Optimising technology-related medication management in home care settings for older adults using a mixed-methods approach

With a rapidly ageing population in the UK, there is an escalating demand for home care and the use of technologies in delivering such care. However, the complex nature of these technologies, coupled with a lack of support for effective use, impedes their sustained implementation [1]. This suggests the need for effective use of such technologies to better understand how to support implementation.

Medication errors are common in home care, causing risks to patient safety. A recent systematic review published in 2022 identified that medication errors in home care occur mainly during transitional care with several risk factors involved. These factors include a lack of interprofessional communication, poor standardised process for medication reconciliation, comprehensive use of computerised tools, and a lack of involvement of the pharmacist in the care team [2].

The Department of Health and Social Care emphasises the necessity of Adult Social Care Reform to meet the needs of older adults through alternative forms of effective care coordination and technology-oriented new models of care [3]. Therefore, the reform requires improvements in shared decision-making and streamlined information opportunities among various health and older care services to ensure safe and integrated care to benefit the wider society [4].

Research Questions

1. What technology-related issues contribute to medication errors in the home care setting?
2. What technologies do the carers adopt to address medication challenges? How effective are technologies in supporting medication management among older adults, their families, health and social care providers, and constantly changing care needs (e.g., transitional care and fluctuating health)?
3. What strategies should be implemented to overcome technology-related medication issues and improve home care practices?

Methods

The project will comprise three phases.

1. Phase 1 (12 months): To identify technology-related medication errors in home care, we will use the DATIX, i.e., retrospectively collected reports from West Yorkshire home care agencies, provided by Leeds Community Healthcare NHS Trust, and deductive approach for analysis This will be supplemented by a systematic review of technology-related medication errors in home care.
2. Phase 2 (12 months): To explore underlying factors, we will work closely with the Bradford Care Association, partnered with the Bradford Home and Care System to gather further data from two home care sites about their strategies and care practices that are supported by technologies (e.g., computerised tools). We will perform focus group discussions (FGD), including care managers and service staff (10×2= 20 participants), to gain insights about best care practices that can help orient the interviews; and interviews with ethnically diverse older adults (65 years or above) to understand the service users’ experience and attitudes on technology use (15×2= 30 interviews). Collected data will be analysed using thematic analysis.
3. Phase 3 (12 months): To develop a set of strategies (actionable guidance) to overcome technology-related medication safety issues, we will design two workshops at each site, including an FGD topic guide. In each workshop, we will report the study findings and then work with home care staff through FGDs to translate the findings into actionable guidance. We will work with key stakeholders, i.e., the NIHR Yorkshire and Humber Patient Safety Research Collaboration (YHPSRC) and the Yorkshire and Humber Improvement Academy, to disseminate the actionable guidance for home care practices.

NB: Patient and Public Involvement (PPI) representatives will be involved in all phases 1-3, recruited by the UoB or the researchers.

Ethical considerations

Several ethical issues may emerge, particularly in terms of interviewing older adults, such as complex, family dynamics, preserving dignity and respect, promoting independence, etc. However, we will seek ethics approval for this proposed project from the Ethics Committee of the UoB, and the HRA approval/ NHS research ethics.

Key research output/ impact

• A shared decision-making process for person-centred medicines management using technology
• Effective use of technologies by home care agencies and more prospects of developed strategies to adopt elsewhere - a more sustainable, affordable home care system
• Allocations of appropriate resources and technologies to older individuals, including the BAME community
• A set of policy recommendations for care providers in the safe use of technological tools in medication management
• Dissemination of findings in articles for academic journals and conference presentations

How to apply

Formal applications can be submitted via the University of Bradford web site; applicants will need to register an account and select 'Full-time PhD in Public Health' as the course, and then specify the project title when prompted.

About the University of Bradford

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