SP7 Medicines optimisation across care boundaries: Experience from a tertiary paediatric asthma clinic
Authors: Makhecha Sukeshi 
Published: June 2023

Background

Regular reviews of children with asthma are essential to ensure adherence to medication and correct use of delivery devices. Any medication changes made in hospital clinics should be continued in primary care. Transfer of information about medications across care boundaries can be challenging; between 30 and 70% of patients have either an error or an unintentional change to their medicines when their care is transferred.1

Aims

i) To determine whether medication changes made in a tertiary hospital asthma out-patient clinics are continued in primary care and ii) to explore parents/carers experience on medicines optimisation across care boundaries.

Methods

Mixed-methods service evaluation using qualitative and quantitative methods. Electronic patient records were used to identify children who had medication changes made in clinic between September-November 2020 and to see if this change was reflected on GP summary care records (SCR) three months later.

Telephone interviews using semi-structured questionnaires were conducted with parents/carers of children in whom medication changes had been made in an out-patient clinic in a tertiary paediatric asthma centre, exploring their experiences and categorized into themes.

The service evaluation was registered with the Trust clinical audit department.

Results

23 parents/carers provided SCR consent to view their child’s prescribing data. Children with a median age of 9 (4-16) years of which 14 were males and 9 females’, prescription records were analysed.

52% (12/23) of changes were accurate on SCR records, 35% (8/23) of changes were inaccurate and in 13% (3/23) no changes appeared on SCR.

Patient’s responses in the interviews were grouped into themes:

1. Medication supply issues:

‘The GP surgery couldn’t find the clinic letter that had been sent to them, so he missed a couple of days of his inhalers whilst we sorted out the issue’

2. Improvements in transfer of care:

‘I struggle to get things added onto the repeat slip after a clinic appointment. When I have gone to collect my child’s prescription from the pharmacy the medications have not been updated. This then takes a while to sort out and has meant that my child has missed a couple of days of their inhalers.’

‘I wanted to confirm why my child was using their new inhaler as a reliever as this went against what I had been told previously that steroids were to prevent asthma attacks.’

Conclusions

Medication changes made in out-patient clinics are either not transferred accurately or no changes appear in primary care records nearly 50% of the time. Better communication between care providers is required for more effective care.

Future research could explore digital solutions such as Electronic Prescribing System (EPS) and Pharmoutcomes® or AccuRx® to facilitate better cross sector communication, in addition to utilization of the Discharge Medication Service (DMS) and New Medications Service (NMS).

Reference

National Patient Safety Agency and National Institute for Health and Clinical Excellence. Technical safety solutions, medicines reconciliation. 2007 Available from: www.guidance.nice.org.uk/PSG001