Developing items for a patient-reported experience measure for post-discharge medicines management in older patients: a stakeholder-led approach.

Abstract

Objectives: Medication-related harm following hospital discharge is a well-documented patient safety concern, particularly among older adults with multiple health conditions. Despite increasing attention to transitions of care, there is no patient-reported experience measure (PREM) specifically focused on post-discharge medicines management. Existing tools primarily measure clinical outcomes, overlooking how patients experience and manage medicines during this vulnerable period. The overarching aim was to develop PREM items for post-discharge medicines management in older adults using a stakeholder-led approach. This paper outlines the methods used to generate, refine, and pilot the PREM items.

Methods: We developed PREM items by drawing on existing literature and working with patient and public involvement (PPI). We organised four iterative co-design workshops involving patients, carers, and healthcare professionals, and we generated, refined, and prioritised items. Items were grouped into domains and revised based on feedback. Readability was assessed and further refined through piloting.

Key findings: The initial pool of 147 items was reduced to an 18-item PREM tool for use two weeks post-discharge and a 15-item PREM tool for three months post-discharge. Items cover five domains: information, involvement, relationships, systems, and autonomy. Piloting indicated good readability and acceptability, with feedback highlighting the importance of clear language and logical question sequencing. Notable differences emerged between patient and healthcare professional perspectives on care and communication priorities, which we reconciled through a collaborative approach.

Conclusion: This work presents PREM items developed through stakeholder-led methods, focused on capturing patient experience in post-discharge medicines management, offering a potential mechanism for assessing care quality. Further validation in diverse populations is underway to support safer, person-centred medicines management.