Abstract
Background: Integrating informal carers into patient care around the transition from hospital to home can be beneficial to patient and carer outcomes, avoiding adverse medication events and readmission, yet the practices of how this is achieved are unclear.
Approach; Informal carers are defined as somebody who looks after a person who cannot cope without support, these people are often family and friends. Using a realist review approach, this work aimed to identify the issues and areas for improvement in incorporating informal carers in medications management. Realism seeks to ask the question ‘what works, for whom, and under what circumstances?’. Given the significance of patient and public involvement and engagement in realism, a diverse panel of members who are, or have been carers, cared for (patients), and representatives of carer organisations, were involved throughout the research, from question formulation through to dissemination. The first phase of the review was to conduct a literature review on the evidence of the informal carer involvement in medication management during the transition from hospital to home. Data is selected, screened, and extracted based on relevance to the visual programme theory (PT), and synthesised. To answer the research question, realism focuses on generative causation, where a context (a pre-existing structure), interacts with a mechanism (an underlying process such as a feeling), to form an outcome, known as Context, Mechanism, Outcome Configurations (CMOC’s). The data found through the database searching in combination with PPIE input is used to form these configurations to explain the transition from hospital to home.
Results: After data extraction, synthesis, and analysis, 208 articles were included and 31 CMOC's were developed. CMOC's were split into a narrative of three themes: 'continuum of support,' 'understanding the carers priorities, role and responsibilities through shared decision making,' and 'access to appropriate materials, resources, and support information'. These themes depict ways in which effectively integrating informal carers into patient medications management at home is key to improving adherence and reducing adverse events and medications related harm while also suggesting ways to improve this support. These findings were sense-checked by patients, informal carers, and carer organisation representatives to ensure it was informed by their lived experience.
Implications: Dissemination of the findings from the review were informed by the PPIE group, with their input on the relevant audiences, we collaborated to develop lay summaries that were disseminated to local and national organisations, as well as academic and professional conferences. This review is anticipated to hold short- and long-term impact. In the short-term, it will influence and inform recommendations and guidance to improve informal carers involvement in discharge from hospital to home, and in the long-term, they will inform intervention development and policy change. Research, such as this review, is key in improving the lives of both patients and informal carers during this transition period through integration. The results from this review demonstrate how the themes could influence changes in care and patient safety.