title: Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings.
abstract: BACKGROUND
  Communication problems contribute enormously to medication errors and adverse events. Encouraging patient engagement can help to facilitate effective medication management.
  
  
  OBJECTIVE
  To examine barriers and enablers affecting how patients engage with managing their medications in specialty hospital settings.
  
  
  METHODS
  An exploratory qualitative design was used involving in-depth interviews with doctors, nurses, pharmacists, patients and family members.
  
  
  METHODS
  An Australian public, metropolitan teaching hospital was the study site and five specialty hospital settings were used, including cardiac care, emergency care, intensive care, oncology care and perioperative care.
  
  
  RESULTS
  In all, 21 health professionals, 11 patients and 12 family members participated in the study (n = 44). Barriers and enablers involved intrapersonal, interpersonal and environmental aspects, and differences in perceptions and experiences were found between the various settings. Health professionals had preconceived notions of what was appropriate behaviour in conveying information about medications. Many health professionals stated that they deliberately chose not to provide medication-related knowledge. Different barriers for patient engagement existed in various settings - in emergency care, patients could only stay for 4 h; in intensive care, medication changes regularly happened; in cardiac care, patients were discharged prematurely due to urgent need of beds; in oncology, there was lack of availability of oncology consultants; while in perioperative care, surgeons and anaesthetists were available just before surgery.
  
  
  CONCLUSIONS
  Complex barriers and enablers are associated with patient engagement in specialty clinical settings. By developing an understanding of these barriers and enablers, health professionals can help patients to understand and participate in their medication management.
authors.affiliation: School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia.|Melbourne School of Health Sciences, The University of Melbourne, Parkville, Vic., Australia.|Department of Medicine, The Royal Melbourne Hospital, Parkville, Vic., Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
authors.affiliation: Melbourne School of Health Sciences, The University of Melbourne, Parkville, Vic., Australia.
authors.forename: Sascha
authors.initials: S
authors.lastname: Rixon
authors.affiliation: Monash Nursing Academy, School of Nursing and Midwifery, Monash University, Clayton, Vic., Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
authors.affiliation: Clinical Epidemiology, Biostatistics and Health Services Research, The University of Melbourne, Melbourne, Vic., Australia.|Centre for Clinical Epidemiology, Biostatistics and Health Services Research, The University of Melbourne, Parkville, Vic., Australia.
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.affiliation: Melbourne School of Health Sciences, The University of Melbourne, Parkville, Vic., Australia.
authors.forename: Sandy
authors.initials: S
authors.lastname: Braaf
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D004358:Drug Therapy / Q000379:methods*; D006782:Hospitals, Special / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D010358:Patient Participation / Q000379:methods; D036301:Qualitative Research; D055815:Young Adult
keywords: barriers; communication; enablers; medication management; medication safety; patient engagement; qualitative interviews