Older patient participation in discharge medication communication: an observational study

OBJECTIVE: To describe the extent to which older patients participate in discharge medication communication, and identify factors that predict patient participation in discharge medication communication. DESIGN: Observational study. SETTING: An Australian metropolitan tertiary hospital. PARTICIPANTS: 173 older patients were observed undertaking one medication communication encounter prior to hospital discharge. OUTCOME: Patient participation measured with MEDICODE, a valid and reliable coding framework used to analyse medication communication. MEDICODE provides two measures for patient participation: (1) Preponderance of Initiative and (2) Dialogue Ratio. RESULTS: The median for Preponderance of Initiative was 0.7 (IQR=0.5–1.0) and Dialogue Ratio was 0.3 (IQR=0.2–0.4), indicating healthcare professionals took more initiative and medication encounters were mostly monologue rather than a dialogue or dyad. Logistic regression revealed that patients had 30% less chance of having dialogue or dyads with every increase in one medication discussed (OR 0.7, 95% CI 0.5 to 0.9, p=0.01). Additionally, the higher the patient’s risk of a medication-related problem, the more initiative the healthcare professionals took in the conversation (OR 1.5, 95% CI 1.0 to 2.1, p=0.04). CONCLUSION: Older patients are passive during hospital discharge medication conversations. Discussing less medications over several medication conversations spread throughout patient hospitalisation and targeting patients at high risk of medication-related problems may promote more active patient participation, and in turn medication safety outcomes.