Newcastle Patient Safety Research Collaboration, Newcastle University, Newcastle upon Tyne, UK.
School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.
BMJ Open. 2024 Sep 12;14(9):e091005. doi: 10.1136/bmjopen-2024-091005.
Transition of care for a patient between hospital and home can cause disruption to normal routines, increasing the risk of medicines-related harm. The transition from hospital to home is more complex when a patient does not self-manage their medicines but relies on an informal or unpaid carer (eg, spouse, family member or friend) to provide support. Given the day-to-day medicines-related support provided by informal carers, there is a need to understand how informal carers manage the transition of care from hospital to home; what aspects of hospital discharge act as barriers and facilitators to their involvement and when, how and why these impact patients.
A realist review will be undertaken to develop a programme theory. The programme theory will theorise which medicines-related interventions are useful to carers, and how they are useful. It will outline what aspects of those interventions are the most useful and why, and how context influences engagement and medicine-related outcomes. The review will be reported in line with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards guidelines. Data will be selected, screened and extracted based on defined inclusion and exclusion criteria and relevance to the developing programme theory with the involvement of at least two authors acting independently. Inclusion criteria relate to the relevance to hospital discharge where patients move back to their home, where a carer is involved and where interventions relate to medicines use. Searches will be conducted in PubMed, CINAHL (via EBSCOhost) and EMBASE databases (see supplementary materials for a draft search strategy).Patients and public, participation, involvement and engagement (PPIE) will be incorporated into all stages of the review through iterative engagement and discussion with patient, carers and representatives from carer organisations. The review will follow four steps: (1) development of the initial programme theory, (2) evidence search, (3) selection, extracting, and organising data and (4) synthesising evidence and drawing conclusions.Informal carer involvement in transitions of care is a complex and varied phenomena. The programme theory will be shaped by sustained PPIE reflecting the priorities and experiences of lived experience. The realist review be progressively focused so we can develop a better understanding of carer involvement in patient transitions when moving from hospital to home relating to medicines use.
Ethical approval is not required. The findings of the review will be disseminated via journal articles and through patient and public facing resources such as a visual patient-public-carer focused summary.
CRD42021262827.
患者从医院到家中的护理过渡期可能会打乱正常的日常生活，增加药物相关伤害的风险。当患者无法自行管理药物，而是依赖非正式或无薪护理人员（例如配偶、家庭成员或朋友）提供支持时，从医院到家中的过渡就更加复杂。鉴于非正式护理人员日常提供的与药物相关的支持，有必要了解他们如何管理从医院到家中的护理过渡期；医院出院的哪些方面会成为他们参与的障碍和促进因素，以及他们何时、如何以及为何会影响患者。
将进行一项现实主义审查，以制定计划理论。该计划理论将从理论上说明哪些与药物相关的干预措施对护理人员有用，以及它们是如何有用的。它将概述这些干预措施中哪些方面最有用以及为什么，以及背景如何影响参与度和与药物相关的结果。该审查将按照现实主义和元叙述证据综合：不断发展的标准指南进行报告。将根据与制定计划理论相关的明确纳入和排除标准以及相关性，选择、筛选和提取数据，并由至少两名独立行动的作者参与。纳入标准与患者返回家中、护理人员参与且干预措施与药物使用相关的医院出院相关。将在 PubMed、CINAHL（通过 EBSCOhost）和 EMBASE 数据库中进行搜索（请参阅补充材料以获取草案搜索策略）。患者和公众、参与、参与和参与（PPIE）将通过与患者、护理人员和护理人员组织代表的迭代参与和讨论，融入审查的所有阶段。审查将遵循四个步骤：（1）制定初始计划理论，（2）证据搜索，（3）选择、提取和组织数据，（4）综合证据并得出结论。
非正式护理人员参与护理过渡期是一个复杂且多样化的现象。计划理论将通过反映亲身体验者的优先事项和经验的持续 PPIE 来塑造。现实主义审查将逐步集中，以便我们能够更好地了解护理人员在患者从医院到家中过渡期间与药物使用相关的参与情况。
不需要伦理批准。审查结果将通过期刊文章以及面向患者和公众的资源（例如视觉患者-公众-护理人员重点摘要）传播。
PROSPERO 注册号：CRD42021262827。
