Providing medicines-related support for people with COPD before and after hospital discharge-a qualitative study of hospital staff perspectives.

Background: People with chronic obstructive pulmonary disease (COPD) are frequently admitted to hospital and experience challenges with their medicines. Changing service delivery to address medicines-related challenges has been shown to reduce readmissions and improve patient outcomes. Before attempting to improve medicines-related support through new interventions, it is necessary to firstly understand contextual factors surrounding the delivery of current usual care. The aim was to identify improvement areas of medicines support during and after hospital discharge, and why this support is not always provided.

Methods: Hospital pulmonary ward staff were included in a focus group and semi-structured interviews. Data were analysed through systematic text condensation.

Results: Six major themes were developed and classified as organisational or practitioner level. Organisational level themes were: (1) transfer between care levels is challenging, (2) follow-up lacks coordination, and (3) low financial resources. Practitioner level themes were: (4) competence about COPD is needed, (5) clarification of professional role and task distribution, and (6) practitioners need to educate and support patients.

Conclusions: Medicines support for people with COPD during and after discharge would benefit from undertaking medicines reconciliation and increasing coordination across care levels. Furthermore, choice of inhaler devices should not be limited by reimbursement systems. Medicines support interventions should be adapted for primary and secondary care settings or include collaboration across care levels.