title: "It's very complicated": a qualitative study of medicines management in intermediate care facilities in Northern Ireland.
abstract: BACKGROUND
  Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery from illness and maximising independence. Older people are at increased risk of medication-related adverse events, but little is known about the provision of medicines management services in IC facilities. This study aimed to describe the current provision of medicines management services in IC facilities in Northern Ireland (NI) and to explore healthcare workers' (HCWs) and patients' views of, and attitudes towards these services and the IC concept.
  
  
  METHODS
  Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with HCWs and patients from IC facilities in NI.
  
  
  RESULTS
  Interviews were conducted with 25 HCWs and 18 patients from 12 IC facilities in NI. Three themes were identified: 'concept and reality', 'setting and supply' and 'responsibility and review'. A mismatch between the concept of IC and the reality was evident. The IC facility setting dictated prescribing responsibilities and the supply of medicines, presenting challenges for HCWs. A lack of a standardised approach to responsibility for the provision of medicines management services including clinical review was identified. Whilst pharmacists were not considered part of the multidisciplinary team, most HCWs recognised a need for their input. Medicines management was not a concern for the majority of IC patients.
  
  
  CONCLUSIONS
  Medicines management services are not integral to IC and medicine-related challenges are frequently encountered. Integration of pharmacists into the multidisciplinary team could potentially improve medicines management in IC.
authors.affiliation: School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Island, UK. amillar18@qub.ac.uk.
authors.forename: Anna N
authors.initials: AN
authors.lastname: Millar
authors.affiliation: Primary Care Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Island, UK. c.hughes@qub.ac.uk.
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hughes
authors.affiliation: School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Island, UK. c.ryan@qub.ac.uk.|Pharmaceutical Science and Practice, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Island, UK. c.ryan@qub.ac.uk.
authors.forename: Cristín
authors.initials: C
authors.lastname: Ryan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007380:Intermediate Care Facilities; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D005791:Patient Care; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration; D036301:Qualitative Research