Dementia, medication and transitions of care.
BACKGROUND
Persons with dementia (PWD) often have complex medication regimens and are at risk of medication problems during the multiple transitions of care experienced as the condition progresses.


OBJECTIVE
To explore medication processes in acute care episodes and care transitions for PWD and to make recommendations to improve practice.


METHODS
Semi-structured interviews were conducted by two pharmacy researchers from a focused purposive sample of fifty-one participants (carers, health professionals, Alzheimer's Australia staff) from urban and rural Australia. After written consent, the interviews were audio-recorded then transcribed verbatim for face-to-face interviews, or notes were taken during the interview if conducted by telephone. The transcripts were checked for accuracy by the pharmacy researchers. Thematic analysis of the data was undertaken independently by the two researchers to reduce bias and any disagreements were resolved by discussion.


RESULTS
Themes identified were: medication reconciliation; no modified planning for care transitions; underutilization of information technology; multiple prescribers; residential aged care facilities; and medication reviews by pharmacists. Sub themes were: access to appropriate staff; identification of dementia; dose administration aids; and staff training.


CONCLUSIONS
Medication management is sub-optimal for PWD during care transitions and may compromise safety. Suggested improvements included: increased involvement of pharmacists in care transitions; outreach or transitional health care professionals; modified planning for care transitions for individuals over 80 years; co-ordinated electronic records; structured communication; and staff training.
Discipline of Pharmacy, Faculty of Health, University of Canberra, ACT 2601, Australia. Electronic address: louise.deeks@canberra.edu.au.
Louise S
LS
Deeks
Discipline of Pharmacy, Faculty of Health, University of Canberra, ACT 2601, Australia.
Gabrielle M
GM
Cooper
School of Psychiatry, University of NSW, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia.
Brian
B
Draper
Faculty of Medicine, University of Sydney, Sydney, Australia; Rehabilitation and Aged Care Service, Hornsby Hospital, Sydney, Australia.
Susan
S
Kurrle
Faculty of Health, University of Canberra, ACT 2601, Australia.
Diane M
DM
Gibson
D003704:Dementia / Q000188:drug therapy*; D006282:Health Personnel; D006801:Humans; D008490:Medical Informatics; D059065:Medication Reconciliation; D054539:Medication Therapy Management; D009517:New South Wales; D010351:Patient Discharge; D011795:Surveys and Questionnaires; D000069341:Transitional Care
Dementia; Medication; Older people; Pharmacy; Transitions of care