title: Seniors managing multiple medications: using mixed methods to view the home care safety lens.
abstract: BACKGROUND
  Patient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs. This study addresses the medication management issues faced by seniors with chronic illnesses, their family, caregivers, and paid providers within Canadian publicly funded home care programs in Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS).
  
  
  METHODS
  Informed by a socio-ecological perspective, this study utilized Interpretive Description (ID) methodology and participatory photographic methods to capture and analyze a range of visual and textual data. Three successive phases of data collection and analysis were conducted in a concurrent, iterative fashion in eight urban and/or rural households in each province. A total of 94 participants (i.e., seniors receiving home care services, their family/caregivers, and paid providers) were interviewed individually. In addition, 69 providers took part in focus groups. Analysis was iterative and concurrent with data collection in that each interview was compared with subsequent interviews for converging as well as diverging patterns.
  
  
  RESULTS
  Six patterns were identified that provide a rich portrayal of the complexity of medication management safety in home care: vulnerabilities that impact the safe management and storage of medication, sustaining adequate supports, degrees of shared accountability for care, systems of variable effectiveness, poly-literacy required to navigate the system, and systemic challenges to maintaining medication safety in the home.
  
  
  CONCLUSIONS
  There is a need for policy makers, health system leaders, care providers, researchers, and educators to work with home care clients and caregivers on three key messages for improvement: adapt care delivery models to the home care landscape; develop a palette of user-centered tools to support medication safety in the home; and strengthen health systems integration.
authors.affiliation: Victorian Order of Nurses (VON Canada), Ottawa, ON, Canada. ariella.lang@sympatico.ca.
authors.forename: Ariella
authors.initials: A
authors.lastname: Lang
authors.affiliation: Dalhousie University, Halifax, Nova, Scotia, Canada. marilyn.macdonald@dal.ca.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Macdonald
authors.affiliation: University of Victoria, Victoria, BC, Canada. pmarck@uvic.ca.
authors.forename: Patricia
authors.initials: P
authors.lastname: Marck
authors.affiliation: Victorian Order of Nurses (VON Canada), Ottawa, ON, Canada. lgtoon@gmail.com.
authors.forename: Lynn
authors.initials: L
authors.lastname: Toon
authors.affiliation: University Health Network, Toronto, ON, Canada. melissa.c.griffin@gmail.com.
authors.forename: Melissa
authors.initials: M
authors.lastname: Griffin
authors.affiliation: University Health Network, Toronto, ON, Canada. Tony.Easty@uhn.ca.
authors.forename: Tony
authors.initials: T
authors.lastname: Easty
authors.affiliation: University of Alberta, Edmonton, AB, Canada. kdfraser@ualberta.ca.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Fraser
authors.affiliation: University of Cincinnati, Cincinnati, OH, USA. RxDeanMac@UC.edu.
authors.forename: Neil
authors.initials: N
authors.lastname: MacKinnon
authors.affiliation: Accreditation Canada, Ottawa, ON, Canada. Jonathan.Mitchell@accreditation.ca.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mitchell
authors.affiliation: Alberta Health Services/University of Calgary, Calgary, AB, Canada. eddy.lang@albertahealthservices.ca.
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
authors.affiliation: Victorian Order of Nurses (VON Canada), Ottawa, ON, Canada. Sharon.goodwin@von.ca.
authors.forename: Sharon
authors.initials: S
authors.lastname: Goodwin
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D017028:Caregivers / Q000193:education* / Q000458:organization & administration; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D054539:Medication Therapy Management / Q000458:organization & administration*; D009674:Nova Scotia / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards; D011792:Quebec / Q000453:epidemiology; D017751:Safety Management / Q000458:organization & administration*; D016903:Drug Monitoring