Responsibility for a patient’s drug therapy : perspectives of primary care and hospital doctors

• Background: Health care provision is complex, with many actors, bringing difficulties in ensuring the responsibility for different health care providers is clear. Perceived lack of responsibility for a patient between primary and hospital care can lead to non-compliance with drug guidelines. The aim of this study was to investigate hospital and primary care doctors’ views of responsibility for patients’ drug therapy.Methods: Four audio-recorded focus groups were held with hospital doctors and four with primary care doctors. Fourteen hospital and 27 primary care doctors participated. The data were transcribed and analysed from an interpretivist perspective, to capture the physicians’ perspectives. Data were coded and categorised and similar categories grouped into themes. A mixed focus group was then held with 14 doctors from both primary care and hospital, who had participated in earlier focus groups. This allowed doctors from both settings to discuss the findings from the separate groups and to explore variations in the data.Results: Taking responsibility for the patient’s drug therapy was seen as being discharged when the doctors reviewed the patient’s drugs and updated the list of medications in the medical record. Nobody said they had the overall responsibility for the individual patient’s drug therapy. Secondary care doctors often only took responsibility for drugs within their own clinical area. Primary care doctors found it difficult to take overall responsibility, especially for highly specialized treatments, even though they described themselves as having a more comprehensive perspective of the patient’s drugs than the hospital doctors. Barriers to taking responsibility for both sectors included time constrains, lack of information regarding prescribing decisions by other doctors, highly specialized or expensive drugs and lack of economic incentives. Doctors from different health care levels did not routinely meet, informally or formally, and, at the time of the study, had no clear channels for communication between them. Conclusions: Taking responsibility to review the patient’s list of medications was perceived as important, but was described as difficult in daily practice.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Medicinska och farmaceutiska grundvetenskaper -- Samhällsfarmaci och klinisk farmaci (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Basic Medicine -- Social and Clinical Pharmacy (hsv//eng)

Nyckelord

computer-assisted drug therapy

prescription drugs

physician’s practice patterns

drug prescriptions

computerised medical records systems

continuity of patient care

hospital medication systems

drug utilisation review

responsibility

Community pharmacy services

Samhällsfarmaci

Social Pharmacy

Samhällsfarmaci

Publikations- och innehållstyp

vet (ämneskategori)

ovr (ämneskategori)