’ medications across transitions of care.

          Methods

          Five databases were searched for quantitative, qualitative and mixed methods empirical studies involving families of patients aged 65 years and older: Cumulative Index to Nursing and Allied Health Literature Complete, Medline, the Cochrane Central Register of Controlled Trials, PsycINFO, and EMBASE. All authors participated independently in conducting data selection, extraction and quality assessment using the Mixed Methods Appraisal Tool. A descriptive synthesis and thematic analysis were undertaken of included papers.

          Results

          Twenty-three papers were included, comprising 17 qualitative studies, 5 quantitative studies and one mixed methods study. Families participated in information giving and receiving, decision making, managing medication complexity, and supportive interventions in regard to managing medications for older patients across transitions of care. However, health professionals tended not to acknowledge the medication activities performed by families. While families actively engaged with older patients in strategies to ensure safe medication management, communication about medication plans of care across transitions tended to be haphazard and disorganised, and there was a lack of shared decision making between families and health professionals. In managing medication complexity across transitions of care, family members perceived a lack of tailoring of medication plans for patients’ needs, and believed they had to display perseverance to have their views heard by health professionals.

          Conclusions

          Greater efforts are needed by health professionals in strengthening involvement of families in medication management at transitions of care, through designated family meetings, clinical bedside handovers, ward rounds, and admission and discharge consultations. Future work is needed on evaluating targeted strategies relating to family members’ contribution to managing medications at transitions of care, with outcomes directed on family understanding of medication changes and their input in preventing and identifying medication-related problems.

          Electronic supplementary material

          The online version of this article (10.1186/s12877-019-1102-6) contains supplementary material, which is available to authorized users.

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          Most cited references 26

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          Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs.

          Persons with continuous complex care needs frequently require care in multiple settings. During transitions between settings, this population is particularly vulnerable to experiencing poor care quality and problems of care fragmentation. Despite how common these transitions have become, the challenges of improving care transitions have received little attention from policy makers, clinicians, and quality improvement entities. This article begins with a definition of transitional care and then discusses the nature of the problem, its prevalence, manifestations of poorly executed transitions, and potentially remediable barriers. Necessary elements for effective transitions are then presented, followed by promising new directions for quality improvement at the level of the delivery system, information technology, and national health policy. The article concludes with a proposed research agenda designed to advance the science of high-quality transitional care.
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            Shared decision making: what do clinicians need to know and why should they bother?

            Shared decision making enables a clinician and patient to participate jointly in making a health decision, having discussed the options and their benefits and harms, and having considered the patient's values, preferences and circumstances. It is not a single step to be added into a consultation, but a process that can be used to guide decisions about screening, investigations and treatments. The benefits of shared decision making include enabling evidence and patients' preferences to be incorporated into a consultation; improving patient knowledge, risk perception accuracy and patient-clinician communication; and reducing decisional conflict, feeling uninformed and inappropriate use of tests and treatments. Various approaches can be used to guide clinicians through the process. We elaborate on five simple questions that can be used: What will happen if the patient waits and watches? What are the test or treatment options? What are the benefits and harms of each option? How do the benefits and harms weigh up for the patient? Does the patient have enough information to make a choice? Although shared decision making can occur without tools, various types of decision support tools now exist to facilitate it. Misconceptions about shared decision making are hampering its implementation. We address the barriers, as perceived by clinicians. Despite numerous international initiatives to advance shared decision making, very little has occurred in Australia. Consequently, we are lagging behind many other countries and should act urgently.
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              How to Do a Systematic Review: A Best Practice Guide for Conducting and Reporting Narrative Reviews, Meta-Analyses, and Meta-Syntheses

              Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question. The best reviews synthesize studies to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory. This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information. We outline core standards and principles and describe commonly encountered problems. Although this guide targets psychological scientists, its high level of abstraction makes it potentially relevant to any subject area or discipline. We argue that systematic reviews are a key methodology for clarifying whether and how research findings replicate and for explaining possible inconsistencies, and we call for researchers to conduct systematic reviews to help elucidate whether there is a replication crisis.
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                Author and article information

                Contributors
                +61 3 9244 6958 , emanias@deakin.edu.au
                tracey.bucknall@deakin.edu.au
                c.hughes@qub.ac.uk
                christine.jorm@sydney.edu.au
                robynwk@unimelb.edu.au
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                29 March 2019
                29 March 2019
                2019
                : 19
                Affiliations
                [1 ]ISNI 0000 0001 0526 7079, GRID grid.1021.2, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, , Deakin University, ; 221 Burwood Highway, Burwood, VIC 3125 Australia
                [2 ]ISNI 0000 0004 0432 5259, GRID grid.267362.4, Alfred Health, ; Commercial Road, Prahran, VIC 3181 Australia
                [3 ]ISNI 0000 0004 0374 7521, GRID grid.4777.3, School of Pharmacy, , Queen’s University Belfast, ; University Road, Belfast, Northern Ireland BT7 1NN UK
                [4 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, Sydney Medical School, , The University of Sydney, ; Edward Ford Building A27, Fisher Road, Camperdown, NSW 2050 Australia
                [5 ]NSW Regional Health Partners, 72 Watt St, Newcastle, NSW 2300 Australia
                [6 ]ISNI 0000 0001 2179 088X, GRID grid.1008.9, School of Medicine, , The University of Melbourne, ; Grattan Street, Parkville, VIC 3052 Australia
                Article
                1102
                10.1186/s12877-019-1102-6
                6441224
                30925899
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: Australian Research Council-Discovery Project
                Award ID: DP170100308
                Award ID: DP170100308
                Award ID: DP170100308
                Award ID: DP170100308
                Award ID: DP170100308
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

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