Practical strategies for improving medication management during care transitions for older adults with dementia: findings from a novel stakeholder-informed review process

Background and Objectives Medication management (MM) can be challenging for older adults with dementia experiencing hospital-to-home-health (HH) transitions. Role ambiguity—lack of clarity regarding who should complete MM tasks—can lead to adverse events. We used a novel stakeholder-informed redesign process (Intervention Refinement Teams; IRTs) to ask family caregivers and HH professionals to: (i) identify MM facilitators and barriers related to role ambiguity during hospital-to-HH transitions, and (ii) develop and prioritize strategies for improvement. Research Design and Methods We conducted three IRT meetings comprised of family caregivers, HH staff and researchers to: (i) detail contributing factors to role ambiguity, (ii) brainstorm strategies to reduce role ambiguity and support MM, and (iii) prioritize strategies by effectiveness, feasibility, sustainability and importance. Results IRT members (n = 14) developed 31 strategies. Top strategies were: (i) establish health system workflows for collection of accurate information to ensure timely home visits, (ii) store home medications securely to decrease risk of adverse events, (iii) notify primary care providers after hospital discharge to ensure timely follow-up, (iv) use cognitive aids for medication storage and administration to reduce risk of errors, and (v) provide dementia-specific training to HH staff. Discussion and Implications Family caregivers and HH professionals identified strategies focused on addressing pandemic- and dementia-specific challenges, MM tasks, clarification of role ambiguity, and care transition quality measurement and feedback. These strategies have potential to improve older adult/caregiver experience during transitions and guide improvement efforts for HH agencies serving recently hospitalized older adults with dementia.